Politzer's text-book of the diseases of the ear and adjacent organs : for students and practitioners / translated by Oscar Dodd ; edited by Sir William Dalby.

  • Politzer, Adam, 1835-1920.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Politzer's text-book of the diseases of the ear and adjacent organs : for students and practitioners / translated by Oscar Dodd ; edited by Sir William Dalby. Source: Wellcome Collection.

    406/760 (page 390)
    4. The Desquamative Processes and the Formation of Cholesteatoma in the Ear during Chronic Middle-ear Suppuration. In chronic middle-ear suppuration there occurs an excessive desquamation of epithelial cells in the external meatus and on the mucous membrane of the tympanic cavity during the secretive stage. In the secretion there is almost always, besides the pus cells, separate cells or collections of epithelium in varying degrees. If the production of epithelium is not excessive and there is no hindrance to the discharge of the pus mixed with epithelium, the process may continue for years without the formation of an epithelial mass in the middle ear. On the other hand, if there is excessive desquamation of the proliferating epithelium, so that during the suppurative process it pushes from the external meatus through the perforation into the tympanic cavity, the epithelial mass forms into larger whitish or yellowish balls which collect in the cavum tymp. and in the external meatus. Besides the excessive epithelial des- quamation the collection of epidermis flakes is favoured by the hindered flow of secretion. To the hindrances belong the following: the narrowing of the meatus, multiple formation of polypi, adhesions between the membrana tympani and the inner wall of the tympanic cavity, and the formation of sacculated spaces in the tympanic cavity. Crumbling epithelial lumps are seen in the secretion with small perforations in the posterior superior quadrant of the membrana tympani, and in Shrapnell's membrane. The formation of such retention masses may go on for years with- out special symptoms. Occasionally there occurs a spontaneous casting-off of a large mass accompanied by severe pain. Very often there occurs after a long stagnation in the deeper portion a breaking down of the retention product, owing to the action of bacteria into dirty, ill-smelling detritus containing a large number of cocci, which often enough produces an ulcerative disease of the bone with a fatal result. These broken-down masses are often met with in the dis- section of cases where death occurred from brain affection or sinus phlebitis due to caries and necrosis of the temporal bone. Besides these formless masses which do not hang together and which extrude from the external meatus and the middle ear, there occurs, as well during the suppuration as after it ceases, the formation of limited masses, often covered with a pearly, glittering coat, con- sisting of a homogeneous mass or of concentric lamellae which are similar in their appearance and structure to the cholesteatomata found in other organs. For these tumours as well as for those structureless lumps of epidermis, the term cholesteatoma of the ear is used.