Diseases of the ear, nose and throat; medical and surgical

Front matter

Fig. 1. — External surface of the adult temporal bone. Landmarks indicated upon key plate.

OVAL WINDOW

SUPRAMEATAL FOSS

Preface

In the preparation of this volume it has been my conscientious endeavor to define the essential features of the principal diseases of the ear, nose and throat, and to outline the modern and approved methods of treatment for these affections.

The work was attempted, in part, in response to repeated requests from many students and practitioners of medicine whom I have been privileged to instruct in the New York Post-Graduate Medical School and at the Manhattan Eye, Ear and Throat Hospital during the past twenty years. Hence, it has been prepared to meet the needs of the general practitioner and surgeon as well as the otologist and laryngologist.

I have purposely refrained from perpetuating discarded theories, or descriptions of operations which are either obsolete or have been superseded by more modern methods, simply for the purpose of completing the record or to conform to the older text-books. Nor have I introduced modern theories or operations unless they possess a reasonable measure of scientific value. In short my purpose has been to write a practical, accurate and concise treatise bearing the approval of personal experience.

Tn the chapters devoted to general considerations I have grouped various symptoms and measures of treatment which are common to two or more affections, in order to avoid needless repetition. A section devoted to the influence of general diseases and conditions upon the ear, nose and throat has permitted the grouping of a variety of affections (numbering about thirty-seven), which exhibit symptoms or lesions referable to these organs, and to depict the necessary local and general measures of treatment for the same. It is believed that this section will appeal to the general practitioner and be valuable for reference. I have purposely placed the section on the ear first in order to give emphasis to the fact that in this book the space devoted to the ear is not a mere addendum, but a complete work on otology. The section on the nose and throat is at the same time equally comprehensive and complete.

The subject-matter is presented in the general form of a text-book, but in the preparation of the text as well as the illustrations I have aimed to make it a practical, comprehensive operative surgery

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iv PREFACE.

of the ear, nose and throat. To this end the illustrations of operations or steps of operations, whether schematic or actual, are accurate and may safely serve as guides to the surgeon.

It is a pleasure to acknowledge the aid received from the publications of my numerous confreres. The standard American and foreign text-books, monographs and published articles have been freely consulted, and many of these have been referred to in the text. Parker's excellent classification of the diseases of the pharynx and larynx has been adopted in part.

I desire also to express my sincere thanks for the encouragement and many courtesies extended by my colleagues in New York and elsewhere, many of whom have been personally consulted regarding numerous phases of this work. The members of my staff at the Manhattan Eye, Ear and Throat Hospital have responded cheerfully to all requests for assistance in various details. I- am specially indebted to Drs. S. J. Kopetzky, J. J. Thomson, L. M. Hubby, E. P. Fowler, J. H. Guntzer and L. J. Denchfield for outlining or compiling various items of descriptive matter, and for abstracting valuable material from foreign and American literature. Air. K. K. Bosse has devoted his best energies and skill to the preparation of the numerous drawings. The valuable assistance rendered by Miss B. Arnaud in attending to the various minor details is gratefully acknowledged.

My thanks are due to the publishers for their valuable suggestions and for the care bestowed upon the numerous details pertaining to the mechanical preparation of this work.

W. C. P.

y 40 West Forty-seventh Street, New York Citv.

Part I. The Ear. Section* I. — General Considerations

CHAPTER. PAGE.

I. The Office Equipment 1

II. The Examination of Patients 8

III. The Physiology of Hearing 24

IV. Functional Examination. The Tests for Hearing 34

V. General Etiology of Ear Diseases 41

VI. General Symptomatology of Ear Diseases 50

VII. General Diagnosis of Ear Diseases 61

VIII. General Therapy of Ear Diseases 80

Section II. — The External Ear

IX. Surgical Anatomy of the External Ear 103

X. Diseases of the External Ear 108

XI. Diseases of the External Ear (Continued) 124

XII. Diseases of the External Ear (Continued). Malformations and

Anomalies 142

XIII. Diseases of the External Ear (Continued ) . Neoplasms 151

Section III. — The Middle Ear

XIV. Diseases of the Middle Ear. Diseases and Injuries of the

Membrana Tympani 167

XV. Diseases of the Middle Ear (Continued ) . Surgical Anatomy of

the Middle Ear and Eustachian Tube 173

XVI. Diseases of the Middle Ear (Continued ). Classification. Acute

Middle-ear Catarrhs 181

XVII. Diseases of the Middle Ear (Continued ) . Chronic Middle-ear

Catarrhs 186

XVIII. Diseases of the Middle Ear (Continued ) . Acute Inflammation

of the Middle Ear and Mastoid Process 196

XIX. Diseases of the Middle Ear (Continued ) . Acute Diseases of

the Mastoid Process 210

XX. Diseases of the Middle Ear (Continued ) . The Simple Mastoid

XXI. Diseases of the Middle Ear (Continued ). Chronic Purulent

Otitis Media 253

XXII. Diseases of the Middle Ear (Continued) . The Radical Mastoid

XXIII. Complicating Lesions of Purulent Otitis Media. Purulent

Labyrinthitis 312

VI

CONTENTS.

CHAPTER.

XXIV.

XXV.

XXVI.

PAGE.

Complicating Lesions of Purulent Otitis Media (Continued).

The Intracranial Complications of Purulent Otitis Media

Lateral Sinus Thrombosis . . 344

Complicating Lesions of Purulent Otitis Media (Continued).

Intracranial Complications. Otitic Diseases of the Meninges. 364 Complicating Lesions of Purulent Otitis Media (Continued).

Otitic Brain Abscess 374

Section IV. — Diseases of the Perceptive Apparatus and Miscellaneous Diseases and Conditions of the Ear.

XXVII. Diseases of the Perceptive Apparatus. Otosclerosis 385

XXVIII. Miscellaneous Otitic Conditions 393

Part II. The Influence of General Diseases upon the Ear, Nose and Throat

XXIX. The Influence of General Diseases upon the Ear, Nose and

Throat. Introduction. Tuberculosis. Lupus 406

XXX. The Influence of General Diseases upon the Ear, Nose and

Throat (Continued ) . Syphilis 432

XXXI. The Influence of General Diseases upon the Ear, Nose and

Throat (Continued). Diphtheria. Scarlatina. Measles .. 449 XXXII. The Influence of General Diseases upon the Ear, Nose and

Throat (Continued) . Typhoid Fever, Typhus Fever, etc. . 472

Part III. The Nose and Accessory Sinuses. — The Pharynx and Fauces. — The Larynx

y

Section I. — The Nose and the Nasal Accessory Sinuses. /

XXXIII. Acute Inflammatory Affections of the Nasal Mucosa 491

XXXIV. Chronic Inflammatory Affections of the Nasal Mucosa 501

XXXV. The Nasal Septum and its Pathological Conditions 518

XXXVI. The Turbinate Bones and their Diseases 547

XXXVII. The Diseases of the Nasal Accessory Sinuses. Anatomical

Classification. The Maxillary Antrum 567

XXXVIII. The Diseases of the Nasal Accessory Sinuses (Continued). The

Frontal Sinuses 587

XXXIX. The Diseases of the Nasal Accessory Sinuses (Continued).

The Ethmoidal Sinuses and the Sphenoidal Sinuses 609

XL. The Correction of External Nasal Deformities, Epistaxis, Foreign Bodies in the Nose, Parasites (Maggots, Screwworms, Fungi, etc.), Rhinoliths, Nasal Furunculosis 629

XL1. Nasal Neuroses 645

XLII. Neoplasms of the Nose 651

COXTEXTS.

vn

CHAPTER.

XLIII.

XLTV

XLV.

XLVI.

XLV1J.

Section II. — The Pharynx and Fauces. PAGE

Diseases of the Nasopharynx. Surgical Anatomy. Acute Nasopharyngitis. Simple Chronic Xasopharyngitis. Atrophic Nasopharyngitis. Adenoids. Neoplasms. Foreign Bodies. 661

Diseases of the Oropharynx. Surgical Anatomy. Malformation and Deformities of the Oropharynx. Malformation and Deformities of the Uvula. Retropharyngeal Abscess. Ulcerations and Adhesions of the Uvula and Soft Palate . . 686

Diseases of the Oropharynx (Continued) . Simple Acute Inflammations. Acute Infective Inflammations. Traumatic Pharyngitis. Toxic Pharyngitis 695

Diseases of the Oropharynx (Continued) . Chronic Hyperplastic Pharyngitis. Chronic Atrophic Pharyngitis. Chronic Tonsillitis. Lingual Varix 714

Diseases of the Pharynx. Neoplasms. Neuroses of the

Pharynx. Unclassified Affections of the Pharvnx 737