by violence should not be con-founded with those occurring idiopathically. Chidden, a German writer and physician for the insane, quoted by Virchow, has shown that the auricles of ancient statues are very frequently ornamented by tumors resembling the vascular effusions seen among the insane. In the gallery at Munich the head of Hercules has such ears. These misshapen auricles are the typical marks of the ancient boxers or pugilists. Such fighters wrapped their hands in leather, and, thus armed, struck the ears of their antagonists ; consequently in the figures of Hercules, Pollux, and other classical fighters, a deformed auricle is a regular appearance. Other historical personages — the Trojan Hector for example — are represented as having othasmatomata. To conclude from these observations that the othaematomata are always the result of traumatic influences, that they are more frequent among the insane because they are very apt to injure themselves or be injured by their attendants, seems to me to be manifestly incorrect, judging both from Dr. Hun's observations and from the fact that these tumors are very uncommon. Even the English writers, living in the land pre-eminent for pugilists, scarcely mention them. Wilde* describes and gives an illustration of one case, however, which seems to have been a haeniatonia, but was not recognized as such by the author. It was idiopathic in origin. It occurred in a male, aged twenty-four, and was about the size of a small pear. It occupied the upper portion of the left auricle, between the helix and the concha. It was treated by incisions, and considerable deformity resulted. Toynbee f describes these cases under the head of cysts, and seems inclined to ascribe a traumatic origin to them, and he states that it is the opinion of Dr. Thurnam, physician to one of the County Insane Asylums of England, that they are * Aural Surgery, English edition, p. 164. f Diseases of the Ear, American edition, p. 53. <Callout type="important" title="Important">These tumors can be difficult to diagnose and may require specialized treatment.</Callout> 112 OTH2EMAT0MATA. less frequent than formerly, on account of the fact that violence is not so much employed in the management of the insane. Dr. Thurnam evacuated the contents of the tumors, and used setons, and thus claims to have prevented the deformity to some extent. Toynbee mentions but one case, that of a boxer, that he has himself seen ; but his description is not detailed enough to allow us to judge whether it was identical with those observed in the insane. Dr. Hun is so strongly of the opinion that the idiopathic othematoma are symptoms of insanity, that he would consider any person having such tumor upon the auricle, even if sane, as a person to be carefully observed, as to cerebral symptoms. This is an opinion of Dr. Hun's which the author gained in a recent conversation with him upon this subject. I have also recently had a very interesting and instructive interview with Dr. Brown-Sequard, now of this city, on the subject of the etiology of vascular tumors of the auricle. Dr. Sequard has found that sections of the restiform bodies, or largest column of the medulla oblongata, in animals (Guinea pigs), will produce a hemorrhage beneath the skin of the auricle in from 12 to 24 hours. This hemorrhage is soon followed by gangrene of the part. I had, through Dr. Sequard's courtesy, the opportunity of examining such ears, and of verifying the fact of the subsequent gangrene. The hemorrhage usually occurs in the fossa navicularis of the auricle. This hemorrhage usually takes place on the same side with that of the section. Dr. Sequard also stated that sections of the sciatic nerve, by reflex action upon the medulla, would produce the same result, and that he had produced in his own person flushing of the auricle by pinching the sciatic nerve. Dr. Sequard believes that disease of the base of the brain, which is, however, not always attended by insanity, is the cause of hematoma auris. In the human animal, gangrene is not apt to result from the hemorrhage ; probably because the thicker tissue of the human auricle has a greater resisting power. It will thus be seen that Dr. Sequard's views confirm those OTHJEMATOMATA. 113 of Dr. Hun, while they shed a new light upon the valuable clinical observations of the latter. Any inflammation of the integument, connective tissue, and cartilage of the auricle, leading to effusion of serum, blood, or the formation of pus, will be apt to cause a deformity of the part ; but such a case should be distinguished from an othematoma. Auricle Deformed by Inflammation, The sketch from a photograph, which is here given, shows the result of what was at first an inflammation of the cartilaginous portion of the auditory canal. A polypus formed from the prolonged use of poultices, the inflammation extended to the tissue of the auricle, and after a long period of suffering, during which small abscesses were formed, which were evacuated, after pursuing a sinuous course in the integument, the auricle attained the shape which is here shown. The hearing power is unimpaired when the very small meatus is kept open. From all that has been written of vascular tumors of the ear, and from my own experience, I think we may safely affirm — First. That there are two distinct varieties of othaematoma : Traumatic and Idiopathic. Second. That the idiopathic is much more common among the insane than among others, but that identically or nearly the same affection does occur among the sane. It is probable, however, from Brown-Sequard's experiments, that the affection is caused by some lesion of the base of the brain, so that although persons suffering from vascular tumor of the ear may not always be insane, they generally have brain-disease. Third. The traumatic form differs from the idiopathic in feeling a simple extravasation of blood from vessels ruptured by violence. In such cases the deformity resulting from the spontaneous effusions does not occur, unless among professional pugilists, where the violence is frequently repeated, and the auricle, from repeated hemorrhages, assumes a shape like that resulting from a true othematoma. MALIGNANT DISEASE. Epithelioma. — The auricle is sometimes, although not frequently, the seat of malignant disease. I have observed one case of epithelioma of this part, in which the whole auricle was destroyed, and the disease had invaded the auditory canal. I lost sight of the patient after some weeks, and I can give no account of the subsequent course of the disease, which was unchecked by the treatment adopted — the application of fuming nitric acid. Dr. J. Orne Green, of Boston,* also reports a case, and quotes one from Velpeau. Epithelioma of the auricle usually begins as a small papule, which finally develops into an open ulcer. This spreads very rapidly, involving finally the auditory canal and, unless arrested, the deeper parts. Excision or amputation of the parts is the only proper treatment. "When the auricle alone is involved, this is very * Transactions American Otological Society, third year. ECZEMA OF THE AURICLE. 115 easily accomplished. In the healing process care should be taken, as suggested by Dr. Green, to prevent the closure of the meatus by the cicatrix, a result which followed in the case reported by him, in consequence of the refusal of the patient to remain under observation until the wound was healed. Sarcoma. — Sarcomatous tumors may occur on the auricle as well as in the auditory canal, where they arise from the cartilaginous portion. They grow very slowly, but they may extend to the auditory canal, causing external otitis, to the middle ear, and even to the labyrinth and meninges of the brain. Early removal is the only safe means of treatment, and even then the growth may return. Vascular Neoplasia. — Angioma, a form of vascular tumor which, at first sight, according to Gruber, resembles an othse- matoma, may occur on the auricle. The treatment that has been attempted in angioma is, in general terms, cauterization with various substances, or inoculation with vaccine lymph, the application of tartar emetic ointment, or subcutaneous injection of dilute tincture of the sesquichloride of iron ; but the simplest and only effectual remedy is the amputation of the affected portion. ECZEMA OF THE AURICLE. Eczema of the auricle is not one of the most frequent affections of the ear, as shown by the statistics of eye and ear hospitals and writers on otology ; but a large number of cases never come under the attention of special observers, and are, consequently, not found in their statistics. Inasmuch as eczema of the auricle is usually attended by the same disease in the auditory canal, it will be more convenient to speak of them both at this time. Eczema of the ear seems to occur more frequently among females than males ; but it is found in both sexes. The symptoms are the same as those of eczema in other parts of the body, with some symptoms peculiar to the ear. The symptoms peculiar to the ear, are redness, swelling, and the formation of vesicles which become pustular, and which finally cover the whole region with unsightly crusts, from which a discharge occurs. The auricle becomes a misshapen mass, while the swelling and in-crustation of the integument lining the auditory passage and membrana tympani impair the hearing to a serious extent. Fulness and noise in the ears are then added to the patient's other symptoms, and the condition is unpleasant in the highest degree. The disease, when left to itself, is apt to have a very chronic course, and yet it is very amenable to proper treatment. The causes of eczema are not very clear. I have usually observed it in persons of weak constitutions, and not among the strong and vigorous. It rarely occurs upon the auricle alone ; but it is usually found in conjunction with the same disease on other parts of the body, most frequently in conjunction with eczema of the face and head, although it sometimes occurs on the auricle and in the meatus alone. According to Ausspitz* formerly an assistant to Hebra, the great dermatologist of Vienna, eczema of the ear differs from the same disease as it appears in other parts of the body, in occurring with a greater amount of swelling and secretion of a serous fluid than is usual, together with the more frequent appearance of fissures in the tissue. Treatment. — The treatment of eczema is simple, and I have usually found the results very good. The advice of Ausspitz, to do as little as possible in the acute form, is excellent. The auricle should be kept from the air. This may be accomplished by the use of oils, powders, or even by a plaster-of-Paris bandage. A good application is the formula of Ausspitz : E Flor. Zinci 3 ij Pulv. Alum ) Amyli Pulv. ) gg ^J M. Ft. pulv. This powder is dusted over the affected portion with a camel's-hair brush. If the auricle be excoriated and sensitive, astringent solutions of sulphate of zinc may be used. At the same time with this local treatment, as in all other diseases, the physician should carefully consider the general * ArcMv fur Ohrenheilkunde, Bd. I., p. 124. ECZEMA OF THE AURICLE. 117 state of the patient, since in this, a cause for the eczema may often be found, which being removed by appropriate management, will prevent a relapse of the affection. Eczema of the auricle and auditory canal is not often brought to the notice of the surgeon until it has become chronic. Its treatment then may require the greatest patience and care The treatment which I have found usually successful is the following : The auricle is carefully poulticed with flax-seed meal until all the crusts can be removed, and is then anointed with an ointment of the sulphate of iron and simple cerate, in the proportions of from one to two grains of the former to a drachm of the latter. This ointment is applied as often as may be necessary to keep the part constantly anointed, until the vesicles have ceased to form. The local treatment of the auditory canal is often unsuccessful from the want of the personal attention of the physician. No one who is unable to examine the external opening of the ear down to the membrana tympani, can tell when it is or is not clean. Without a thorough removal of the material thrown off in an eczema, there can be no cure. An eczematous auricle may perhaps recover spontaneously, an eczematous auditory canal will, probably, never thus return to a normal condition. The material thrown off from the inflamed integument collects in the narrow passage, and by mechanical irritation increases the swelling, and produces the most troublesome symptom of the disease — deafness. The auditory canal should be therefore carefully cleansed every day with the syringe and angular forceps or cotton-holder, under a good illumination with the otoscope, and then an appropriate liquid application be made. A liquid preparation is to be preferred to an unctuous one, for the simple reason that an ointment will again block up the passage, and thus prevent the patient from securing the full benefit to his hearing-power which the removal of the epidermis, crusts, and pus has produced. We may fail to cure many a case of disease of the integument lining this part, if we do not carry out our own advice ; we should never give over the treatment into the hands of the parents or attendants of the patient, for they will be incompetent assistants. 118 ECZEMA OF THE AURICLE. The warm douche is very valuable in the treatment of chronic eczema of the canal. It allays itching sensations, and is usually very grateful to the patient. The use of the douche may be entrusted to the patient himself. It is well to use it very often in the early periods of treatment, say once an hour. The warm water is a direct antiphlogistic ; I have seen its use alone, cure most obstinate cases of inflammation of the canal, that have existed for years. The only specific remedy for internal use in chronic eczema of the auricle, as well as that of the same disease in other parts of the body, is arsenic. In very chronic cases I usually give Fowler's solution in connection with the local treatment, and it is usually of great avail. I am aware of various other modes of treating eczema, and of the almost innumerable applications which are recommended ; but I feel confident that that which I have sketched will serve its purpose so well, when modified by individual judgment in practice, as to fulfill all reasonable requirements. Calcareous formations are often found in the auricle, in persons of a gouty habit, as in other parts of the body. These symptoms of gout often cause a great deal of local pain, which is sometimes relieved by an unctuous application to the hardened and tender parts. Dr. Garrod* of London, first called attention to these formations, which he found to be urate of soda. They were most frequently found by Garrod on the upper border of the helix, and were supposed not to exist on the lower part of the auricle ; but I found what seemed to be such a formation, in the concha of a gentleman who suffered from gout. Unlike those cases reported by Dr. Garrod, this spot was very painful. * Von Troltsch, Diseases of the Ear, p. 56. CHAP TER V. DIFFUSE AND CIRCUMSCRIBED INFLAMMATION OF THE EXTERNAL AUDITORY CANAL. The affections of the external auditory canal may be con- veniently arranged as follows : I. — Diffuse inflammation. II. — Circumscribed inflammation. III. — Vegetable fungous growths. IV. — Inspissated cerumen. V. — Eczema. VI. — Foreign bodies. VII.— Polypi. VIII. — Exostoses and hyperostoses. IX. — Syphilitic condylomata and ulcers. To avoid any misconception, I would remark that while bony growths (exostoses and hyperostoses) are classed under the affections of the external auditory canal, they are actually consequences of inflammations of the middle ear. It will therefore be more appropriate to consider this rather important subject under the head of diseases of the cavity of the tympanum. An account of their pathology and treatment will be found in the chapter devoted to the Consequences of Chronic Suppuration of the Middle Ear. The subject of Aural Polypi will also be deferred until a subsequent chapter, for they are also much more frequently the result of inflammation of the middle ear, than of disease of the external auditory canal.
Key Takeaways
- Hematomas can be either traumatic or idiopathic in origin.
- Idiopathic hematomas are more common among the insane, but can occur in sane individuals as well.
- Vascular tumors of the auricle may result from lesions at the base of the brain.
- Eczema of the auricle is often accompanied by eczema in other parts of the body and requires careful treatment.
Practical Tips
- Be cautious when treating hematomas, as they can be difficult to diagnose without specialized knowledge.
- For persistent or severe cases of eczema, seek professional medical advice for proper diagnosis and treatment.
- Regularly clean the ear canal to prevent blockages that could lead to hearing loss.
Warnings & Risks
- Do not attempt to treat vascular tumors with home remedies; they may require surgical intervention.
- Avoid using harsh chemicals or substances on the auricle, as this can worsen conditions like eczema.
- Be aware of the potential for chronicity in cases of eczema and be prepared for long-term management.
Modern Application
While the specific techniques described in this chapter are historical, the principles of identifying and treating ear diseases remain relevant. Modern medical practices have improved diagnostic tools and treatments, but understanding the signs and symptoms can help prevent complications and ensure timely care.
Frequently Asked Questions
Q: What is the difference between traumatic and idiopathic hematomas?
Traumatic hematomas are caused by physical injury, while idiopathic hematomas occur without a clear cause. The chapter notes that idiopathic hematomas can be more common among the insane but may also affect sane individuals.
Q: How does Dr. Sequard's research contribute to our understanding of vascular tumors in the auricle?
Dr. Sequard found that cutting certain parts of the brain, such as the restiform bodies or sciatic nerve, can cause hemorrhages and gangrene in the auricle. This suggests a link between brain lesions and vascular tumors.
Q: What are some signs of eczema affecting the auricle?
Eczema of the auricle causes redness, swelling, vesicles that become pustular, and crusts. It can impair hearing due to swelling and in-crusting of the ear canal.
Q: What is the recommended treatment for chronic eczema of the auricle?
The chapter recommends keeping the auricle from air exposure, using a poultice with flax-seed meal, and applying an ointment of iron sulfate and simple cerate. Regular cleaning of the ear canal is also advised.
Q: Can calcareous formations in the auricle be treated at home?
The chapter notes that calcareous formations can cause pain and may require treatment with unctuous applications, but it advises seeking professional medical advice for proper diagnosis and management.