THE EFFECT OF DISEASES OF 
THE EAR’ UPON THE GEN- 
ERAL CONDITION. 
. by . 
WILLIAM CHEATHAM, M. D., 
Professor of Diseases of the Eye, Ear, Throat and Nose, 
Louisville Medical College; Eye, Ear, Throat and 
Nose Physician, Louisville City Hospital. 
Reprint: Medical and Surgical Reporter. 
PHILADELPHIA : 
Penfield Bros., Tenth and Filbert Streets. 
1892. THE EFFECT OF DISEASES OF THE 
EAR UPON THE GENERAL 
CONDITION.* 
By WILLIAM CHEATHAM, M. D., 
PROFESSOR OF DISEASES OF THE EYE, EAR, 
THROAT AND NOSE, LOUISVILLE MED- 
ICAL COLLEGE; EYE, EAR, THROAT 
AND NOSE PHYSICIAN, LOUIS- 
VILLE CITY HOSPITAL. 
It shall be my endeavor in this short 
paper to cite some cases which have 
come under my observation in recent 
years, hoping they may be of profit not 
only to the general practitioner, but also 
to the aurist. The ear and its diseases 
appear to be less understood by the gen- 
eral practitioner than diseases of the eye, 
yet the former are of much more conse- 
quence than those of the latter, as more 
'’‘'Read before the Mitchell District Medical So- 
ciety at West Baden, Indiana, July 7, 1892. 2 
serious results are liable to follow their 
neglect. 
The subject of this paper was brought 
to my mind on the day I received a note 
from our most worthy Secretary, asking 
me to prepare an article for this meeting 
of your Society. A prominent lawyer of 
our city had just made one of his monthly 
visits to my office to have his ear cleansed, 
saying his nausea had returned. On that 
day this gentleman said to me, “ Doctor, 
you cured me three years ago of a cough 
that had troubled me much for several 
years, that had resisted all previous treat- 
ment.” The cough has never returned. 
I remembered syringing from his ear a 
mass of inspissated wax and pus, and re- 
lieving him by treatment of quite an acute 
attack of inflammation of his external 
auditory canal. As I was wiping out his 
ear on the day of this conversation it made 
him cough, and recalled to him what re- 
lief I had given him by removing that 
mass three years before. Since then he 
has visited me frequently complaining of 
nausea; he has what we call necrosis of the 3 
attic of the middle ear, which has never 
healed, suppurating just the slightest all 
the time, and every four or six weeks pastes 
over the upper and outer parts of the ex- 
ternal auditory canal with dried pus. 
When this accumulates to a certain extent 
he suffers a great deal from nausea and 
comes in to have me remove it. This I do 
and relieve his nausea until there is another 
accumulation. Ilis first reflex trouble 
was a cough; this has been replaced by 
nausea. The suppurating surface in this 
case has no connection with the middle 
ear cavity. 
Reflex symptoms of this kind are not 
uncommon; in all cases of obscure cough 
which I am called upon to treat, it is 
part of my routine examination to look 
into the ears. Auditory canals of different 
individuals differ very much in sensitive- 
ness, as that of other parts of the body of the 
same individuals do. But that sneezing, 
cough, vomiting and even epilepsy may 
be the result of reflex irritation from the 
external auditory canal is beyond ques- 
tion. Fabricius, of Hilden, quoted by 4 
Roosa and other authorities on diseases of 
of the ear, reports a case of a girl ten 
years of age, who put a small glass ball in 
her ear, who was finally seized with hemi- 
crania, anaesthesia of the left side of the 
body, alternating with severe pain, until 
at last epileptic attacks occurred, with 
other symptoms. Fabricius wrote his friend 
Bauhinus, that he had cured the child 
by removal of the foreign body. A Dr. 
Kupper, as quoted by Roosa, reported a 
case of epilepsy the result of a foreign 
body in the external auditory canal, and 
another of cerebral irritation the result of 
impacted wax; these cases can be easily 
multiplied. Some years ago I reported a 
case of a young lady from Central Ken- 
tucky, who had been treated for a per- 
sistent hacking cough; she had been 
treated by a noted specialist of Chicago 
for some obscure nerve disease. I relieved 
her entirely by removing from one 
ear a mass of impacted wax. Woakes not 
only admits that ear cough is common, 
but says by continued irritation of the 
auricular branch of the pneumogastric, 5 
derangement of the innervation of the 
laryngeal muscles may follow. Spasmodic 
croup he gives as one of the possibilities 
of this reflex action. Woakes traces the 
irritation (Roosa says, p. 206): First, 
from the vaso-motor fibres associated with 
the auricular branch of the pneumogas- 
tric. Second, to the secondary vaso- 
motor center the ganglion of the pneumo- 
gastric, whence he says it is deflected 
through sympathetic fasciculus, to the 
first crevical ganglion; third, thence by 
the nervi molles, to the vessels distributed 
to the mucous membrane of the larynx. 
He rejects the simple idea that the mor- 
bid impression is conducted along the 
sensitive fibres, from one region to another. 
There yet remains in the minds of good 
men a doubt of the presence of a branch 
of the vagus in the external auditory canal. 
Quain and Fox say the branch of the 
pneumogastric supplies only the posterior 
part of the auricle, yet Fox has written 
one of the most extensive articles on ear 
cough ever printed. Clarke and Fox say 
ear cough has its origin “ in the fibers of 6 
the fifth cerebral nerve distributed to the 
auditory canal.” It remains a fact that 
ear cough is not uncommon, and. that the 
weight of authority gives a branch of the 
pneumogastric nerve, distributed to the 
external auditory canal. Tissol reports a 
case of uncontrollable cough, the result 
of touching the external auditory canal. 
Teehlin reported with other cases, a case 
in the person of a military officer, who 
vomited considerably whenever his external 
auditory canal was touched. This sensi- 
tiveness may be in but one canal. 
General Symptoms from Accumulations 
of Cerumen in the Auditory Canal: 
Aitken (British Medical Journal, No. 
1630, p. 652) records three interesting 
observations in which general symptoms 
disappear after the removal of accumula- 
tions of cerumen in the auditory canal. 
In a little girl, eight years of age, with 
incessant cough, bad nights, frequent 
night-terrors, loss of appetite, and emacia- 
tion, without physical signs of pulmonary 
disease, one of the ears was found blocked 
with wax. In a man, eighty-one years of age, with restlessness, tremor, derange- 
ment of digestion, and deafness, the ears 
were found filled with large masses of 
hardened wax. A girl, eleven years of 
age, with a tuberculous family history, pre- 
sented elevation of temperature, frequency 
and irregularity of pulse, but without 
other signs of organic disease. An ac- 
cumulation of wax was found in the ear. 
Not only wax and foreign bodies, but 
eczema, aspergillus, and furunculous in- 
flammation of the external auditory canal 
may produce such symptoms as referred to. 
Inflammations of the middle ear, and 
the danger therefrom I believe are begin- 
ning to be better understood than those of 
the external ear. Abscess of the brain, 
meningitis, pyaemia, phlebitis, mastoid 
periostitis and necrosis, kidney complica- 
tions from continued suppuration, are all 
well known results of suppuration of the 
middle ear. Abscesses of the brain (and 
middle ear suppuration produces a large ma- 
jority of them) are getting rather common; 
many of them are now relieved by the 
trephine and incision or aspiration. 8 
Cases of phlebitis as a result of middle 
ear suppuration are now relieved by tying 
the jugulars and curetting the brain sin- 
uses. I have recently had a case of this 
latter trouble die before the mastoid 
could even be opened. I have recently 
seen a case of pyasmia in a stout healthy 
boy from Louisiana, the result of a sub- 
acute suppuration of the middle ear. With- 
in the last week I have had two very bad 
cases of vertigo the result of acute suppur- 
ation of the middle ear. These cases are 
quite common. The last two cases men- 
tioned were the result of pressure. Chronic 
catarrhal inflammations of the middle 
ear quite frequently cause vertigo. I have 
quite a number of such cases on hand, 
which have been treated by good men for 
cerebral and spinal trouble, as causing 
the vertigo. I have a lady under my 
charge now, who has frequent severe 
attacks of vertigo, which can be relieved 
only by the Eustachian bougie to dilate 
the tube, then inflation by the Eustachian 
catheter. Air cannot be gotten into the 
middle ear in this case except by use first of the bougie. I have one case of aural 
vertigo, in which the mouth of the Eusta- 
chian tube is dislocated, in which I had 
to pass the Eustachian catheter through 
the nose, and watch the instrument post- 
rhinoscopically and make a very long 
curious bend in the catheter before I could 
get air into the tube. Vertigo from 
disease of the internal ear is still better 
understood than that depending upon dis- 
ease of either the external or middle ear. 
Meniere’s disease has long been written of. 
The pathology of the disease has changed 
some in the last few years. These few notes 
I then hope will remind some of the gen- 
tlemen present, that in cases of vertigo, 
cases of obscure cough and nausea, and 
other affections referred to, and some not 
mentioned, an examination of the ears 
should not be neglected. That suppura- 
tion of the middle ear is always dangerous; 
that the advice to let such cases alone, 
that they will outgrow it, is a thing of 
the past; that suppuration of the middle 
ear can cause pyaemia without involving 
the brain; such a case I forgot to mention, 10 
I saw with Drs. Bodine and Yandell, in 
which with other abscesses, there was one 
over the left scapula, which held about 
two pints of pus. Such cases cannot, of 
course, be relieved unless the cause is cor- 
rected. I could multiply instances enough 
of all the complications reported in this 
paper to fill many pages, but think enough 
has been said to show what diseases of 
the external, middle and internal ears can 
do, how they affect the general economy, 
and consequently how important it is to 
attend to them early and knowingly.