Recovery.—­The outcome is usually good in this disease if proper care is taken; Generally in a few weeks the inflammation is gone and the hearing is restored.

[362 Mothers’ remedies]

Serous mucous exudation into the middle ear.—­The disease just described is often associated with an (exudation) watery oozing of fluid into the middle ear, but the following condition is different.  Sometimes a comparatively normal middle ear is found to contain a variable amount of either fluid or mucus, or a fluid which represents a combination of both.  The failure of the fluid to absorb is due first to the fact that the drainage through the eustachian tube is still obstructed; second, that the absorbing process in the cavity is not acting normally.

Symptom.—­Sudden change from somewhat poor to good hearing and the reverse.  It is due to the changing in the position of the fluid.  The hearing may be normal when the head is thrown far backward, for the fluid then escapes into the antrum, or when the chin is resting upon the chest.

Another symptom that is peculiar is a feeling of something moving in the ear.  This is only felt when the head is moved suddenly.  Sometimes the patient says:  “I went in bathing and got some water into my ear, and I am unable to get it out.”  He thinks the water went into the ear by the way of the external ear canal.  It was due to the chilling of the surface of the body, or the water accidentally entered into the ear through the mouth, or nose, throat, and eustachian tube, and this caused an exudation of fluid to take place in the middle ear.  Hearing gurgling sounds in the ear during coughing, sneezing and swallowing is an important symptom.  The drum on being examined varies greatly.  The simplest case is seen when fluid contained in the cavity is small in quantity and consists of a thin serum.  The upper level of this fluid can then be seen like a hair crossing the drum in a more or less horizontal direction.  It retains its horizontal position when the patient moves his head backward and forward.

Treatment.—­The fluid can be evacuated by an opening made into the drum, but it usually accumulates again.  The proper treatment is to treat the diseased condition of the nose and throat, as described in other parts of this book.

Chronic catarrhal inflammation of the middle ear.—­The expression, acute inflammation of the middle ear, is rightly employed when it is applied to a case in which the underlying cause is of a temporary nature, as for example, a cold in the head, and mild attack of influenza, perhaps also in an attack of hay fever.  But when the causes are of a more permanent character and the middle ear continues for an indefinite period to be the seat of all sorts of disturbances the combination of these different diseased phenomena receives the name of chronic catarrhal inflammation of the middle ear.