The purpose of this paper is to emphasize the importance of the thin sheet of mucus which covers the mucous membrane of the respiratory tract. I shall confine my consideration to normal mucous membrane and the slight variation which may occur at the start of an acute cold. For several years I have thought that the value of constantly maintaining a mucus covering on the epithelium of the upper respiratory tract, especially that of the nose, has been dismissed too lightly. Suppose the glands which secrete this material should be out of operation for an hour; there would be sufficient departure from the normal condition to allow any prevailing invader, be it a recognized germ or a so-called filtrable virus, to pass the first line of defense. This same thought was expressed in a paper which I read before the Indiana Academy of Ophthalmology and Otolaryngology in 1934.1 It has been known for many years that nasal respiratory mucous membrane must have cilia actively moving a thin sheet of mucus along in order to be normally healthy and that one without the other is more or less helpless. For instance, in cases of atrophic rhinitis, in which the cilia are absent, the mucus remains stagnant and soon becomes infected. Conversely, when cilia are removed from their moist surroundings they soon cease to function.2The cilia are found abundantly in the nose and nasopharynx but not in the vestibule or oropharynx. Their wavelike action results in mucus being swept backward, toward the nasopharynx. This movement is not in the form of an unbroken wave but appears periodically in isolated groups of cells. The action of the cilia is such that the pos-Read before the
There are several reasons why vestibular tests have less clinical interest than auditory tests. First, the auditory tests are more pertinent and definitely more localized in the field in which the otologist works. Second, a vestibular test, when completely executed, takes considerable time. Third, the individual variation among patients makes standardization difficult. The highly nervous person, for instance, has a quicker reflex response than the slower, more lethargic person. Finally, at times contradictory findings are disheartening. Still these tests provide a source of much information which will be of value when otologists learn to interpret the findings.Aside from the localization of various lesions in the end organ, the information obtained with these tests could be of great value to neurologists and neurosurgeons ; it seems unlikely, however, that the data obtained by an otologist will ever contribute as much aid as that provided by the ophthalmologist, since the optic nerve runs a more unique intracranial course. The intimate relation with other vital structures, the greater susceptibility to the intracranial pressure and the desiccation of the chiasma all offer opportunities for study which the eighth nerve does not.There have appeared in the literature many clinical reports which would lead one to believe that nearly any kind of intracranial condition can be diagnosed by a vestibular test alone. This is a little misleading, for it is difficult with our present capabilities to make a diagnosis of such a condition without using neurologic signs and symptoms. By the time a diagnosis can be made with neurologic methods, it is too late to be of much value, except to verify a previous diagnosis.However, there are a few instances in which vestibular tests serve a useful purpose, particularly early in the course of a disease, before neurologic signs are well developed. In cases in which nystagmus, vertigo, instability, headache and deafness, either singly or combined, are present, differentiation by means of these tests between a peripheral and a central lesion is of great value. The table offers an outline of differential characteristics which is reliable in all except a few cases.
Our postwar planning should include some thought for improving our detection of the loss of hearing. The cabinet to be described has been in my office for some time and has some useful points which seem worthy of description.The cabinet should not be called soundproof because that term must be reserved for rooms built solidly of hollow blocks with a soundproof door, well insulated, and with no noisy pipes running through the walls. However, for the average private office sufficient sound is screened out by this type of cabinet so that the lesser hearing losses may be detected. The hearing tests usually conducted in the average office will not be sufficiently accurate to detect losses below 20 to 30 decibels, particularly when a masker is used since that usually lowers the curve about 10 decibels. The use of this cabinet alone with a rubber padded receiver on each ear and no masker allows the detection of heating at the zero line when it is present.The receivers are connected by a head band and fit tightly over the ears. The phone over the ear not being tested may be used as a masker when the tone being tested becomes so loud that it is heard by the operator through the room or a shadow curve of the other ear may be suspected.As a rule the responses which result from testing children under eight years of age (depending upon their alertness) are not so reliable when done with the average equipment. However, with a light placed in front of the patient, connected with another over the audiometer and both operated simultaneously by a push button on a cord, more accurate responses are obtained. These lights work off the city current and are independent of the audiometer with all the wiring and fixtures connected with the lower half of the back of the cabinet. The patient is asked to keep the light in front of him lit as long as he hears the tone being tested. Thus a great deal of unintentional flickering of the light is avoided and more reliable responses result, particularly in children as young as six years of age.
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