PARASITIC INFLAMMATION OF THE EXTERNAL AUDITORY CANAL. SYPHILITIC ULCERS AND CONDYLOMATA. It is not more than six years since the profession became generally aware of the fact, that vegetable fungi were germinated in the auditory canal, and that they caused or aggravated inflammations of this part and of the surface of the membrana tympani. By the publications of Professor Schwartze of Halle, Dr. Wreden of St. Petersburg, and many others whose names will be quoted in this chapter, this fact has now become well known, and has enabled us to more clearly understand and more successfully treat certain cases of otitis externa. <Callout type="important" title="Important">The presence of aspergillus fungus is a well-recognized fact for which we are indebted to Schwartze.</Callout> Causes. — In order that we may correctly understand the nature of parasitic otitis, it should be remembered that it is not a primary disease, but a consequence of a diffuse otitis, which may have been of such a mild character as scarcely to have attracted the attention of a patient, especially if it occur in one who is taught to believe, as most patients are, that an aural disease will 'wear away' of itself, or, at any rate, that medical assistance will be of no avail for it. The disease which usually precedes the formation of a vegetable fungus in the ear, is, as I believe, an eczema. <Callout type="warning" title="Warning">The habits of Russians living in poorly ventilated rooms are very favorable to the production of aspergillus.</Callout> Symptoms. — The subjective symptoms of the growth of a vegetable fungus in the ear, are very similar to those from inspissated cerumen. There is a sensation of fulness in the ear, with tinnitus aurium, vertigo, impairment of hearing, and pain. As is well known, pain is not a common symptom of inspissated cerumen, although it does occur. Pain is, however, usually one of the symptoms of otitis parasitica. It is not, however, the severe pain of a furuncle, or of acute catarrh of the middle ear, but it is a dull, heavy sensation in the ear. The objective symptoms consist in the adherence to the walls of the canal and to the outer surface of the membrana tympani of whitish or blackish flakes, that may be readily mistaken for simple epidermis or hard wax. Sometimes these flakes or casts block up the whole passage. They cannot be removed by a syringe; but the angular forceps, which should only be used under a good illumination by means of the oto-scope, are required to detach them. When the casts are removed the tissue beneath is found to be reddened and tender, and in a very few hours the growth will be found to be reproduced. The microscope must be called in to make the diagnosis certain. <Callout type="tip" title="Tip">The practitioner who has once carefully observed the objective evidences of a vegetable fungus will, however, not be apt to fail to recognize it in a subsequent case.</Callout> Treatment. — The treatment of otitis parasitica is exceedingly simple, but it is often very tedious, and the practitioner must not expect that all the aural symptoms will be relieved when the vegetable fungus has ceased to appear. If the theory which I have adopted, that the parasitic affection is a secondary disease, be correct, we may only expect to relieve the most troublesome symptoms, pain, vertigo and impairment of hearing, by the destruction of the parasite. The inflammation will continue, in some cases, long after the microscope has failed to find any traces of aspergillus in the auditory canal. But the loosened epidermis and the flakes of mould should be carefully removed every day by means of the forceps and syringe, the ear being well illuminated while the former is used, and the canal frequently douched with warm water by means of Clarke's douche. I am in the habit of pencilling the canal with nitrate of silver in strong solution, after the cleansing process is over, not for the purpose of destroying the fungus, but to subdue the inflammation of the integument. At the same time, I treat any affection of the middle ear, that may co-exist with that of the canal, by the appropriate means. Dr. Wreden gives a long list of agents which he believes to be useful as parasiticides. He mentions, among others, alcohol, bichloride of mercury, acetate of lead, tincture of iodine and carbolic acid. He prefers the hypochlorate of lime, which he recommends to be used in the strength of one to two grains to the ounce of water. The salt must be freshly dissolved in water at each application. Fowler's solution ranks next to the lime as a parasiticide, according to Wreden. Solutions of tannic acid, gr. x ad 3 j, are used by some authorities. Drs. Orne Green of Boston, and Knapp of this city, concur with me in believing that a thorough use of warm water is the only parasiticide necessary. Dr. Eugene Peugnet, of this city, believes from experience in one very obstinate case, that the following formula is very useful. R. Veratria gr. ij Acid. Acst m. x Aq.Eosa)-- § gg_ Glycerine ) M. This is to be pencilled on the ear after the canal is thoroughly cleansed. I have used this formula but in one case. The following cases will furnish a commentary on what has been said, and perhaps illustrate the nature of the affection better than any more extended remarks. The first two have already been published, but the third has never before been printed. CASES OF ASPERGILLUS. Case I.— I was consulted, June 30, 1869, by J. F. B., a gentleman set. 24, in regard to pain and impairment of hearing in the left ear. He stated that about a year before he had experienced a sense of fulness in the ear, as if it were 'stopped up,' and that, at the same time, there was considerable tinnitus aurium. He consulted a physician, who diagnosticated inspissated cerumen, and removed a large quantity of what seemed to be ear-wax from the canal. The relief afforded was of short duration, for the ear soon filled up. From that time to the present the patient has been in the habit of syringing the ear, and at times masses of some foreign substance were removed by this process. Of late he noticed black particles strewn in the substance removed, which he thinks are due to the entrance of dust from the smoke-pipe of a steamer during a recent voyage from Europe. The patient now experiences very considerable pain in the ear, and it is the occurrence of this new symptom which has led him to consult me. The other symptoms— the sensation of fulness, tinnitus aurium, and impaired hearing, continue. Patient's general health is good, though he is very subject to naso-pharyngeal catarrh. On examination, a watch which is usually heard at least thirty inches from the auricle is only heard one and a half inches, and the auditory canal is filled with a lardaceous mass, punctated by minute black spots. This mass was very adherent to the walls of the canal, and could not be thoroughly removed by syringing, but required the use of the angular forceps, under a good illumination by means of Troltsch's otoscope and ordinary daylight. The surface beneath this mass, which peeled off from the canal, was red and very sensitive. After the removal of the foreign substance, a minute perforation of the membrana tympani was found situated in the anterior and inferior quadrant. There was no true suppuration, but mucus alone bubbled out from the opening during the inflation of the Eustachian tube. The Eustachian tube was shown to be permeable by Politzer's method, but there was very little sensation experienced in the ear when the air was forced in. On the removal of the collection, the patient experienced immediate relief from the pain and tinnitus aurium, but the hearing was not very much improved. The diagnosis catarrh of the middle ear was made, while an exact definition
Key Takeaways
- Aspergillus fungus is a well-recognized cause of parasitic otitis.
- The disease usually follows an eczema or diffuse inflammation of the ear canal.
- Treatment involves removing the fungus and managing symptoms.
Practical Tips
- Regularly clean your ears with warm water to prevent fungal growth.
- Be aware that aspergillus can thrive in poorly ventilated environments, like those found in cold climates.
- Use a good otoscope for proper illumination when examining the ear canal.
Warnings & Risks
- Avoid using cotton swabs or other objects that may push debris deeper into the ear canal and cause irritation.
- Do not ignore persistent symptoms; they could indicate a more serious condition like aspergillus infection.
- Be cautious with over-the-counter treatments; some may irritate the ear further.
Modern Application
Understanding parasitic infections in the ear, such as those caused by aspergillus fungus, remains crucial for modern survival preparedness. While techniques have improved, recognizing and treating these conditions can prevent serious complications like hearing loss or even systemic infections.
Frequently Asked Questions
Q: What are the symptoms of aspergillus in the ear?
Symptoms include a sensation of fullness, tinnitus, pain, and impaired hearing. The ear canal may be filled with adherent whitish or blackish flakes that can block it.
Q: How is aspergillus diagnosed in the ear?
Diagnosis requires microscopic examination to identify the presence of aspergillus fungus. This involves using an otoscope and examining the ear canal for characteristic growths.
Q: What are some effective treatments for aspergillus in the ear?
Treatments include removing the fungal growth with forceps, irrigating the ear with warm water, and applying antifungal solutions like hypochlorate of lime or tannic acid. In some cases, using nitrate of silver may help subdue inflammation.