EAR SMEARS 



107 



EAR SMEARS 



C. (Laryngoscope, 1951, 59, (in press)). 

 The precipitation of Prussian Blue in 

 the small vessels or the lead chromate 

 method of Williams, T. W. (Anat. Rec, 

 1948, 100, 115-125) gave satisfactory 

 preparations. 



A method for graphic reconstruction 

 of the organ of Corti was introduced by 

 Guild, S. R., Anat. Rec, 1921, 22. 141- 

 157. This method has been used for 

 ascertaining damage to the organ of 

 Corti and for measurements of the 

 length of the organ of Corti in man by 

 Hardy, M., Am. J. Anat., 1938, 62, 291- 

 311. A simple technique for measuring 

 the length of the basilar membrane is 

 reported by Keen, J. A., J. Anat., 1939- 

 40, 74, 524-527. To study the mode of 

 vibration of the basilar membrane 

 B^k^sy, G. v., J. Acous. Soc. Am., 1948, 

 20, 227-241, used fresh human temporal 

 bones and suspended fine silver crystals 

 in the cochlear duct to visualize the 

 transparent memarane. 



Various methods of reconstruction 

 have been employed particularly for 

 study of development of the ear. See 

 Bast, T. H., Arch. Otol., 1932, 16, 19-38 

 and others. Casts of the labyrinth 

 have been made of a number of different 

 materials including Wood's metal, wax, 

 rubber and so forth. Cummins, H., 

 J. Comp. Neurol., 1924-25, 38, 399-459 

 used mercury for this purpose. With 

 monomeric methyl methacrylate (Pera- 

 pe.x) Gray, 0., J. Laryng. and Otol., 1948, 

 62, 308, developed a method for making 

 an accurate anatomic cast of the laby- 

 rinth. See Endolymph. 

 Ear Smears — Written by Marian Pfingsten 

 Bryan, Dept. of Otolaryngology, Wash- 

 ington University, St. Louis 10, Mo. 

 September 20, 1951 — Cytological studies 

 of aural exudates are valuable in help- 

 ing to understand the patterns of disease 

 pertaining to the middle ear, mastoid 

 and external canal of the ear. The 

 smear technique, more fully appreci- 

 ated now, although stressed by Dean, 

 L. W. (J. A. M. A., 1932, 99, 543-546), 

 yields reliable information. When this 

 is accurately correlated with clinical 

 symptoms it is of diagnostic value. 

 With repeated consecutive smears the 

 course of an inflammatory reaction in 

 the middle ear can be charted and the 

 bacteria generally observed. The se- 

 verity and type of infection is often 

 indicated by the number and variety 

 of inflammatory cells. The response of 

 the individual, as evidenced by the 

 number and type of phagocytes is im- 

 portant. The phagocytic power of the 

 polymorphonuclear neutrophilic leuco- 

 cytes along with the monocytes and 

 other cellular forms can be evaluated. 



These, with other distinguishing cy- 

 tological features, are evident in the 

 following-categories of aural disease: 

 chronic and acute suppurative otitis 

 media, cholesteatoma of the middle ear 

 and mastoid, acute and chronic mas- 

 toiditis, external otitis and carcinoma. 



Studies of these aural secretions have 

 been sparsely scattered through the 

 literature. Ts'en, Shih-Ping (China 

 Med. J., 1926, 40, 136) reported seven 

 aural smears with case histories and 

 suggested that the differences in 

 cytology were due to the duration of 

 the discharge. He noted that in 

 chronic cases the neutrophiles were more 

 degenerated than in acute ones. Since 

 then it has been found that chronic 

 suppurative otitis media can readily 

 be differentiated from acute suppurative 

 otitis media by smears. The amount 

 of fatty squamous epithelial degenera- 

 tion is of importance. This type of 

 degeneration is rarely found in acute 

 otitis media. The cytology in these 

 cases was studied by Dean, L. W. Jr. and 

 Pfingsten, M. G. (Ann. Oto., Rhinol. 

 and Laryngol., 1933, 42, 484-496). 

 Chronic suppurative otitis media is 

 also characterized by excessive numbers 

 of mixed bacteria and the neutrophiles 

 usually exhibit marked degeneration. 

 If there is an acute exacerbation of a 

 chronic condition, the typically chronic 

 picture is seen plus the acute one, in 

 which the neutrophiles are many, well 

 preserved, and often exhibit phagocytic 

 activity as evidenced by containing 

 bacteria. In acute otitis media all gra- 

 dations of monocytes are found from 

 those characteristic of the circulating 

 blood to other larger mononuclears, 

 but in chronic otitis media the larger 

 ones are rare. 



In some cases of chronic otitis media 

 an increase of eosinophiles has been 

 observed in the exudates. Dohlman, 

 F. G. (Nord. Med. Tidskr., 1943, 17, 

 224) worked on this problem. In 178 

 cases of varying types of otitis he found 

 in 99 of them some increase in eosino- 

 philes. Koch, Hjalmar (Acta Otolaryn- 

 gol., 1947, Supp. 62) has also made a 

 complete and detailed study concerned 

 with the finding of eosinophiles in the 

 ear discharges from cases of chronic 

 otitis media. He stated that in the 

 210 chronic ears examined, there were 

 52 cases which exhibited an increase 

 in eosinophiles. He concluded that in 

 the eosinophile cases the healing time 

 of the lesion was lengthened and that 

 they were characterized by a very vis- 

 cous secretion varying from clear glass 

 to serum-like in appearance. Hansel, 

 F. K., Allergy of the Nose and Para- 



