S. J. Crowe i^o 



cannot be cured, but this finding in a child demands an examination of the 

 nasal passages and nasopharynx with a nasopharyngoscope, and a correction 

 of any condition that interferes with Eustachian-tube function and so leads to a 

 further loss of hearing. Lymphoid tissue is an integral part of the mucous mem- 

 brane of the pharynx and nasopharynx and cannot be removed unless the 

 entire thickness of mucous membrane is taken out. After removal of tonsils 

 and adenoids before the age of puberty, it is a common occurrence to see nu- 

 merous nodules on the posterior and lateral walls of the pharynx— a "graiadar 

 pharyngitis." A similar condition is almost invariably seen in the nasopharynx 

 if the examination is made with a nasopharyngoscope. These nodules may not 

 be large enough to cause mouth breathing, but nevertheless are a source of 

 potential danger to the hearing. Physicians are too prone to think that ade- 

 noids can be removed in their entirety, and after operation the nasopharynx is 

 dismissed withotit further examination as a source of trouble. Recurrence is 

 so frequent, however, that it must be regarded as normal. It is not the size but 

 the location of lymphoid nodules that leads to deafness. 



Frequently children with beginning deafness due to these causes sponta- 

 neously recover their hearing, or further loss is prevented by the regression 

 of lymphoid tissue and restoration of the patency of the Etistachian tubes 

 which occurs at puberty. Our duty is to recognize the fact that good hearing 

 depends on open Eustachian tubes, to examine school children with this point 

 uppermost in our mind and to institute some form of safe, conservative therapy 

 that will tide the child over the dangerous period, which tisually ends at 

 puberty. Every year the hearing of millions of children is tested with some 

 type of audiometer. Those with severe impairment are recognized and placed 

 in vocational classes, but the incipient cases, the ones which can be benefited 

 the most, are either not recognized or are inadequately treated. Surgical re- 

 moval of tonsils and adenoids often fails to remedy permanently the conditions 

 that may cause deafness; certainly a second or third operation is not the proper 

 treatment for a recurrence. 



It has been known for nearly forty years that lymphoid tissue is more sensi- 

 tive to irradiation with X ray or radium than any other structure in the body. 

 Therefore in treating hyperplastic lymphoid tissue with these rays the size 

 of the mass may be reduced in three or four treatments with a dosage so small 

 that there is no danger of a burn, or injury to bone, cartilage, hypophysis, or 

 central nervous system structures. The life cycle of the lymphocyte is short, 

 certainly less than a month. Irradiation treatment effects a reduction in size 

 of a mass of lymphoid tisstie by retarding or entirely stopping cell division and 

 the formation of new lymphocytes to replace the ones that have been cast off. 



For nearly twenty years we have used X rays and radon, sometimes as a 

 substitute for, and often to supplement, surgical removal of tonsils and 

 adenoids in children, and have come to the conclusion that radon is a much 

 simpler, safer, and more effective method for irradiation of the nasopharynx. 

 The objections to the use of X rays for this purpose are: the difficulty of direct- 



