On Obstruction of the Pharyngeal Orifice of the Eustachian
Tube. By Jno. Neill, M. D., Surgeon to the Pennsylvania
Hospital.
The accompanying wood cuts represent a condition of the
pharyngeal orifice of the Eustachian tube, which I believe has
hitherto been overlooked. There will be seen in each of the speci-
mens figured, a growth which completely overhangs and occludes
the orifice of the tube, from its posterior and superior border.
Fig. 1, a. The growth seems to consist of a thickened fold of
mucous membrane, in which the mucous follicles are very distinct.
Fig. 2, b. The structure resemb'es more in appearance and in
size the tonsil, but when carefully exa mined, is found to be com-
posed of several folds of mucous membrane, thickly studded with
mucous glands.
Fig. 3, c. This mass also resembles the tonsil in structure,
presenting those wide-mouthed follicles which are characteristic
of the gland.
The subjects from which these specimens were obtained were
not known to be affected with these peculiarities previous to death,
nor were they selected for the purpose of illustrating this condi-
tion ; and, therefore, it is either a remarkable coincidence that
this pathological formation should be found in three instances
under such circumstances, or it is to be inferred that the condition
is a very common one.
I am inclined to think that this condition of the orifice of the
tube exists quite frequently, especially in children, and that it is
a common source of temporary deafness.
How many cases of deafness in children are considered to be
dependent upon enlarged tonsils, and yet how few are the in-
stances in which the tonsil is sufficiently enlarged to encroach
upon the orifice of the tube ? In fact, the distance between the
tonsil and the orifice is so great as to induce some to believe that
enlarged tonsils are never the cause of deafness; and yet we
certainly do find this enlargement coexistent with deafness, though
it may not be the cause of it. Mr. Wilde says, “I have never seen a
preparation showing the greatest possible degree of enlargement
of the tonsil, in which it pressed upon the trumpet-mouth of the
Eustachian tube. Anatomists will, therefore, find it as difficult
to believe that enlarged tonsils produce deafness, as practical
surgeons to believe that their removal can in any way relieve the
loss of hearing. Even in cases of cynanche tonsillaris, when so
large a collection of matter forms in the gland that suffocation
threatens, there is no deafness. When deafness co-exists with
enlarged tonsils, I believe that it is produced by the thickening
of the mucous membrane extending into the Eustachian tube or
into the tympanum.”
The structure which I have described is so closely allied to the
tonsil in its nature, that it is perfectly natural to suppose that
it would be enlarged under the same circumstances by which the
tonsil is enlarged; and thus we may have in it the real cause of
deafness so often attributed to the tonsil. Besides, from the
nature of the tissue, there is no difficulty in supposing that this
hypertrophy of the mucous membrane around the orifice may exist,
independently of any enlargement of the tonsil. That this
structure is a hypertrophy of the mucous membrane is evident
from its existing on both sides in each case, whereas, were it a
polypus or an epithelial formation, it is hardly probable that it
would occur on both sides at the same time.
It is somewhat remarkable that such a structure has not been
noticed in the frequent catheterizations of the tube. In two
of these specimens the orifice (o) was so concealed that a probe
could not be introduced from the pharynx even, without ele-
vating the overhanging mass, and it would have been next to
impossible to have introduced a catheter in the ordinary manner
to determine the permeability of the tube:
The usual mode also of determining the permeability of the
tube, by closing the nostril and mouth and making forcible ex-
piration must fail, when such a condition of the orifice exists,
although the upper part of the tube be entirely free from con-
striction. Forcible expiration, would, in fact, force this growth
more tightly into the orifice, as a cork into the mouth of a bottle.
The position of this morbid structure is such that it cannot be
reached by the knife, nor could caustic be applied very satisfac-
torily through the nose. The only manner of reaching the diffi-
culty would be by a properly curved caustic holder introduced
through the mouth.
Inspection of these specimens may justify the following reflec-
tions.
1.	That there is a pathological condition of the orifice of the
Eustachian tube hitherto not described.
2.	A form of deafness may depend on its existence, which has
been ascribed to enlarged tonsils.
3.	An explanation of a difficulty sometimes preventing cathe-
terization of the tube.
4.	The true mode of cure in such cases.