The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
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.