Archive for December, 2005

Examination of the Face

Examine the face before a close-up mirror using a secondary mirror as required.
1. Examine the texture of the facial skin. Note any recent growth, bleeding points, long unhealed sores, or any painful swollen areas on the entire face. These abnormalities indicate skin growth possibilities, cancerous or benign.
2. Observe any involuntary movement of the face, eyes or mouth, note any difference in motion between sides of the

Fig. 19. The face is our most important human feature, and is the reason for existence of the rest of the body. It has its own diseases and difficulties found in no other region of the body.

face during facial movements; raise the eyebrows, squint the eyes, bare the teeth widely as in smiling, pucker the lips in a whistling motion. Such findings may indicate tics or facial paralysis.
3. By placing two mirrors at right angles, mirror the face so that the left side of the face is a mirror of the right. Difference between the right side of the face and left side, immediately seen show any facial deformity or asymmetry.

Sinus Trouble. The sinuses are hollow, air filled spaces in the bones of the eyebrows, cheekbones and face and are similar to small rooms opening directly into the nose chamber. They are easily infected, do not drain easily, and are prone to carry infectious material for long periods. A large proportion of people living in humid climates have difficulty with their sinuses, but definitely more than average sinus trouble follows: 1. Nasal Deformity. 2. Allergy. 3. Low Body Resistance.

Nasal Deformity. A broken nose sometimes blocks the sinus communication within the nose, presenting an obstacle to free drainage of the sinus, which is a necessity for a disease free sinus.

Allergy. Swollen, boggy, and inflamed mucous membranes in the nose tend to block the sinus openings, irritate the sinus linings and stimulate them to produce infectious material which cannot drain out easily.

Low Body Resistance. Improper diet and nutrition can produce very low resistance to infection. This applies particularly to areas prone to infection like the sinus areas.

Because chronic sinus infection is often a focci of infection for many other ailments, it is well to consult a physician so that he may prescribe proper treatment for this difficulty. Heat application is a popular and safe home remedy, but all other forms of treatment should be under the direction and guidance of a physician, who alone has the knowledge, ability and experience to treat the sinus sufferer.

Skin cancer and Other Growths. Skin cancers often begin on the skin of the nose, especially where the nostril flares into the cheek. Other skin growths, for instance, warts and blood-filled tumors, oftentimes are found in the skin of weather-beaten faces such as farmers and outdoors men. (See Skin Diseases).

External Nasal Deformity. Irregularities of the nose are very common. It is rare to find both sides of any nose exactly alike and the inside of the nostril varies slightly in size and shape, although such variances have no importance at all. The septum of the nose, which should be nearly in the mid-line, is often somewhat off to one side, possibly as a natural occurrence or as a result of trauma. This is of no significance unless it results in breathing difficulty. Deformities in the profile of the nose claim most people’s attention because of cosmetic appearance. It can be reshaped considerably with plastic surgery, however, patients are rarely satisfied after nose surgery.

Allergy (Rhinitis). Allergic rhinitis, or hay fever, produces a wet, dripping nose through which it is usually very difficult to breathe. Considerable irritation and redness of the nose may be present along with swelling and soreness and tears often flow from the eyes because they cannot drain into the nose as they normally should.

In seasonal rhinitis, air-borne pollen from trees, grasses, and weeds are most frequently the offenders. However, in the type which is present the year round, allergic factors such as animal danders, house dust, feathers or mattress stuffing are more than likely the cause. People with allergies should avoid these offending substances as determined by an exact investigation, and testing by the allergist, the doctor who specializes in the investigation and treatment of allergic diseases.

Fig. 18. Sinuses are room-like cavities within the skull, communicating with the nose. They lighten the skull and “hollow out” the voice. The biggest sinuses form the eyebrows and cheekbones. Frequently infected, they often cause bad breath and continual throat dripping.

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Examination of the Nose

The nose should be examined by close-up mirror observation with a good light in various positions of the head.

1. Observe the skin of the nose for any unhealing sore, warty growth, soreness, redness, recent enlargement or bleeding areas. These findings may indicate skin cancer or other growths.
2. Observe the profile and centering of the nose on the face. Both nostrils should be equal with the nasal septum in the center. Major differences indicate the very common external nasal deformity.
3. Determine the patency of each nostril by rapid inhaling and exhaling. An obstructed nostril may mean an internal
nasal deformity, allergic rhinitis or sinus disease.

Fig. 17. The nose encloses large volumes of air passageways above the mouth and deep behind the visible nose. Disease in these chambers is very common and is termed “upper respiratory disease.”

4. Tap along the bony ridge of the eyebrow, cheekbone and bridge of the nose with the knuckles. Tenderness in these regions and continuous discharge from either nostril usually denote sinus trouble.

Nerve Deafness. A person is not really deaf until the hearing nerve loses its function. This is particularly important in the over fifty age group since there is distinct loss of hearing (especially for higher tones) with each decade of life. Thus, like the eye, the ear has a gradual decline in hearing power with age. A simple test of nerve deafness is to hold a buzzing object,

Fig. 16. Inside-ear machinery gives us our sense of balance. Like a glass of water, it contains fluid which remains stationary when we turn or tilt. The position of the fluid allows recognition of body position even in darkness. When faulty, this mechanism may be a source of annoying dizziness and a spinning sensation.

such as a tuning fork, or kitchen knife tightly against the skull or between the teeth. When the fork or knife is plucked and caused to vibrate, hearing the buzzing means that the nerve is intact. If it is not heard, improving the hearing may be very difficult or impossible since this indicates that the nerve itself is not working. A hearing aid may possibly be of help for partial nerve deafness, but not for total nerve deafness.

Inner Ear Infection; Labyrinthitis; Dizziness. The innermost ear, a fluid filled compartment within the bone, containing the balancing mechanism may become irritated or infected to produce a labyrinthitis. Because the enclosed fluid within this area acts much like water in a glass, motion of the head creates motion of the fluid. In diseased or irritated labyrinths, such motion is exaggerated in its impulse to the brain, so that we feel a spinning unsteady or moving sensation to our surroundings. When labyrinthitis becomes severe, balancing becomes of such great effort, that it is not possible to stand erect, or even get out of bed. Effective treatment of this difficulty can be prescribed only by the physician, who alone can identify this uncomfortable inner ear disease.

Infection of the Inner Ear. Infections of the hearing part of the ear are called “otitis media,” and are usually seen in childhood, but rarely may begin after fifty. Accompanied by intense pain in the ear and high temperature, these ear infections are apt to be followed by a perforation of the eardrum with a running ear commonly following. With infections in the inner ear, as in other parts of the body, it is important that general health be maintained at a high level, to combat this lingering type infection. The aid of the experienced physician is necessary for the successful treatment of infection in the inner ear.

Otosclerosis (Buzzing in the Ear). Otosclerosis is a chronic disease of the ear’s hearing mechanism which reduces fine hearing and produces a buzzing, ringing sound in the ear. When the three small bones that transmit sound within the ear become diseased, they acquire a stickiness and pass a continual message. The result is the constant buzzing, ringing or roaring noise which seems loudest when it is most quiet, as in bed at night. This does not interfere completely with hearing and is least noticed in noisy public places. Otosclerosis is very common in the upper age bracket and is most difficult to cure, but a good ear doctor can be of considerable help in this disease.

Deafness Due to Ear Canal Blockade. Occlusion of the external ear canal often is the sole cause of reduced hearing and removal of the block produces sudden and definite improvement. Wax is sometimes the offender, but occlusion may be due to a boil-like infection in the canal or a formation caused by accumulated dust particles. Irrigation of the ear with warm water is sometimes sufficient to clean out the ear canal and improve the hearing.

Deafness Due to Eardrum Difficulties. Perforation or destruction of the eardrum may result in decreased hearing, but not a complete loss of hearing. Perforations of the drum are common, usually a result of old middle ear infections. The eardrum with a

Fig. 15. Like the skin of a drum, the human eardrum vibrates when struck by sound waves. Damaged eardrums still may function satisfactorily.

small hole in it will continue to function fairly well until the eardrum is almost all gone, and then clear distinct hearing is lost. Loss of the entire eardrum however, does not cause total deafness, since sound can still be conducted through the bones of the ear and the skull.

Difficulties of the ear

The most widely known purpose of the ear is hearing, but it also has the important function of balance and equilibrium. Difficulties of the ear involve hearing, the balance mechanism and the external ear.

Deformity of External Ear. The shape of the ear is quite variable and of slight importance in actual hearing ability. Huge or oddly formed ears can be a source of embarrassment, but rarely interfere with work or real hearing. An example is cauliflower ear deformity, which faintly resembles the surface of cauliflower. It is caused by bleeding and clot formation under the skin with resulting permanent deformity. Loss of hearing is slight and plastic surgery can achieve very good cosmetic results which are seldom appreciated.

Infection. Most infections of the external ear are fungus infections or eczema. (See skin diseases). They are prevented largely through cleanliness and by avoiding the use of frequently used medicine and healing agents. Routine gentle cleaning of the ears, inside and out, is recommended as prevention against skin infections, but an ear or skin disease which does not respond in two or three weeks to simple cleansing, might be serious and should be seen by a physician.

Skin cancer. Skin cancers about the ear have long been noted for their confusing appearance. The ear may be the seat of many chronic infections, but skin cancer about the earshell is also quite common. The ear’s exposed position openly invites irritation from sunlight, chemicals, windburn and many other agents. Any external ear sore over two weeks old, might be a cancer and should be seen by the physician. (See Skin Diseases).

Examination of the Ear

With a mirror and good light, examine closely the ear skin and shell; look for any obvious blocking of the ear canal and test the ear’s hearing ability in the suggested manner.

1. Examine the external ear for any soreness, bleeding or discharge from the ear canal. These findings can mean infection, skin cancer or infection from the inner ear.
2. Gently pull the ear upward and backward, and use a double mirror to sight into the ear canal. Blockage prob
ably means impacted wax, or if it is painful, an infection in the ear canal.
3. Tap the hard mastoid bone, directly behind the ear with the fingertips and note any soreness or tenderness which
may indicate infection in the middle ear.
4. Achieve complete silence by holding a pillow to both ears, and note any ringing or buzzing noise, which usually means otosclerosis.

Fig. 14. The design of the outside ear traps sound waves for delivery against the eardrum. There are many different shapes and sizes, all apparently effective. The covering skin is subject to several skin diseases, including skin cancer.

5. Note any dizziness after rapidly turning the head from side to side twenty times, and then facing directly forward. Dizziness or unsteadiness may indicate labyrinthitis, an irritation of the balance mechanism in the far inner ear.
6. Test hearing ability by holding a ticking watch six inches away from the ear and check against the other. Inability to hear watch ticking can mean drum or nerve deafness.
7. Wrap the handle of an ordinary table knife in a cloth and grasp firmly between the teeth. Pluck the blade to start it vibrating and note the ability to hear the “vibration.” When vibration cannot be heard, nerve deafness may be
present.

Senile Ectropion. In later years, when skin has lost some of its elasticity and firmness, the facial skin may sag. The lower eyelids are often affected, and may sag so that they no longer touch the eyeball, and the inner surface of the eyelid visible to others. This difficulty, called ectropion, does not reflect any systemic disease, other than aging of the skin and its loss of tone.

Fig. 12. In the years past middle age, sagging, drooping eyelids, called senile ectropion, are due to a loss of skin tone of later life and occur mostly in thin-skinned persons of the outdoor type, such as farmers. This difficulty can be cured by plastic surgery.

Ectropion frequently brings about irritation of the eyeball and promotes constant, annoying tearing and so treatment is often recommended in the form of a minor surgical operation. This consists of removing a portion of the sagging lower eyelid, and stretching out the remainder to a normal appearance. Such a procedure must be undertaken by a surgeon skilled in plastic surgery, and the results of this treatment are highly gratifying.

Pterygium. A Pterygium is an accummulation of scar tissue over the eyeball resulting from exposure to dust, wind, sun and general outdoor life. This scar tissue is nature’s attempt to heal areas of constant irritation, to which the eye is frequently subjected in outdoor life, and is usually seen on the eyeball as a pie-shaped wedge of milky tissue extending outward from the nasal border of the eye. It may grow to cover the pupil and cause partial blindness.

Fig. 13. Growth of eyelid-type tissue over the eyeball, usually from the nasal side, is called pterygium. Affected by long years of outdoor life, wind, and dust, the growth may grow completely over the pupil to blur vision or even cause blindness. It is very slow growing, never cancerous, and easily cured with surgery.

The treatment of a pterygium is its removal by surgical means. While not a fatal disease, its progress may lead to permanently impaired vision or blindness when allowed to go on untreated. The prevention of a pterygium calls for care of the eyes with goggles and other protection, especially during outdoor activities.

Astigmatism. Astigmatism is the eye fault of unequal curvature in the eyeball, particularly of the cornea. It is very common and causes most eye strain and vision distortion. Theoretically,

Fig. 10. Astigmatism, unequal curvature of the eyeball, distorts entering light rays, possibly to very slight degree. This out-of-round situation of the front of the eye distorts vision and creates eye strain. Effectively treated with glasses, it is a most common if not universal eye difficulty.

because nothing in this world is perfect, no eyeball is perfectly round and therefore, everyone has some astigmatism. It is usually relieved with suitable glasses.

Exophthalmos. This uncommon eye condition makes the eyeball appear enlarged, staring, and frightened; often as the result of disease. This appearance is caused by the eyeball being pushed outward, sometimes by a swollen or congested area behind the eye. It is frequently seen in over-activity of the thyroid, but can also occur from high blood pressure, kidney disease or

Fig. 11. Wide, staring eyeballs, called exopthalmus, sometimes are caused by thyroid disease. Enlarged thyroid (goiter), along with wide, staring eyes, shows the origin of the medical term, “exopthal-mic goiter.”

as an inherited family characteristic. It is seen mostly in men, and develops toward middle age. Even after effective treatment, it is usual for the exophthalmos to remain as a permanent feature.

Cataract. Cataract is a loss of transparency in the lens of the eye and is usually progressive from the rim inward toward the center. Most cases of cataract occur in the over-fifty group, and seem to be caused by systemic diseases such as diabetes and difficulties of the parathyroid gland, among others. They are also caused by difficulties within the eyeball itself such as chronic uveitis (inflammation of one of the eyeball linings), or to excessive heat and infra-red rays such as occurs in glass blowers. When cataract occurs without any disease within the eye or without, in the later years of life, the term senile cataract is applied to it.

Fig. 8. Cataract is a disease of the eye lens-growing from clear glass-like transparency to an opaque, milky appearance in which some light rays are prevented from entering the eye. Caused by diabetes, infection and other difficulties, it can be removed and sight restored if proper glasses are used.

Removing the lens from the eyeball is the only satisfactory therapy for cataracts. Drugs and other treatments have been found worthless in restoring vision or preventing blindness caused by cataract. The surgical treatment of cataract however, is very successful with well over ninety-five percent recovering good eyesight. Only a physician can diagnose a cataract and perform the necessary surgery.

Glaucoma. Glaucoma, the thief in the night, is a disease of increased pressure within the eyeball. It afflicts nearly two people of every hundred, over the age of forty years, and is responsible for one out of every eight cases of blindness.

Fig. 9. Glaucoma is caused by greatly increased pressure within the eyeball. Possibly very painful, it may lead to complete blindness unless adequate treatment is effected.

Although pain is not always a prominent factor in glaucoma, a dull aching in the eyes is usually present. Reasons to suspect glaucoma are: 1. Progressively poor vision in one or both eyes. 2. Blurring vision with rings visible around bright lights. 3 So-called “gun-barrel” vision in which the field of vision is narrowed to a small “target” with difficulty in seeing toward the sides. The eye doctor has drugs and other measures effective for the treatment of this disease of our senior years.