The Practice and Applied Therapeutics of Osteopathy Charles Hazzard, D. O. 1905      CHAPTER XVII   DISEASES OF THE EAR  
 
    CASES: (1) Deafness of two years duration in a lady of forty-two, caused by displacement of atlas to the right, tightening muscles and ligaments around the ear and lower jaw.  Tenderness was extreme in the cervical region.  Dry catarrh was present.  There was lesion of the 2nd cervical vertebra.  The patient had been injured in a railroad wreck, being confined to bed.  She could not hear a clock strike in the room, nor the playing of a piano.  After three treatments the patient could hear the clock strike.  After five weeks treatment the hearing was completely restored.
    (2) Deafness in a young boy, due to lesion of the atlas.  The deafness was complete in one ear, and almost so in the other.  After one months treatment he could hear conversation spoken
in an ordinary tone.
    (3) In a boy of fourteen, a continuous discharge from the right ear, of ten years standing.  Lesion of the atlas and axis, luxated to the right, and contraction of the tissues.  The case
was cured in nine treatments.
    (4) In a boy of eleven, partial deafness in, and continual discharge from, one ear.  The lesion was a slip of the atlas.  The case was cured in one months treatment.
    (5) In a young lady, an abscess in one ear had been discharging for several months.  After one treatment there was no further discharge, and after four treatments the trouble had disappeared.
    (6) In a young lady, partial deafness of some years standing, continually growing worse.  Several members of her family are afflicted in the same way.  An ear specialist had pronounced. her case hopeless.  Lesions were luxation of the 2nd and 3rd cervical vertebrae; thickened tissues at the base of the skull; irregularity of the upper dorsal vertebrae.  The entire treatment was directed to the head, neck, and upper dorsal region, with the result that after one months treatment the patient could hear a watch tick at double the distance that she could upon beginning treatment.
    (7) A case of growing deafness, of some years standing, in a gentleman who had given up his profession upon this account.  Lesion was found at the atlas, which was turned backward and to the left.  Upon its adjustment the hearing was much improved.
    (8) Complete deafness in the left ear, and partial deafness in the right ear, complicated with facial neuralgia, of about 20 years standing.  The atlas was posterior and to the left.  In two months treatment great improvement was made.
    (9) A case of intense earache of years standing.  The atlas was displaced slightly to the right, This was adjusted at the first treatment, and no earache appeared after that.
    The LESION in ear diseases, as illustrated by the above cases, is almost as a rule in the atlas and axis.  The 3rd cervical and other cervicals may be affected, but in the vast majority, of cases the atlas and axis, one or both, are affected.  It is more often at the atlas than elsewhere.  A luxation of the tempo-maxillary articulation, impinging probably the articular fibres of the auriculo-temporal branch of the inferior-maxillary division of the fifth nerve, and contractured tissues about the upper cervical region and the angle of the jaw, may act as lesions in these diseases.
    The fifth nerve supplies the external auditory canal by its auriculo-temporal branches, the upper one of which sends a branch to the tympanum.  Also the vidian of the fifth sends nasal branches to the membranes of the end of the Eustachian tube.  The internal throat treatment given to affected this tube, does so by stimulating these fibres, thus freeing the secretions in this portion of the Eustachian tube.  Reasoning by analogy, doubtless the secretary, trophies and vaso-motor functions of the fifth nerve with relation to the eye and other parts of the head and face are extended to the ear, secretion of cerumen and circulation about the ear being to some extent, under control of the fifth.  Experience connects lesions of this nerve with ear diseases.  It has been known that the nerve suffers from lesion of the upper cervical region, such as occur in ear troubles (see Diseases of the Eye).  The treatment of this nerve, so important in nasal catarrh and other inflammatory affections of the eye, nose, and parts of the head, is important likewise in these catarrhal, inflammatory, and other circulatory troubles, so commonly complicated with the diseases of the ear.
    Vaso-constrictor fibers for the ear are contained in the cervical sympathetic.  They constitute another pathway for the effect of cervical lesion to reach the ear.  Likewise the atlas and axis lesion may affect the blood supply of the ear through the medulla, which suffers from these lesions.  It is possible that vaso-motors for the head exist in the upper dorsal nerves, though upper dorsal lesion is rare in ear trouble.  It is that much of the effect of cervical lesion upon the ears is gotten through the vaso-motors and other sympathetics.
    The pneumogastric nerve has an auricular branch, and is in close connection with the fifth in relation to the car, as well as with the cervical sympathetic.  The petrosal ganglion of the glosso-pharyngeal is related to upper cervical lesion by sending a branch to the superior cervical ganglion.  Its tympanic branch passes from this ganglion and contributes fibers to the mucous lining of the middle ear, and to the mastoid cells.  It sends branches to unite with the sympathetic and form a plexus on the carotid artery in the carotid canal.  Thus is this nerve connected both with neck lesions and with the blood supply to the ear.  The facial nerve, well known to be influenced by lesions of the atlas and axis, as seen in facial paralysis, has direct communication with the auditory nerve and with the auricular branch of the pneumogastric.
    The various simple methods described in the texts on this subject will aid one to determine the location of the trouble in the external, middle, or internal ear.  The disease may be seated in the auditory nerve or in the brain, in such case being as directly connected with cervical lesion, before shown to affect the brain and cranial nerves.  Examination of the ear is given in detail in Part I.
TREATMENT: An ear syringe may be used in the ordinary ways to cleanse the ear of secretions, discharges, foreign objects, insects, etc.  Care must be used with the syringe.  It should have an olivary tip to prevent introducing it so far as to touch the drum.  If a piston syringe be employed, care must be taken not to press the piston in too quickly, as it may inject the fluid with sufficient force to injure or perforate the drum.  It is best to use an ordinary fountain syringe, with an appropriate tip, and hung up not more than a foot or eighteen inches above the level of the patient's head, in order to have a gentle flow.
    For antisepsis, to insure cleanliness when there are discharges from the ear one may use a warm solution of boric acid, saturated, or containing from one to two teaspoonfuls of the powder to a pint of water.
    When there is a firm plug of cerumen in the canal, it is well to first soften it by dropping t few drops of sweet oil into the canal, and allowing it to remain over night after having plugged the meatus with a little absorbent cotton.  After the softening process, a good deal of the wax may be carefully removed with a spatula, but it is not always advisable to attempt to remove it all in this way, as the canal may be sensitive or the drum may be irritated.  The remnants may always be safely and easily removed by gentle syringing.  Considerable water may be used if necessary.
    When insects get into the ear they should be first drowned with a little water or sweet oil, then removed by syringing.
    The removal of bony lesion and the cervical treatment as before described are the main osteopathic treatments applied in ear diseases.  The presence of the original cause of these diseases in the form of neck lesion necessitates practically the whole treatment being cervical. There is no local ear treatment, except as in common methods in vogue in use of syringe, etc.
    Outside of removal of lesion, an almost specific treatment for eye and ear is that of opening the mouth against resistance (Chap.  IV, Div. I, II, VII), and the neck treatment, with the object of increasing circulation through the carotid arteries.  Due attention is given to the cervical sympathetics and vaso-motors in this connection.
    A valuable local treatment of the ear in cases where the drum, or local circulation, or normal secretions, etc. are affected, is as follows:
    The tragus is pressed rather firmly into the external meatus, and then quickly released, the operation being repeated about once per second.  Or the finger may be moistened and introduced into the meatus, being worked in and out like a piston.  These treatments create a local suction and pressure which circulation and all the local tissues, stretches and massages the drum, and helps to soften and relax it in cases of retraction due to catarrhal processes, etc.  In cases of retraction of the drum it is sometimes helpful to frequently introduce a little sweet oil into the canal to aid in softening it.  Such treatments also aid in loosening the ossicles in catarrhal deafness, thus rendering them more susceptible to vibrations of sound.  These treatments will materially aid in improving the hearing in some cases.
    A similar effect is gotten, also, by inflating the ear drum in the familiar manner of holding nostrils and mouth closed and blowing.  This should be judiciously practiced by the patient in all cases of retraction of the drum in catarrhal deafness, in order to keep the drum and ossicles relaxed and able to vibrate, but this must not be done to excess for fear of eventually leading to hypertrophy of the drum.  A few inflations, once or twice per day, are enough.
    The drum may also be inflated by the practitioner, who spreads a clean handkerchief over the ear and applies his lips close over the meatus and blows.  It is probable that by these means, and more especially by the latter, subluxations of the ossicles may be reduced, restoring or aiding the hearing.  There are on record some cases in which a few such inflations have greatly increased the power of bearing, probably because thereby luxated ossicles have been articulated.
    The throbbing, buzzing or humming sounds that occur in the ear with catarrhal affections, etc., can sometimes be stopped by use of the above measures.
    Perforations of the drum generally, readily heal up, as do incisions by the knife, but not always.  These perforations may not be in the drum proper, but at the notch of Rivinius, which is covered with skin and will quickly heal.
    The internal throat treatment may be used, the finger being directed about the opening of the Eustachian tube to stimulate the local points of the fifth nerve, the mucous membranes, and thus the secretions.  This aids in freeing the tube, an object that is well accomplished by the aid of the external throat treatment upon the carotids, etc.
    In catarrhal affections of the ear the treatment is as described for nasal catarrh.
    In earache the treatment embraces the repair of lesion, inhibition of the upper cervical nerves, and inhibition about the mastoid process, below the ear, in front of the ear, etc.