20I2 DISEASES OF THE ORGANS OF SPECIAL SENSE 



These fungi cause mild inflammations of the external auditory 

 meatus, and are found not merely in natives, but also in Europeans. 



If they grow superficially, they cause no symptoms; but if they 

 penetrate into the mucous membrane, they give rise to itching, and 

 sometimes to pain. If they grow into the cerumen, they may give 

 rise to blocking of the passage, and cause tinnitus aurium and 

 deafness. 



On inspecting the ear, it will be seen that the wall of the auditory 

 meatus is covered with a white or black macerated mucosa. The 

 diagnosis can be made by microscopical examination, and, if neces- 

 sary, by cultivation. The treatment is to syringe with a watery 

 solution of peroxide of hydrogen, or peroxide solution (2 parts) and 

 alcohol (i part) once or twice a day, followed by the insufflation of 

 boracic powder, or, if there is eczema, some boracic ointment. 

 Damond recommends injecting a few drops of a dilute solution of 

 sodium iodide, followed by the injection of the same amount of 

 12 volumes hydrogen peroxide. 



Hypersecretion. — Excessive secretion of the products of the ceru- . 

 minous and sebaceous glands of the external auditory meatus is 

 common in the tropics, and is probably induced by some hyperaemia, 

 perhaps in part due to irritating dust, and partly to the hot, damp 

 air. As a rule both ears are affected, giving rise to a sensation of 

 fulness and heaviness in head, diminution in hearing, and tinnitus 

 aurium, and more rarely to autophony, while pain is rare, though 

 neuralgia may occur, and reflex coughing. The diagnosis is easily 

 made by seeing the brownish-red or black mass filling up the 

 meatus. 



If the plug is soft, it can easily be removed by warm syringing; 

 if hard, it requires to be softened by a warm solution of bicarbonate 

 of soda (20 grains to i ounce of water) or glycerine of borax, and 

 then to be removed by syringing. If deafness persists after the 

 cerumen has been removed, it is necessary to inflate the middle ear 

 by a Politzer's bag, which must be used with care. 



Otitis Externa Circumscripta.— Boils due to the entrance of 

 pyogenic germs into a sebaceous gland or hair-follicle are not rare. 

 They usuaUy cause much pain, which is aggravated by moving the 

 jaw or touching the auricle, and may cause toothache, salivation, 

 and vertigo. 



The treatment should be to relieve pain by cocaine, and the 

 meatus should be lightly packed with gauze soaked in weak carbolic 

 lotion. Later an incision may be made into the boil with a Dundas 

 Grant's furuncle knife, and the meatus dressed with carbolized, 

 glycerine on gauze. To relieve the irritable condition of the meatus, 

 which often persists after the boil has been relieved, a little cocaine 

 or boracic ointment combined with lanoline may be applied, and a 

 general tonic prescribed. 



Otitis Externa Ossificans. — Miiller has described a diffuse inflammation of 

 the mucosa of the external auditory meatus in the tropics which often invades 

 the periosteum and leads to ossification, and may cause exostosis. 



