Ear, Nose and Throat Diseases

There is a sense of tickling referred to the larynx; cold air irritates and, owing to the increased sensibility of the mucous membrane, the act of inspiration may be painful. There is a dry cough, and the voice is altered. At first it is simply husky, but soon phonation becomes painful and finally the voice may be completely lost. In adults the respirations are not increased in frequency, but in children dyspnea is not uncommon and may occur in spasmodic attacks and become urgent if there is much oedema with the inflammatory swelling.

The laryngoscope shows a swollen mucous membrane of the larynx, particularly the ary-epiglottidean folds. The vocal cords have lost their smooth and shining appearance and are reddened and swollen. Their mobility also is greatly impaired, owing to the infiltration of the adjoining mucous membrane and of the muscles. A slight mucoid exudation covers the parts. The constitutional symptoms are not severe. There is rarely much fever, andin many cases the patient is not seriously ill. Occasionally cases come on with greater intensity, the cough is very distressing, deglutition is painful, and there may be urgent dyspnea.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (10th ed, pp. 616). New York: D. Appleton & Company.

Created by: Taha Jilani, 06/23/2021

Entered by: Rachel Johnson, 11/05/2021

The patient, who has been comparatively comfortable, may suddenly experience deep-seated pain in the region of the mastoid process. Or, in the absence of actual pain, there may be a distressing sense of fulness, soreness, or discomfort referred to the mastoid. On the other hand, there are many cases in which the patient complains little either of mastoid pain or discomfort. In the presence of mastoid pain or discomfort, and in proportion to its severity, insomnia is usually present, and sudden inability to sleep at night is in some cases a useful guide to arrested resolution.

Elevation of temperature, usually of moderate degree, may be more or less continuously present during suppurative disease of the mastoid… though fever can be absent, or so slight as to be of no special diagnostic value, in a majority of cases.

The aural discharge may undergo certain quantitative changes which would lead an experienced aurist to suspect mastoid involvement. For example, a rather copious discharge may suddenly cease, this abrupt cessation being accompanied by no amelioration of the patient’s condition and being followed within a few days or hours by a renewed flow of pus. Or, again, a moderate discharge may suddenly or gradually increase in volume until it becomes necessary upon purely physical grounds to assume involvement of the mastoid cells in order to explain the amount excreted in the twenty-four hours. In still another group of cases, the long persistence of the discharge may of itself force the inference of a focus of disease beyond the limits of the small tympanic cavity.

Undoubtedly the most reliable sign of acute mastoid disease is sensitiveness to pressure over the mastoid cortex.

Kerrison, P. D. (1923). Diseases of the Ear (3rd ed.). Philadelphia: J.B. Lippincott Company.

Entered by: Bernardo Galvan, 6/28/2020

This disease, indicating loss of the sense of smell, may owe its origin to either central or peripheral lesions or to mere functional disturbance of the nerve-centres. When of central origin it may arise from the pressure of a tumor on the double nerve-centre, or Sara Ahmedupon the nerves themselves, as in Loder's case, in which the pressure arose from scirrhus of the pituitary body. Appert's case also arose from pressure upon the olfactory nerves by abscess of the pituitary. Bonet's case was caused by pus-formation within the olfactory bulbs. It may arise also from atrophy of the bulb or trunk of the nerve as a functional result of insanity and as the result of lesion caused by fracture of the bone of the base of the skull. By far the larger number of cases arise from peripheral com pression or lesion, or from causes that will prevent the contact of odoriferous particles with the olfactory area of the nose. The causative effect of lesion of the terminal nerve -filaments is well illustrated in cases of atrophic rhinitis and malignant disease. Here the nerve endings are destroyed, in the one case by atrophy, in the other by the substitution of neoplasm. In all cases of anosmia the sense of taste is likely to be impaired. Excessive tobacco-smoking will sometimes impair the sense of smell. The pressure of nasal polypi not infrequently will destroy the sense also. When the anosmia is the result of atrophic rhinitis, a thorough and systematic treatment of the latter is not infrequently followed in the end by restoration of the olfactory sense.

Price-Brown, J.(1900). Diseases of the Nose and Throat (pp. 104-105). United States: F.A. Davis.

Created by: Sara Ahmed, 07/27/2021

Entered by: Rachel Johnson, 11/05/2021

The term is applied to an increase or perverted action of the auditory nerve or centres. While deafness is much more frequently due to diseases of the ear than to morbid states of the nerve, the opposite true of hyperesthesia, which is commonly due to altered nerve function.

 (1) True hyperesthesia, increased keenness of hearing, “hyperacusis,” is a rare morbid state in which sounds are heard with undue loudness, and even such as are inaudible to other persons are distinctly perceived. It occurs . . . usually in association with augmented acuteness of other senses, and is probably, in such cases, of central origin. It has also been observed at the onset of acute cerebral and general diseases.

From true hyperaesthesia we must distinguish certain forms of hyperacusis due to disorder of the conducting mechanism. In paralysis of the stapedius muscle, from the disease of the facial nerve, low notes may be heard with undue loudness.

(2)  Auditory Dysaethesia, “Dysacusis.”— Sounds, although not heard with undue loudness, cause discomfort. This is common in cerebral affections, functional and organic, during attacks of headache, in many cases of meningitis, etc. The pain in the head seems to be intensified by the noise. There is no evidence that irritation of the auditory fibers ever produces pain directly.”

Gowers, W. R. (1888). A Manual of Diseases of the Nervous System. Philadelphia: P. Blakiston, Son and Co. Pg. 674-675.

Entered by: Sonia Y. Khan, 6/29/2020

The most common cystic tumor of the mouth is the so-called ranula (French grenouillette), which may arise from the sublingual glands or it’s ducts, from Wharton’s duct, or from a small group of glands—the glandula incisiva—in close proximity to the neck of the middle of lateral incisor. In rare instances, a ranula may take its origin from the remains of the thyroglossal duct or […] from the branchial clefts, or […] from Blaudin Nuhn’s glands on the under surface of the tongue […] Those from the thyroglossal duct have a lining of columnar ciliated epithelium, while those arising from the acini or excretory ducts of the salivary glands have a lining that more or less faithfully reproduces the epithelium of the parent structure. Suprahyoid and submental cysts are sometimes found associated with cysts of the sublingual region […] The ordinary ranula results from obstruction of the gland duct, and is […] chronic […] An acute ranula has also been described; it is due to an acute inflammation of the duct of the submaxillary or sublingual gland, or both. Cysts of the parotid gland are extremely rare […] The characteristic symptom of a ranula is the presence of a cystic tumor on the floor of the mouth, usually to just one side of the median line, pushing up the mucosa, which is tightly stretched over it, and displacing the various structures of the mouth. Fluctuation is easily obtained.

Osler, W. (1908). The Principles and Practice of Medicine. New York and London: D. Appleton and Company. Pg. 52.

Entered by: Sonia Khan, 3/31/2021

In addition to the characteristic vestibular phenomena described later there are frequent vomiting, high temperature, and severe headache. […] If the eyes are observed at this time, there will invariably be seen an active rotary nystagmus with the quick eye movements toward the sound ear. The eye movements are increased in rapidity and extent when the eyes are voluntarily turned in the direction of the quick nystagmic movement and are noticeably diminished when they are turned in the opposite direction. The nystagmus is noticeable, however, and the direction of the quick movement is unchanged, whatever the position of the eyes. […] The vertigo also is of the rotary type, i.e., the patient has the impression that surrounding objects are rotating about him […]. When he is able to do so, it is found that the plane in which objects seem to rotate always corresponds to the plane of the nystagmus. When, therefore, he stands or is supported with head erect, objects seem to rotate about him in a plane approaching the vertical, but when he lies upon his back, the plane of the nystagmus falls more into the horizontal plane, and his sensation is of the rotation of objects in the horizontal plane about him.[…] the patient frequently assumes a characteristic position in bed,—i.e., he lies with the sound ear buried in the pillow, so that, when tempted to look about the room, the movement of the eyes will be in the direction of the slow eye motion, which position tends to lessen not only the nystagmus but also the distressing subjective symptoms. […] If the patient stands or is supported in the upright position with head erect, he exhibits marked disturbance of equilibrium, and falls or tends to fall toward the diseased ear. Supposing, for example, that the lesion is an acute suppurative invasion of the right ear, the nystagmus will be to the left and the patient will fall to the right. If he turns his face toward the right shoulder, thus changing the plane of the nystagmus, he will fall backward. […] Usually the deafness is such as to force itself upon the physician’s attention. […] one of the earliest symptoms—apparently synchronous with the vestibular phenomena—was the profound deafness of the diseased ear. 

Kerrison, P. D. (1923). Diseases of the Ear (3rd ed.). Philadelphia: J.B. Lippincott Company.

Entered by: Bernardo Galvan, 6/28/2020

Edited by: Erin Choi, 7/15/20

Eruptions: The most frequent is the fever blister—herpes labialis, cold sore—usually found on the skin surface and red border. There may be but a single vesicle, more often there are several, which become confluent with the formation of reddish-brown crusts. According to Schamberg, herpes simplex is most common in childhood and early life; 55 percent of the cases occurring between the ages of ten and thirty years. Herpes is an accompaniment of croupous pneumonia, malaria, and cerebrospinal meningitis. It is comparatively rare […] in influenza, and exceedingly uncommon in typhoid. There is a belief among clinicians that the occurrence of herpes in pneumonia is a favorable omen; this is also true of herpes in malaria. Herpes is of infectious origin […].

Tumors: The principal tumors of the lips are angioma (hemangioma), lymphangioma, and carcinoma.

Osler, W. (1908). The Principles and Practice of Medicine. New York and London: D. Appleton and Company. Pg. 44-45.

Entered by: Sonia Khan, 03/16/21

The symptoms are those characteristic of sudden, intense irritation of the vestibular apparatus plus ablation of the cochlear function. The attack begins with severe subjective vertigo, great disturbance of static equilibrium, loud tinnitus, nausea, and vomiting, and pronounced deafness in one or both ears. The patient does not, as a rule, lose consciousness.

At the onset he is forced by the urgency of the symptoms to go to bed. Sudden movements of the head or the attempt to rise aggravate the subjective symptoms and may induce vomiting. Nystagmus without doubt is an invariable phenomenon of the onset.

Kerrison, P. D. (1923). Diseases of the Ear (3rd ed.). Philadelphia: J.B. Lippincott Company.

Entered by: Bernardo Galvan, 6/28/2020

These are tumors of the nose, presenting several marked characteristics. They have smooth surfaces, are lobulated, but usually are regular in form, each being attached by its own broad or narrow pedicle. The color is grayish blue, sometimes slightly pink. They are tense and elastic to the touch, and are of jelly-like consistency. They rarely appear simultaneously for the first time in both nasal fossæ, but attack one nostril first. Sometimes, through a long course of years, the other one is never invaded. In other instances the development of polypi on one side is quickly followed by their formation on the other [...] The external surface of the polypus is composed of an epithelial layer similar to that of the ordinary mucosa; it may be mixed in character, or either squamous or ciliated , according to circumstances and situation. Within this there is hypertrophy of the structural elements of themucous membrane and connective tissue, giving a fine reticular frame-work, the meshes of which are filled with semifluid mucin and leucocytes. Glandular tissue may be present, but there is usually a minimum of vascular elements [...]The site of attachment is usually the internal surface of the middle turbinated. It may be around the margin of the ostium maxillare or along the whole of the lower border of the bone. Sometimes they are attached to the inferior turbinated and occasionally to the septum; but these instances are rare.

Price-Brown, J.(1900). Diseases of the Nose and Throat (pp. 116-117). United States: F.A. Davis.

Created by: Sara Ahmed, 07/27/2021

Entered by: Rachel Johnson, 11/05/2021

The earache is usually sudden in its development. Following a few premonitory twinges, it soon assumes the character of a constant pain, rapidly reaching an unbearable degree of severity. Not infrequently the patient retires at night with no noticeable discomfort, to be awakened during the night or toward morning by the severity of the ear pain. Once established, the pain is usually constant, but is subject to exacerbations of intensity. With the beginning of pus formation, the pain becomes throbbing or “drawing” in character… Naturally, sleep becomes impossible; and when prompt relief is not forthcoming, the resulting insomnia adds to the nervous strain to which the patient is subjected.

The severity of the pain often distracts the patient’s attention from lesser symptoms. If questioned, however, he usually becomes conscious of subjective sounds, — i.e., tinnitus aurium, the sound is usually of rather high pitch. The hearing is also noticeably impaired… With adults, the temperature may throughout be normal or nearly so, or it may be moderately elevated. With infants and young children, on the other hand, even the mildest type of acute middle-ear inflammation is usually announced by rather high fever, —i.e., temperature ranging from 102° to 105°F. With the rupture of the drum membrane and the appearance of aural discharge, there is usually complete cessation of pain.

Kerrison, P. D. (1923). Diseases of the Ear (3rd ed.). Philadelphia: J.B. Lippincott Company.

Entered by: Bernardo Galvan, 6/28/2020