62 SMITHSONIAN MISCELLANEOUS COLLECTION'S VOL. 93 



Whether syphiHs, acquired or inherited, may in some way favor 

 the appearance or growth of ear exostoses cannot be decided from 

 my sources. But these do show beyond question that ear exostoses 

 may exist, and that to a far greater extent than in White people, 

 without a trace of syphiHs being present ; and that on the other hand 

 a whole series of skulls with most pronounced syphilitic involvement 

 may exist with not a vestige of ear exostoses. 



LOCAL IRRITATIONS AND INFLAMMATIONS 



Of all the possible causes of ear exostoses, none in otological litera- 

 ture receives as much attention as ear irritations and inflammations. 

 The irritations are secondary, due particularly to injuries and dis- 

 charges, and act by setting up an inflammation. The inflammations 

 may be of any intensity, acute or chronic, localized or generalized. 

 They range from mild focal periostitis or osteitis to serious involve- 

 ments of the meatus, and to otitis media. All were, and largely still 

 are, believed to be more or less directly influential in favoring the 

 development of the bony growths in the meatus, directly or through 

 their irritating discharges. 



Wilde (1855, p. 241) concluded that ear exostoses were the results 

 of chronic osteitis and periostitis in the meatus. Rau (1856) ex- 

 pressed the same opinion. For Toynbee (i860), one class of the 

 growths was due to " congestion of ear lining ", secondary to a dis- 

 eased condition of the ear. Roosa (1866, p. 428) saw in their pro- 

 duction a process " substantially an irritative one, often even inflam- 

 matory " ; " irritation and probably periostitis due to chronic otor- 

 rhoea." Similarly for Dalby (1876) they were "at times called into 

 existence by an irritation .... by the irritating influence of a 

 discharge ". 



Delstanche (1878, pp. 17, 65) enumerates " among the most potent 

 causes" of ear exostoses, "chronic phlegmasia (inflammation), pri- 

 mary or secondary, of the walls of the meatus .... inflammation 

 of bone and periosteum .... inflammation of irritation, spontan- 

 eous or traumatic ". Similarly, the chief or one of the chief causes 

 (jf the growths is, in the opinion of Hedinger (1881), " hypertrophic 

 inflammation of the lining membrane, with subsequent osseous meta- 

 morphosis of the new-formed connective tissue." For Masini (1882, 

 p. 616), continued local irritation (as in otorrhoea) is a cause of the 

 growths. Moos, Kessel, Politzer, Pritchard, Jacquemart, Heiman, 

 Kuhn, Jackson, Sabroux, Ballenger, Michailowskij, and others express 

 themselves in a more or less similar manner. 



