Causes.—­Soaps, alkalies, foreign bodies in the ear, removing ear wax and a chronic discharge from the middle ear.  There is a tendency to it in some families; stomach trouble, improper food are also causes.

Symptoms.—­Itching,—­and this is very pronounced,—­burning feeling.  The part is somewhat reddened, fluid oozes out, crusts form, the skin thickens, and scales.  Sometimes it swells very much.

Treatment.—­Regulate the bowels, give a simple easily digested and proper food for children and adults.  Cleanse the inflamed skin gently with castile soap and tepid water once a day.  Cloths dipped in some cooling lotion, such as the lead and opium wash, or in plain water to which has been added a little alcohol or eau de cologne, should be wrapped around the inflamed ear during the acute stage and they should be kept wet.  Clean vaselin, etc., is good to put on the scabs.  The ear should be covered as before directed to keep dirt, dust, etc., out.

[360 Mothers’ remedies]

Hardened wax or impacted cerumen.—­This mass may be mixed with foreign bodies or be made up of “wax” alone.

Symptoms.—­A large mass of wax may remain in the ear for many years without causing any special loss of hearing so long as the plug does not rest against the drum and there remains a passage between the mass so that the sound-waves can strike the drum.  Generally the hearing gradually grows less.  Loss of hearing may take place suddenly, as after washing the head, or after a general bath, or after an attempt to clean the ear with the end of a towel.  Patients will often say the dullness of hearing appeared suddenly.  This no doubt was due to the fact that the mass of wax was displaced against the drum suddenly by an unusual movement of the head or the jaws, or the mass became swollen through fluids getting into the canal.  If the canal is filled there will be more or less deafness, ringing in the ear, and there may be piercing pain produced by the hardened mass, especially if the jaws are moved from side to side.  If the mass is thoroughly and carefully removed, the hearing may entirely return if it was caused by this wax.

Treatment.—­The mass is best removed by syringing the hardened plug and softening it gradually.  Removing it with a currette and forceps without softening it may do injury to the parts.  The syringe and hot sterilized, boiled water should be used for some time, and the patient asked occasionally if there is any faintness or dizziness caused by it.  It often comes, in a lump after the water has been used for some time.  A strong solution of bicarbonate of sodium is also good to use.

Foreign bodies in the ear.—­These are not of frequent occurrence.  In the case of children these bodies may comprise such objects as pebbles, beads, beans, pieces of rolled paper, fly, bed-bug; insect of any kind may get into ear of adults.  If they reach the drum a very unpleasant sensation is produced by the attempt to escape.  Sometimes a layer of wax may gather around the dead object.  These bodies should be removed, for their presence may produce a swelling or soreness in the canal.  If the object is a dried pea or bean the syringe should not be used.  The object must be carefully removed.  Sometimes an operation is necessary to remove the object.