OBSERVATIONS ON 
NASAL CATARRH 
AXD 
CATARRHAL DEAFNESS. 
BY 
A. N. WILLIAMSON, M. D., 
SURGEON TO THE NEW YORK THROAT AND EAR INSTITUTE ; LATE CLINICAL PHYSIC lAN IN 
THE MEDICAL DEPARTMENT OF THE UNIVERSITY OF NEW YORK ; LATE ATTEND- 
ING PHYSICIAN IN THE THROAT AND LUNG DEPARTMENT OF THE 
NORTHWESTERN DISPENSARY, ETC., ETC. 
FOSTER & EPPLEY, PRINTERS AND STATIONERS, 
NEWYORK: 
35 Pine Street. 
1877. NASAL CATARRH 
AND 
Catarrhal Deafness 
Chronic Nasal Catarrh is usually considered an incurable 
disease. I propose to show, in as brief a space as possible, 
that it is not, as a rule, an incurable disease, and that the 
reason it has come to be so considered is due to the fact that 
no one has hitherto attempted to put in force an intelligent 
and practical mode of treatment. Having devoted many years 
to the especial investigation and treatment of Catarrhal 
diseases and impairment of hearing, I submit my views to 
the profession and public to be judged on their merits. 
Catarrh is a term used to designate any excessive or abnor- 
mal discharge from a mucous membrane. Thus we may have 
aural catarrh, gastric catarrh, vesical catarrh, uterine catarrh, 
<fcc., &c. In consequence of the frequent and sudden changes 
of temperature in our climate, Nasal Catarrh is an exceed- 
ingly prevalent complaint. A cold in the head is an affliction 
very few persons escape during the winter months. If this 
is repeated, or not properly cured, it soon degenerates into 
Chronic Catarrh. A temporary assault of the disease may be 4 
caused by local irritants, as dust, acrid vapors, and certain 
odors. The chief constitutional causes are Scrofula and 
Syphilis. Morbid growths, especially polypi, cause Catarrh 
more frequently than is generally recognized; since very 
often they are so situated in the naso-pharyngeal space as 
not to be easily discovered except by careful instrumental 
examination. Another manifestation of this disease, due to 
a specific cause, is known as Hay Fever, or Rose Catarrh, 
making its appearance only at certain seasons, and disap- 
pearing on the approach of cold weather, or the removal of 
the sufferer from the vicinity where the exciting cause is felt. 
A mucous membrane, in a healthy condition, is constantly 
moist. An essential part of its healthy function consists in 
the exhalation of this moisture. When such a membrane 
becomes inflamed, as from a cold in the head, this normal 
secretion becomes changed in character. In the outset the 
membrane becomes dry and feverish, and the natural secre- 
tion is stopped; then it becomes tumid, swollen, thick, and 
extremely sensitive to external impressions. Sensations of 
heat, fullness and itching are experienced, with frequent sneez- 
ing. If confined to the Schneiderian membrane, the nostril 
is at first unusually dry, yet though dry it is difficult to 
breathe through it; it is stopped, not by mucus, but by the 
mere swelling of the membrane. The sense of smell is often 
perverted : and in severe cases the inflammation may extend 
into the frontal sinuses, causing headache and oppression; 
into the Eustachian tube, causing deafness, or into the lachry- 
mal canal, closing the lachrymal ducts, and causing the tears 
to flow over the cheeks. 
After the stage of heat and dryness, the membrane begins 
to secrete a thin, serous, acrid fluid, which frets and irritates 
the nose and lip as it flows over them. This thin fluid soon 
becomes thicker and less irritating; more viscid, opaque, 
and yellow; the swelling diminishes, and the symptoms of 5 
the acute stage begin to vanish. The general symptoms may 
vary, from a mere consciousness of disturbance to a condition 
of marked pain, fever, loss of appetite, headache, sleepless- 
ness, mental and physical debility, &c. Sometimes the in- 
flammation, instead of extending towards the eye or ear, tra- 
vels downward, causing sore throat, and perhaps bronchitis. 
These are the principal symptoms of a severe cold in the 
head, or acute coryza. The usual duration of the attack is 
from three to seven days. At the end of this time, all symp- 
toms should pass away, leaving no ill effects. But in many 
cases, from a debilitated condition of the system, perhaps, or 
from an access of fresh colds through neglect and careless- 
ness, this does not occur; the secondary symptoms remain, 
and the disease gradually degenerates into a chronic catarrh. 
Impairment of hearing may sometimes date from the first 
attack, but more frequently comes on months and sometimes 
years after the access of the catarrhal disease. 
As a rule, when the disease becomes chronic all the symp- 
toms of the cold in the head vanish except the discharge. 
That, on the contrary, becomes tenacious, often yellow or 
greenish, and frequently acquires an intensely disagreeable, 
salty taste, accompanied by an offensive odor. If ulceration 
takes place, the discharge will often be streaked with blood. 
This stage of the disease is known as ozcena. Crusts or scabs 
often form, and become moulded to the form of the cavity, 
but are finally forced out through the nostrils or drawn down 
into the throat. Small cheese-like concretions are often dis- 
charged, apparently hawked up from the throat. Very often, 
the greater part of the discharge drops down from the head 
into the throat, compelling the person to be constantly hawk- 
ing and spitting, and rendering him unfit for society. In the 
night it is very troublesome, the air-passages becoming 
clogged up, and oftentimes large quantities of the discharge 
swallowed, to the great injury of the stomach. In syphilitic, and sometimes in scrofulous ozoena, the 
bones become diseased, resulting in permanent deformity. 
The mucous membrane in these cases is pale, flabby and 
very little sensitive to touch. The obstruction in the nos- 
trils is only when they are plugged with mucus. But there 
is another form of the disease in which quite a different state 
of things exists. Instead of being pale and flabby, the mem- 
brane will be found to be of a deep red color, sensitive to 
touch, puffed up, and, in old cases, quite hard from indura- 
tion. The slightest irritation will cause a swelling of the 
membrane, sometimes one nostril and sometimes the other 
being almost impervious to the passage of air. The discharge 
is not yellow nor large in quantity, but whitish in color, 
stringy and tenacious, giving most trouble in the throat. 
Damp weather usually aggravates the symptoms. Examine 
the pharynx at any time, and it will be found coated with 
this discharge, which is a source of annoyance, not so much 
from the quantity of it, as the difficulty with which it is re- 
moved. As might be expected, 'pharyngitis is an accompani- 
ment of nearly all cases of Chronic Catarrh. Of laryngitis it 
is, beyond question, the most frequent cause. The dis- 
charges, acrid, irritating and filthy as they are, constantly 
trickling down into the throat, not only induce disease of the 
parts, but effectually neutralize any attempts to cure, so long 
as the Catarrh exists. Persistent hoarseness is one of the 
earliest symptoms of laryngeal affection, and sometimes 
aphonia, or loss of voice, results. 
When the tendency of the inflammation is downward, it 
may be expected to extend beyond the larynx to the bron- 
chial tubes, causing bronchitis, and thence to the lungs. The 
influence of Catarrh in predisposing to consumption is un- 
doubtedly considerable, especially where there is the least 
hereditary taint. Professor Loomis, in his recent work on the 
Heart and Lungs, writes as follows:—“ Clinical experience 7 
establishes the fact that a large proportion of cases of fibrous 
and catarrhal phthisis began with naso-pharyngecd catarrh, 
which gradually extended to the larger bronchial tubes, then 
to the smaller, and finally developed pneumonia, which led to 
consumption.” All authorities admit, that although Catarrh 
itself is not a dangerous disease, it lays the foundation for 
the greatest disorders. 
A great deal of injury is done to the system by swallowing 
this catarrhal discharge. This occurs not only at night, but 
at the table or in society, the sufferer desiring to make him- 
self as little obnoxious to others as possible. When this has 
taken place the patient awakes with a bad taste in his mouth, 
loss of appetite, and not unfrequently nausea and vomiting. 
If there is food in the stomach, it becomes coated with the 
foul secretion, which prevents it from being properly acted 
upon by the gastric juice, whence arises almost constant in- 
digestion. This, of course, helps to debilitate the system, 
and render it more liable to the assaults of disease. Catarrh 
of the stomach and bowels is also likely to be induced by 
contact of this irritating matter with the mucous membrane. 
Among the serious ill effects which may follow catarrhal 
affections of the nasal passages, impairment of hearing is, per- 
haps, the most frequent. Deafness caused by other than 
naso-pharyngeal trouble is the exception. Professor Chisholm, 
of Baltimore, an aurist of the first rank, says: “ Chronic 
pharyngeal and nasal troubles are the starting-point for 
most affections of the ear, which makes throat deafness a 
common form of defective hearing.” 
The external passage to the ear, passing from the side of 
the face to the drum membrane, is lined with skin. There 
is seldom any trouble here, the lining being well calculated 
to resist the encroachments of disease. The internal pas- 
sage, extending from the throat to the drum membrane, is 
called the Eustachian tube. This is lined with mucous mem- 8 
brane, directly continuous with that of the nose and throat. It 
is over an inch in length, and of very narrow calibre. When- 
ever, therefore, there is any disease in the post-nasal cavity, 
this continuation of the lining membrane very rarely es- 
capes injury. The least congestion of the mucous membrane 
narrows the Eustachian opening, and interferes with the 
free passage of air to the inner ear. Indistinct vibrations 
are therefore transmitted to the fibres of the auditory nerve 
in the tympanic cavity. This gives rise, at first, to a feeling 
of fullness, and a constant sound in the ears like that heard 
on placing a large shell against the ear. This sound will 
vary according to the character and gravity of the obstruc- 
tion, sometimes resembling the buzz of a saw or of insects, 
sometimes the ringing of bells, and, not unfrequently, all 
combined. Temporary obstruction may result from a drop 
of liquid or a particle of mucus in the tubes, and some- 
times, on blowing the nose violently, this will be dislodged, 
when, the air rushing in with a loud noise, all fullness and 
hardness of hearing will vanish. 
In the ulcerative form of Catarrh, the ulceration is liable 
to extend through the tube to the tympanic cavity; and the 
matter, collecting there, may finally burst through the drum 
and discharge externally. In the other form, characterized 
by congestion and swelling of the membrane, this condition, 
at first involving the orifice only, may gradually extend 
through the entire length of the canal. The probabilities of 
effecting a cure in either form will be considered when we 
come to speak of the treatment of Catarrh. 
There exists, in many persons, an unusually sensitive con- 
dition of the mucous membranes. It is in such cases that 
the lachrymal duct is liable to become affected, causing water- 
ing of the eyes, and an increase in the pain so frequently 
complained of in that region. 
The sense of smell is usually blunted in Chronic Catarrh; 
sometimes entirely destroyed. To the perfection of this 9 
sense, a free passage of air and a healthy condition of the 
mucous membrane are necessary. The taste is also more or 
less affected, as this sense requires the co-operation of the 
sense of smell, in order to render it perfect. I have observed 
that this loss of smell is more frequent in those cases in 
which there is little or no discharge, dry catarrh, as it is 
popularly called, than in the ulcerative form. The sensi- 
tiveness of the nerve filament is blunted by the congestion 
and thickening of the mucous membrane. This obstruction, 
also, frequently gives a “ nasal twang ” to the voice. 
In speaking of the treatment of Nasal Catarrh, and the 
little success that has hitherto attended it, it is proper to 
state that this has been due almost entirely to the location 
of the disease, and the lack of any adequate means of reach- 
ing, for any effective purpose, the post-nasal cavity. This 
cavity is large, complicated by many sinuosities, interrupted 
by many bony and membranous projections, and, therefore, 
not readily accessible. 
The mucous discharge, whatever its nature, lodges in this 
cavity, and is not easily removed. Now it will be readily 
seen that medicinal applications will be utterly useless, if the 
surface they are intended to reach is coated with a thick, 
tenacious discharge. A thorough cleansing, then, of the entire 
nasal cavity is the first step to be accomplished. Hoiv is this 
to he done ? The instrument in common use throughout the 
country, introduced mainly by quacks, is the douche. This 
consists simply of a small vessel of water placed in an ele- 
vated position, to which a flexible rubber tube is attached. 
The free end being in the nostril, a current of water flows 
around the base of the septum and out of the other nostril. 
This arrangement is almost entirely valueless. It does not 
cleanse the post-nasal cavity, but only the nostrils, that are 
seldom affected by the disease. The naso-pharyngeal cavity is 
the seat of the disease, and it is to this spot our efforts must 
be directed if a cure is to be effected. Moreover, it is well 10 
to understand the danger incurred in using the douche, inas- 
much as it frequently happens that some of the water, in its 
course backwards, may enter and run along the Eustachian 
tubes to the inner ear, thus risking inflammation and entire 
destruction of the hearing apparatus. 
That which it is requisite to do, is to cleanse the post-nasal 
cavity thoroughly, and to do it from within outwards. The in- 
strument I use, operated by the hand, throws a constant 
stream with great rapidity and force. A long, hard rubber 
tube, properly curved, is attached to it, which, passing in 
through the mouth, enters the opening behind the soft palate 
with perfect ease, causing no pain or annoyance whatever. 
Then, operating the instrument, the water flows forward in a 
powerful stream out of both nostrils, sweeping everything 
before it, and cleansing the entire passage, both anterior and 
posterior, thoroughly. A gallon of water can be passed 
through in two minutes, and the relief is immediate. I often 
use two or three gallons of alkaline water at one sitting;— 
less being insufficient to dislodge all scabs, concretions and 
tenacious mucus, collected in different parts of the cavity. 
When this cleansing has been thoroughly done, then and then 
only can medicinal applications be made with a certainty of 
benefit. 
So, likewise, in making applications to the throat: it 
should first be cleansed of all mucus coating the surface. 
For this mucus will frequently exclude absolutely the con- 
tact of the medicinal application with the affected part. It 
is frequently desirable to make applications to all parts of 
the throat. This should not be attempted by gargling, as in 
this way little more than the anterior surface of the soft 
palate and uvula is reached. By means of a camel’s-hair 
brush or soft sponge, attached to a long handle, all the parts 
can be readily reached. Medicated fluids may be used with 
excellent effect by means of the atomizer, the fine spray from 
which penetrates readily in every direction. 11 
As regards the remedies suitable to restore the diseased 
membrane to a healthy state, they are numerous, and vary 
according to the conditions of the case. The greatest care 
and skill is necessary on the part of the physician to deter- 
mine the proper application for a given case, and the proper 
strength of that application. As regards the sensitiveness 
of the parts, rarely are two cases found alike. In one, very 
strong solutions can be borne ; another can barely tolerate 
the mildest. The character of the discharge varies with 
the condition of the membrane, and a knowledge of this is 
quite as important as a personal examination in aiding to 
form a correct diagnosis. 
In the ulcerative cases, with pale, flabby membrane and 
yellow discharge, alteratives are necessary in the outset, of 
which nitrate of silver and bichloride of mercury are the best. 
In the over-sensitive cases, with red, swollen membrane, seda- 
tive solutions, composed of morphia, opium or prussic acid, 
exercise a very beneficial effect. To the class of astringents, 
which are always called for at some stage of the treatment, 
belong alum, sulphate of zinc, sulphate of copper, tannin, &c. 
In dry catarrh, and where there is a loss of smelling power, 
stimulating lotions are found useful, as Eau de Cologne and 
water. In regard to the bad odor attending ozoena, it is never 
noticed after once the use of my instrument has begun, since 
it keeps the parts perfectly clean, and therefore there is nothing 
to give rise to any offensive smell. 
It should be borne in mind that faithful and close applica- 
tion is necessary, in order to bring about permanent good 
results. The parts should be cleansed, and applications made 
daily; in fact, it is much better that it should be done twice 
a day; and I direct all my patients throughout the country 
to whom I send instruments, and who treat themselves under 
my instructions, to cleanse the parts and make the applica- 
tions on rising in the morning and retiring at night. So sat- 12 
isfactory are the results, that I am proud to say I have never 
had a letter of complaint since I first introduced this treat- 
ment to the public notice. Most persons suffering from 
Catarrh have tried dozens of different remedies, all of which 
have proved failures, and they very naturally have arrived 
at the conclusion that it is an incurable disease. The ques- 
tion that remains for them to consider is this :—Have they had 
'proper treatment ? Have they been treated by men of standing in 
the profession, who have made the disease the subject of special 
study and investigation ? If not, then they have no reason 
whatever to despair of being able to obtain a complete and, 
permanent cure. 
The cause of Catarrhal Deafness has been explained in the 
preceding pages. In regard to the treatment, the first thing 
to be said is : Cure the catarrh. For, unless this is done, all 
attempts to treat the impairment of hearing successfully 
will most certainly fail. The cure of the catarrh alone often 
proves of great benefit, without any special treatment of the 
hearing apparatus. This occurs when the orifice alone of the 
Eustachian tube is involved. But usually the congestion 
and thickening have extended along the canal to the inner 
ear. We must then, while restoring the naso-pharyngeal 
space to a healthy condition, resort to artificial means to ren- 
der the canal permeable and restore the equilibrium. Dilata- 
tion of the Eustachian tube is effected by forcing air into the 
tympanic cavity. The simplest called the method of 
Valsalva, consists in a forcible expiration, the nose and mouth 
being tightly closed, so that the air is compelled to enter the 
ear passages. This often gives rise to unpleasant symptoms 
of congestion about the head, therefore the Politzer air-bag 
is commonly used to effect the same purpose. 
In addition to these methods, the Eustachian catheter is 
used in many instances—some aurists, indeed, use it in nearly 
all cases. This is introduced through the nose, and the 
point so manipulated as to enter the orifice of the Eustachian 13 
tube. Tims tlie air-blast may be concentrated with greater 
force upon the obstructing surface. In my opinion, how- 
ever, the catheter is used too frequently by aurists. The 
pain and the annoyance of the operation are considerable, 
and the irritation caused by the point of the instrument at 
the Eustachian orifice often renders the result of the opera- 
tion decidedly injurious. If it is desirable to introduce 
medicated fluids to the cavity of the tympanum, the cathe- 
ter is seldom required. If the head be placed in a recum- 
bent posture, so as to make the upper part of the throat the 
most dependent part of the passage, any fluid poured 
through the nostrils will lodge in the upper portion of the 
throat. Tilt the head slightly to one side, and the fluid con- 
tained in the throat will submerge the Eustachian orifice. 
Then, inflating by the Valsalva method, the current of air acts 
directly upon the surface of the liquid, until, being finally 
forced into the drum cavity, it pushes before it the layer of 
medicated fluid resting upon the orifice of the tube. By this 
simple process the lining membrane of the tube and drum 
cavity can be brought under the direct influence of remedial 
agents. 
In medicating this cavity, it must be remembered that the 
mucous membrane here is of very delicate structure, and that 
drops that are introduced remain for a long time without 
diluting ; contrary to what takes place in the case of mucous 
membranes lining other cavities, Avhere the contact of any 
foreign substance instantly causes an abundant secretion. 
The medicated fluid should always be warm, and made about 
one-fourth the strength of ordinary drops. In case of sul- 
phate of zinc, for instance, one-half grain to one ounce of warm 
water would form a solution of suitable strength. It should 
always be explained to patients that the introduction of the 
fluid will probably have the effect to diminish the hearing 
power temporarily. It will be from twenty-four to twenty- 
eight hours before all unusual sensations pass away and the 14 
relief becomes perceptible. In many instances where pa- 
tients are annoyed by a continual ringing and buzzing in the 
ears, due often to inspissated mucus clogging the drum cav- 
ity, a warm injection of soda or ammonia will give immedi- 
ate relief. 
In cases of ulceration, with perforation of the drum and 
discharge from the external ear, the results of treatment are 
often more satisfactory than in those cases where the trouble 
is due to congestion and thickening. For in the latter case 
the joints among the ossicles of the ear may become stiffened, 
the little bones may become anchylosed to the opposing sur- 
faces, or a depression of the drum-head may result in its ad- 
herence to the opposing walls of the cavity of the labyrinth. 
Whereas, when the ulcerated surfaces are healed, although 
perforation still remains, there will often be sufficient vibra- 
tion transmitted to the nerve terminations to allow of almost 
or quite pefect hearing. 
While only a moderate proportion of cases of deafness can 
be cured, nearly all or quite all can be benefited; and it is 
most certainly the fault of the sufferer if in any case the im- 
pairment of hearing is allowed to increase. 
It is necessary to warn patients to be careful how they med- 
dle with the external ear. Many have the idea that the first 
and about the only thing to do is to syringe the ear with warm 
water. Except there is some accumulation, as impacted wax, 
to be removed, this always does harm. The natural secre- 
tion of wax is washed away, and the ear is left bare and ex- 
posed to irritation, unless, as is frequently the case, some 
kind of oil is applied, which in all probability permanently 
injures the drum membrane. The ear is a delicate organ, and 
should never be handled except by those who have made its 
diseases a special study, and who at the very least will do no 
harm, if they can be of no benefit.