DISEAS E 
OF THE 
Naso = Pharynx 
As a Cause of Deafness. 
BY 
HERMAN BENDELL, M.D., 
Ophthalmic and Aural Surgeon to the Albany Hospital, 
ALBANY, N. Y. 
Reprinted from Albant Medical Annals. 
ALBANY, N. Y.: 
Burdick & Taylor, Printers, 481 Broadway. 
1885. DISEASE OF THE NASO-PHARYNX AS A 
CAUSE OF DEAFNESS.* 
BY HERMAN BENDELL, M.D., 
Albany, 
Ophthalmic and Aural Surgeon to the Albany Hospital. 
The frequent occurrence of deafness, in connection with dis- 
ease of the naso-pharyngeal cavity, forcibly suggests the impor- 
tance of careful examination and early treatment of the adjacent 
organs, associated by continuity of their lining membrane with 
the middle ear. The presence of inflammatory changes in the 
eustachian tubes and tympanic cavity, be the same of an acute 
or chronic character, of a suppurative or non-suppurative form, 
accompanied with or without impairment of hearing, has its 
origin, in a large percentage of cases, in some abnormal changes 
in the mucous membrane lining the nose and pharynx. It is 
remarkable that many of the symptoms indicating a diseased 
condition of the mucous membrane of the naso-pharyngeal cavity, 
especially such pronounced symptoms as snuffles, impeded nasal 
respiration and snoring, and those symptoms so frequently the 
accompaniment of infancy and childhood, should be generally 
overlooked, and as a rule pronounced to be of little or no con- 
sequence, until the anxious parent or patient, alarmed by the 
persistency of an offensive discharge from the ear, coupled with 
partial or total deafness, consults the specialist for an explanation 
* Read before the Medical Society of the County of Albany, Wednesday evening, Decem- 
ber 17, 1884. 2 
of the causes, and the chances of treatment for the restoration 
of the hearing power. 
The causes tending to a development of catarrhal disease of 
the mucous membrane lining the nose and pharynx are, in a large 
percentage of cases, the sequel® of diseases incident to infancy 
and childhood, and the responsibility of failing to provide early 
and timely treatment—that is, before the mischief caused by 
this disease is beyond repair—must be assumed by the practi- 
tioner, who oftentimes fails to recognize the importance of check- 
ing catarrhal inflammation of the naso-pharynx before the mid- 
dle ear is implicated and deafness has resulted. In looking over 
the history of the many cases of acute and chronic otitis media 
which have come under my observation, I am convinced that the 
primary and predisposing cause in exciting and maintaining cat- 
arrhal disease of the middle ear is, in seventy-five per cent, of cases, 
due to abnormal changes in the mucous membrane lining the 
nose and pharynx. The existence of acute or chronic catarrhal 
inflammation, the presence of adenoid vegetations, or any abnor- 
mal changes in the naso-pharynx, if not early arrested by proper 
treatment, will eventually set up, by spreading through the 
pharyngeal entrance of the eustachian tube, disease of the mid- 
dle ear. It is also by this channel of communication that the 
inflammatory changes in the naso-pharyngeal cavity, associated 
with exanthematous disease, especially in scarlet fever and mea- 
sles, are apt to invade the middle ear and establish disease of 
such a character that it will, if not prudently managed at the 
outset, result in incurable deafness. The frequency of chronic 
purulent inflammation of the middle ear, commonly known as 
otorrhoea, can generally be traced to the causes above mentioned. 
Acute and chronic catarrhal conditions of the naso-pharyngeal 
cavity are accepted as predisposing causes for the development 
of inflammatory changes in the middle ear. It will, therefore, 
not be out of place at this time to briefly refer to the process by 
which catarrhal disease of the naso-pharynx is communicated to 
the middle ear through the eustachian tubes. The eustachian 
tube acts as a ventilator for the cavity of the tympanum, and 
forms a channel for the escape of mucus from the middle ear; 
hence any change or obstruction interfering with the normal 
ventilation of the ear, be the same caused by closure due to 
abnormal growths, by inflammatory condition in the mucous 
lining, or by structural changes in the walls of the tubes, even- 3 
tually destroys the patency of the same and disturbs the free 
interchange of air between the outer atmosphere and the tym- 
panic cavity. The spreading of catarrhal disease from the naso- 
pharynx to the mucous lining of the eustachian tube necessarily, 
to a greater or lesser extent, interferes with the normal ventilat- 
ing function of the tube, and by the rarefaction of air in the 
middle ear the drum membrane and ossicula are forced inwards, 
and the structural changes resulting from this obstruction rapidly 
deprived of their vibrating power, develop irreparable deafness. 
In acute catarrhal disease of the naso-pharyngeal cavity, the 
inflammatory process, extending into the eustachian tubes, causes 
a slight swelling of the lining membrane, with increased secre- 
tion of mucus; and even if this inflammatory process spreads 
to the tympanic cavity, it readily yields to timely and proper 
treatment, but in the chronic and neglected forms of catarrhal 
disease, the structural changes in the eustachian tubes and mid- 
dle ear are of such a character that no encouragement should be 
given to the patient for the restoration of the hearing power. 
In many cases of chronic otitis media, especially those of a sup- 
purative form, and when the discharge is of an offensive nature, 
the assurance that treatment will arrest the discharge is of suffi- 
cient encouragement to the patient that he will gladly submit to 
treatment. Caution should govern all promises for the restora- 
tion of the hearing power in cases of chronic suppurative 
inflammation of the middle ear. The predisposing causes, by 
reason of easy access to the naso-pharynx and the discharge 
from the ear, will yield to treatment, but the changes which 
have taken place in the eustachian tubes and middle ear, and to 
which the total or partial deafness resulting is due, are permanent 
and irreparable. The intensity of acute and chronic catarrhal 
disease of the middle ear is largely governed by the condition 
predisposing to the same in the naso-pharynx, and the condition 
of the naso-pharynx is oftentimes dependent upon bronchial 
and pulmonary troubles; hence the importance of careful 
examination of the throat and chest, together with diligent 
search for the causes that produce disease of the tympanic 
cavity, which will greatly assist the treatment and prognosis. 
The experience of every practitioner will justify the assertion 
that a large number of people of all ages, sex and classes are 
victims of catarrhal disease of the naso-pharyngeal cavity, and 
it is safe to say that fully thirty per cent, of such people 4 
suffer more or less from impairment of hearing. The indiffer- 
ence and little encouragement with which this class of patients 
are advised by physicians frequently compels them to seek the 
service of charlatans, who loudly and with flattering testimonials 
advertise their skill in curing these chronic ailments. How 
many of these unfortunate patients are incapacitated, in conse- 
quence of partial or total deafness, to enjoy the comforts of 
life, and deprived, in consequence of an offensive discharge 
from the fauces and ear, to mingle in the pleasures of society, 
only those who are daily brought in contact with the large num- 
ber of patients seeking relief from this most annoying disability 
can best judge. It is a fact to be regretted that with singular 
indifference many physicians fail to recognize the impor- 
tance of conquering the early symptoms of catarrhal disease 
of the naso-pharyngeal cavity — and of thus placing the 
patient beyond the chances of contracting a disability likely to 
result in incurable deafness, notwithstanding the assurance that 
prompt treatment of these cases may prevent a partial or total 
loss of hearing—and cling to the erroneous belief that no harm 
can result from a progressive suppurative inflammation of the 
pharynx, nasal passages and middle ear. Every practitioner of 
medicine should be qualified to readily diagnose any abnormal 
changes occurring in the naso-pharynx and eustachian tubes; he 
should be especially watchful in cases of scarlet fever and mea- 
sles, and by daily examination of the naso-pharyngeal cavity 
and middle ear prescribe, when necessary, proper treatment. 
In the management of exanthematous diseases it is important 
to note the condition of the ears during the several stages of the 
disease, for it is safe to say that in all cases of acute and pro- 
gressive exanthema the eustachian tubes participate in the gen- 
eral febrile and inflammatory condition, and if timely treatment 
and attention be directed to these parts, the large percentage of 
incurable cases of deafness and chronic otorrhcea resulting from 
neglected treatment will be materially reduced. In scarlatina 
associated with diphtheria, and in small-pox, the occurrence of 
inflammatory changes in the eustachian tubes and middle ears 
are of such virulent nature that unless vigilant care is exercised 
by physician and nurse the conditions eastablished speedily 
result in permanent impairment of the hearing power. 
In searching for the causes that predispose to catarrhal disease 
of the naso-pharynx and middle ear, statistics clearly demon- 5 
strate that a large percentage of those cases are the result of 
diseases incident to infancy and childhood; and, in connection 
with this fact, it is well to add that the peculiar susceptibility of 
the lining of the naso-pharyngeal cavity in children, owing to a 
more active and plethoric condition of the blood vessels and a 
more liberal development of the glandular tissue, especially sur- 
rounding the orifice of the eustachian tube and covering the 
pharyngeal arch, predisposes to inflammatory disturbances; and 
it is owing to this undue activity of the vessels and strongly 
developed glandular tissue that children when suffering from 
coryza, influenza or an acute exanthema, are more susceptible to 
the development of catarrhal disease than persons of a more 
mature age. 
In considering the many local causes surrounding the habits 
of children that predispose to the development of naso-pharyn- 
geal ailments—in the home circle frequently subjected to the 
inhalation of the impure air of poorly ventilated rooms and 
crowded nurseries, during out-door sports exposed to the changes 
of temperature, during the period of school life brought in con- 
tact with the irritating effect of an atmosphere loaded with 
innumerable particles of chalk crayon and frequently impreg- 
nated with gases from defective drainage and heating—does it 
not stand to reason that the naso-pharynx, as a part of the respi- 
ratory tract, during childhood is more exposed to the influences 
predisposing to catarrhal inflammation than in adult life? 
In infancy and early life the intimate connection of the dura 
mater with the cavity of the tympanum, at the juncture of the 
petrous with the squamous portion of the temporal bone, de- 
mands that the symptoms and progress of catarrhal inflammation 
of the middle ear should be carefully watched; for, owing to 
the anatomical relations above mentioned, there is danger of the 
inflammation extending to the membrane of the brain and devel- 
oping intracranial disturbances. The danger of cerebral compli- 
cations in diseases of the middle ear in young children is equally 
as great in the acute and non-suppurative as in the chronic and 
purulent forms of otitis media. 
In children suffering from acute and chronic aural catarrh, a 
partial or complete closure of the nasal passages materially 
interferes with the respiratory act, and greatly disturbs the equi- 
librium between the internal and external interchange of atmos- 
pheric pressure, causing a rarefaction of air in the tympanic 6 
cavity and constituting a condition favorable for the development 
of deafness. Inability to breathe by the nose is a symptom fre- 
quently observed in children, with which every physician is 
familiar; it is a condition which greatly annoys the patient, and 
a common feature resulting from an influenza or cold. As a 
rule no importance is attached to this condition. Its presence is 
generally claimed to be dependent, and justly so, upon the 
severity of an attack of influenza or to a common cold, and if 
nature fails to remedy the trouble, the patient reaches the age 
of maturity with a chronic nasal catarrh and its detrimental 
consequences. Impeded nasal respiration is a symptom of 
abnormality of the naso-pharynx, the presence of which it is 
essential to consider in all forms of catarrhal disease of the 
middle ear. It may be accepted as an inflammatory and hyper- 
trophied condition of the mucous lining of the naso-pharyngeal 
cavity, of malformation of the turbinated bones, of nasal 
polypi, of the presence of adenoid growths in the post-nasal 
space, and as exercising, by interfering with normal respiration, 
an important factor for the development of catarrhal inflamma- 
tion of the middle ear and subsequent deafness. Usually this 
condition is ascribed by physicians to a force of habit, with the 
belief that the same will yield as the child grows older without 
the aid of therapeutic or operative treatment, and unfortunately 
this erroneous belief is the cause of the general chronic charac- 
ter of this trouble, with its nasal, pharyngeal and aural compli- 
cations, which specialists are so frequently called upon to remedy 
in connection with partial or total deafness. It is the duty of 
the physician to urge the importance of prompt treatment in 
the incipient stages of nasal obstruction and to remedy by thera- 
peutic or operative procedure the presence of any pathological 
changes of the nasal air passages. Prompt treatment for the 
relief of nasal obstruction will prevent inflammatory disturbances 
in the pharynx and middle ear, and abort the danger of disabling 
the patient, not only by a loss of the acuteness of hearing, but 
also by destroying the sense of smell and materially reducing 
the resonant clearness of the voice. The annoying and often- 
times serious consequences likely to result from this impediment 
demand prompt and energetic treatment tending to a radical 
cure of the same. 
Acute catarrhal inflammation of the mucous membrane lining 
the pharynx frequently, by reflex irritation, produces a vascular 7 
condition of the drum membrane and impairs the acuteness of 
hearing without the presence of any trophic changes in the 
eustachian tubes and middle ear. This form of catarrhal disease 
has a tendency to recurrence, and in many people there exists a 
predisposition for development of acute pharyngitis upon the 
slightest exposure to the changes of temperature. In many 
cases the repeated occurrence of this trouble eventually develops 
a hypertrophied condition of the mucous membrane and glan- 
dular tissue of the vault of the pharynx, and this chronic condi- 
tion, extending to the eustachian tubes, seriously interferes with 
normal hearing. Recurring attacks of pharyngitis are decidedly 
operative in causing abnormal changes in the eustachian tubes 
and middle ear, and the importance of energetic treatment tend- 
ing to relieve this fluctuating pharyngeal inflammation must not 
be overlooked. The presence of growths or vegetation in the 
pharyngeal cavity undoubtedly induces — especially when the 
same are located close to the orifice of the eustachian tube, either 
by obstructing the mouth of the tube or producing inflammatory 
changes in the mucous lining—a diminution of the normal acute- 
ness of hearing, and it is the disability resulting from deafness, 
and not from these excrescences that prompts the patient to 
apply for treatment. Failure to remove these growths by sur- 
gical or chemical means renders all treatment for the restoration 
of the hearing power ineffectual. 
It is claimed that the existence of adenoid growths in the 
post-nasal or pharyngeal space, and their association with a con- 
dition in the eustachian tubes and middle ear interfering with 
the hearing power, are not of as frequent occurrence as demon- 
strated by the researches of many eminent specialists, who have 
endeavored to convince the profession that the frequency of such 
symptoms as impeded nasal respiration, snuffles, and especially 
snoring, indicate the existence of these growths, and that the 
diminution of the hearing power, when associated with such 
impediments, can invariably be traced to the presence of abnor- 
mal growths in the naso-pharynx. 
On a former occasion I presented to this society the history oi 
several cases of deafness resulting from adenoma at the vault of 
the pharynx, and the happy results attained in restoring the 
normal acuteness of hearing by operative treatment for the 
removal of these growths. Since then experience has thoroughly 
convinced me that deafness resulting from post-nasal and phar- 8 
yngeal growths, especially among children, is not of rare occur- 
rence ; and, judging from the cases that have come under my 
observation, both in private and dispensary practice, I am satis- 
fied of the correctness of the theory that the predisposing cause 
of deafness, in all cases where the presence of these vegetations 
are diagnosed, can safely be traced to the changes produced in 
the pharynx, eustachian tubes and middle ear by the existence 
of adenomatous tumors. 
Aural diseases from causes that can be traced to abnormalities 
in the naso-pharynx, with the exception of those cases that are 
chronic in character, and where the loss of hearing is due to 
structural changes in the eustachian tubes and middle ear, prom- 
ise encouraging results when proper attention and treatment are 
devoted to the patient before serious complications are devel- 
oped. 
The frequency of aural diseases during the period of infancy 
and childhood, and the general lack of importance attached to 
prudent management of a condition likely to result in irrepara- 
ble structural changes, clearly points to the fact that many of 
the causes developing partial or total deafness are due to ear 
troubles contracted during early life. It is no longer a theory, 
but an established fact, that aural complications are the frequent 
accompaniment of ailments incident to infancy and childhood, 
and the profession can scarcely fail to appreciate the efforts of 
the specialist in directing attention to the fact that the large 
percentage of cases of incurable deafness will be materially 
reduced by a proper knowledge of the pathology and therapeu- 
tics of aural diseases.