The meaning of the symbols of bachelors, buttons seen in a dream.

Diseases may affect the EAR alone or as part of a more generalised condition. The disease may affect the outer, middle or inner ear or a combination of these.

Examination of the ear includes inspection of the external ear. An auriscope is used to examine the external ear canal and the ear drum. If a more detailed inspection is required, a microscope may be used to improve illumination and magni?cation.

Tuning-fork or Rinne tests are performed to identify the presence of DEAFNESS. The examiner tests whether the vibrating fork is audible at the meatus, and then the foot of the fork is placed on the mastoid bone of the ear to discover at which of the two sites the patient can hear the vibrations for the longest time. This can help to di?erentiate between conductive and nerve deafness.

Hearing tests are carried out to determine the level of hearing. An audiometer is used to deliver a series of short tones of varying frequency to the ear, either through a pair of headphones or via a sound transducer applied directly to the skull. The intensity of the sound is gradually reduced until it is no longer heard and this represents the threshold of hearing, at that frequency, through air and bone respectively. It may be necessary to play a masking noise into the opposite ear to prevent that ear from hearing the tones, enabling each ear to be tested independently.

General symptoms The following are some of the chief symptoms of ear disease: DEAFNESS (see DEAFNESS). EARACHE is most commonly due to acute in?ammation of the middle ear. Perceived pain in this region may be referred from other areas, such as the earache commonly experienced after tonsillectomy (removal of the TONSILS) or that caused by carious teeth (see TEETH, DISORDERS OF). The treatment will depend on the underlying cause. TINNITUS or ringing in the ear often accompanies deafness, but is sometimes the only symptom of ear disease. Even normal people sometimes experience tinnitus, particularly if put in soundproofed surroundings. It may be described as hissing, buzzing, the sound of the sea, or of bells. The intensity of the tinnitis usually ?uctuates, sometimes disappearing altogether. It may occur in almost any form of ear disease, but is particularly troublesome in nerve deafness due to ageing and in noise-induced deafness. The symptom seems to originate in the brain’s subcortical regions, high in the central nervous system. It may be a symptom of general diseases such as ANAEMIA, high blood pressure and arterial disease, in which cases it is often synchronous with the pulse, and may also be caused by drugs such as QUININE, salicylates (SALICYLIC ACID and its salts, for example, ASPIRIN) and certain ANTIBIOTICS. Treatment of any underlying ear disorder or systemic disease, including DEPRESSION, may reduce or even cure the tinnitis, but unfortunately in many cases the noises persist. Management involves psychological techniques and initially an explanation of the mechanism and reassurance that tinnitus does not signify brain disease, or an impending STROKE, may help the person. Tinnitus maskers – which look like hearing aids – have long been used with a suitably pitched sound helping to ‘mask’ the condition.

Diseases of the external ear

WAX (cerumen) is produced by specialised glands in the outer part of the ear canal only. Impacted wax within the ear canal can cause deafness, tinnitis and sometimes disturbance of balance. Wax can sometimes be softened with olive oil, 5-per-cent bicarbonate of soda or commercially prepared drops, and it will gradually liquefy and ‘remove itself’. If this is ineffective, syringing by a doctor or nurse will usually remove the wax but sometimes it is necessary for a specialist (otologist) to remove it manually with instruments. Syringing should not be done if perforation of the tympanic membrane (eardrum) is suspected. FOREIGN BODIES such as peas, beads or buttons may be found in the external ear canal, especially in children who have usually introduced them themselves. Live insects may also be trapped in the external canal causing intense irritation and noise, and in such cases spirit drops are ?rst instilled into the ear to kill the insect. Except in foreign bodies of vegetable origin, where swelling and pain may occur, syringing may be used to remove some foreign bodies, but often removal by a specialist using suitable instrumentation and an operating microscope is required. In children, a general anaesthetic may be needed. ACUTE OTITIS EXTERNA may be a di?use in?ammation or a boil (furuncle) occurring in the outer ear canal. The pinna is usually tender on movement (unlike acute otitis media – see below) and a discharge may be present. Initially treatment should be local, using magnesium sulphate paste or glycerine and 10-per-cent ichthaminol. Topical antibiotic drops can be used and sometimes antibiotics by mouth are necessary, especially if infection is acute. Clotrimazole drops are a useful antifungal treatment. Analgesics and locally applied warmth should relieve the pain.

CHRONIC OTITIS EXTERNA producing pain and discharge, can be caused by eczema, seborrhoeic DERMATITIS or PSORIASIS. Hair lotions and cosmetic preparations may trigger local allergic reactions in the external ear, and the chronic disorder may be the result of swimming or use of dirty towels. Careful cleaning of the ear by an ENT (Ear, Nose & Throat) surgeon and topical antibiotic or antifungal agents – along with removal of any precipitating cause – are the usual treatments. TUMOURS of the ear can arise in the skin of the auricle, often as a result of exposure to sunlight, and can be benign or malignant. Within the ear canal itself, the commonest tumours are benign outgrowths from the surrounding bone, said to occur in swimmers as a result of repeated exposure to cold water. Polyps may result from chronic infection of the ear canal and drum, particularly in the presence of a perforation. These polyps are soft and may be large enough to ?ll the ear canal, but may shrink considerably after treatment of the associated infection.

Diseases of the middle ear

OTITIS MEDIA or infection of the middle ear, usually occurs as a result of infection spreading up the Eustachian tubes from the nose, throat or sinuses. It may follow a cold, tonsillitis or sinusitis, and may also be caused by swimming and diving where water and infected secretions are forced up the Eustachian tube into the middle ear. Primarily it is a disease of children, with as many as 1.5 million cases occurring in Britain every year. Pain may be intense and throbbing or sharp in character. The condition is accompanied by deafness, fever and often TINNITUS.

In infants, crying may be the only sign that something is wrong – though this is usually accompanied by some localising manifestation such as rubbing or pulling at the ear. Examination of the ear usually reveals redness, and sometimes bulging, of the ear drum. In the early stages there is no discharge, but in the later stages there may be a discharge from perforation of the ear drum as a result of the pressure created in the middle ear by the accumulated pus. This is usually accompanied by an immediate reduction in pain.

Treatment consists of the immediate administration of an antibiotic, usually one of the penicillins (e.g. amoxicillin). In the majority of cases no further treatment is required, but if this does not quickly bring relief then it may be necessary to perform a myringotomy, or incision of the ear drum, to drain pus from the middle ear. When otitis media is treated immediately with su?cient dosage of the appropriate antibiotic, the chances of any permanent damage to the ear or to hearing are reduced to a negligible degree, as is the risk of any complications such as mastoiditis (discussed later in this section). CHRONIC OTITIS MEDIA WITH EFFUSION or glue ear, is the most common in?ammatory condition of the middle ear in children, to the extent that one in four children in the UK entering school has had an episode of ‘glue ear’. It is characterised by a persistent sticky ?uid in the middle ear (hence the name); this causes a conductive-type deafness. It may be associated with enlarged adenoids (see NOSE, DISORDERS OF) which impair the function of the Eustachian tube. If the hearing impairment is persistent and causes problems, drainage of the ?uid, along with antibiotic treatment, may be needed – possibly in conjunction with removal of the adenoids. The insertion of grommets (ventilation tubes) was for a time standard treatment, but while hearing is often restored, there may be no long-term gain and even a risk of damage to the tympanic membrane, so the operation is less popular than it was a decade or so ago. MASTOIDITIS is a serious complication of in?ammation of the middle ear, the incidence of which has been dramatically reduced by the introduction of antibiotics. In?ammation in this cavity usually arises by direct spread of acute or chronic in?ammation from the middle ear. The signs of this condition include swelling and tenderness of the skin behind the ear, redness and swelling inside the ear, pain in the side of the head, high fever, and a discharge from the ear. The management of this condition in the ?rst instance is with antibiotics, usually given intravenously; however, if the condition fails to improve, surgical treatment is necessary. This involves draining any pus from the middle ear and mastoid, and removing diseased lining and bone from the mastoid.

Diseases of the inner ear

MENIÈRE’S DISEASE is a common idiopathic disorder of ENDOLYMPH control in the semicircular canals (see EAR), characterised by the triad of episodic VERTIGO with deafness and tinnitus. The cause is unknown and usually one ear only is affected at ?rst, but eventually the opposite ear is affected in approximately 50 per cent of cases. The onset of dizziness is often sudden and lasts for up to 24 hours. The hearing loss is temporary in the early stages, but with each attack there may be a progressive nerve deafness. Nausea and vomiting often occur. Treatment during the attacks includes rest and drugs to control sickness. Vasodilator drugs such as betahistine hydrochloride may be helpful. Surgical treatment is sometimes required if crippling attacks of dizziness persist despite these measures. OTOSCLEROSIS A disorder of the middle ear that results in progressive deafness. Often running in families, otosclerosis affects about one person in 200; it customarily occurs early in adult life. An overgrowth of bone ?xes the stapes (the innermost bone of the middle ear) and stops sound vibrations from being transmitted to the inner ear. The result is conductive deafness. The disorder usually affects both ears. Those affected tend to talk quietly and deafness increases over a 10–15 year period. Tinnitus often occurs, and occasionally vertigo.

Abnormal hearing tests point to the diagnosis; the deafness may be partially overcome with a hearing aid but surgery is eventually needed. This involves replacing the stapes bone with a synthetic substitute (stapedectomy). (See also OTIC BAROTRAUMA.)... ear, diseases of

Linn.

Family: Rosaceae.

Habitat: Cultivated chiefly in Uttar Pradesh and Bihar.

English: Cabbage Rose, Provence Rose, Hundred-leaved Rose.

Ayurvedic: Shatapatri, Shatapatrikaa (Shatapatra is equated with Nelum- bo nucifera.), Taruni, Devataruni, Karnikaa, Chaarukesharaa, Laak- shaa, Gandhaaddhyaa. (Flowers— usually pink and double.)

Unani: Gul-e-Surkh.

Siddha/Tamil: Iroja, Rajapoo.

Action: Flowers—a decoction is prescribed for inflammation of the mouth and pharynx, and ulcers of the intestine. Powder of rose buttons and seeds—astringent in haemorrhage and diarrhoea.

The flowers and leaves contain 1.3 and 8.5% of saponin respectively. Pe- tels are reported to contain methionine sulphoxide.

Cabbage rose yields a volatile oil (0.2%) consisting mainly of citronellol, geraniol, nerol, phenylethanol, linalool and citral. It contains 15% tannins (oligomeric proanthocyanidins).

Dosage: Dried flower—3-6 g powder. (API, Vol. III.)... rosa centifolia

Beggar’s buttons. Lappa. Arctium lappa L. French: Bardane. German: Filzklette. Spanish: Bardana. Italian: Lappolone. Parts used: herb, root, seeds.

Constituents: fatty acids, organic acids, phenolic acids, lignans, sesquiterpenes, tannin, mucilage, inulin. Contains iron, sulphur and B-vitamins.

Action. One of the most powerful and reliable blood tonics of herbalism. Antibiotic action of the root against staphylococcus. Adaptogen, alterative, anti-fungal, hepatic, lymphatic, diaphoretic, diuretic, laxative, hypoglycaemic, orexigenic, bitter.

Anti-tumour activity reported (Farnsworth, Kiangsu-429)

Uses: Arthritis, gout, rheumatism, boils, styes, seborrhoea, cystitis, anaemia, anorexia nervosa. To lower blood sugar. Skin diseases – especially psoriasis, acne, eczema. To reduce cholesterol level. Measles (Chinese traditional).

Combination 1. Dandelion 2; Burdock root 1; (rheumatism).

Combination 2. Yellow Dock, Red Clover, Burdock, BHP (1983). Inulin, present in the root, of value in diabetes (Krantz & Carr, 1931)

Preparations: Thrice daily. Persistence with low doses is more favourable than larger, over short periods. Some herbalists have observed more favourable results from use of the decoction.

Decoction. Half-1 teaspoon root to each cup water, simmer gently 5 minutes in a closed vessel. Half-1 cup.

Liquid Extract. BHC Vol 1 (root). 1:1, 25 per cent ethanol. Dose: 2-6ml.

Tincture. BHC Vol 1 (root). 1:5, 25 per cent ethanol. Dose: 8-12ml.

Powder. Two 250mg capsules with meals.

Topical. Compress: 2 teaspoons shredded root or powder to two cups water simmered 5 minutes and allowed to stand for 30 minutes; saturate piece of suitable material and apply.

Not used in pregnancy or lactation. ... burdock

n. 1. a courtesy title given to a qualified medical practitioner, i.e. one who has been registered by the *General Medical Council (GMC). Most doctors in the UK obtain bachelors’ degrees in medicine and surgery (MB, BS) or the diplomas of the conjoint boards of the Royal Colleges of Physicians and Surgeons of England and Scotland or the Society of Apothecaries (e.g. LRCP, MRCS, LMSSA): these degrees or diplomas are required by the GMC before a person is provisionally registered as a doctor. Normally it is also necessary to undertake training under the medical *Foundation Programme in a hospital recognized for this purpose. Such a doctor has the title foundation doctor and is debarred from independent practice. Thereafter doctors undertake further training to be eligible for full registration on the GMC’s specialist or GP registers (see Appendix 9). Surgeons in the UK do not use the title Doctor and are referred to, as a mark of distinction, as Mr, Mrs, or Ms. Qualified dentists also use the courtesy title Doctor. See also consultant. 2. the title given to a recipient of a higher university degree than a Master’s degree (this is usually a Doctor of Philosophy (PhD or DPhil) degree). The degree Medicinae Doctor (MD) is awarded by some British universities as a research degree to those with a first degree in medicine. In the US, the degree is awarded on qualification.... doctor

n. an alkaloid present in mescal buttons (the dried tops of the Mexican cactus Lophophora williamsii) that produces inebriation and vivid colourful hallucinations when ingested.... mescaline

Tanacetum vulgare

FAMILY: Asteraceae (Compositae)

SYNONYMS: Chrysanthemum vulgare, C. tanacetum, buttons, bitter buttons, bachelor’s buttons, scented fern, cheese.

GENERAL DESCRIPTION: A hardy perennial wayside herb, up to 1 metre high with a smooth stem, dark ferny leaves and small, round, brilliant yellow flowers borne in clusters. The whole plant is strongly scented.

DISTRIBUTION: Native to central Europe; naturalized in North America and now found in most temperate regions of the world. The essential oil is mainly produced in France, Germany, Hungary, Poland and the USA.

OTHER SPECIES: Closely related to the medicinal herb feverfew (Tanacetum parthenium), the marigolds and daisy family.

HERBAL/FOLK TRADITION: Traditionally used to flavour eggs and omelettes. It has a long history of medicinal use, especially among gypsies, and is regarded as something of a ‘cure all’. It was used to expel worms, to treat colds and fever, prevent possible miscarriage and ease dyspepsia and cramping pains. Externally, the distilled water was used to keep the complexion pale, and the bruised leaves employed as a remedy for scabies, bruises, sprains and rheumatism. It was also used generally for nervous disorders and to keep flies and vermin away.

The flowers are still current in the British Herbal Pharmacopoeia as a specific (used externally) for worms in children.

ACTIONS: Anthelmintic, anti-inflammatory, antispasmodic, carminative, diaphoretic, digestive, emmenagogue, febrifuge, nervine, stimulant, tonic, vermifuge.

EXTRACTION: Essential oil by steam distillation from the whole herb (aerial parts).

CHARACTERISTICS: A yellow, olive or orange liquid (darkening with age) with a warm, sharp spicy herbaceous odour.

PRINCIPAL CONSTITUENTS: Thujone (66–81 per cent), camphor, borneol, among others.

SAFETY DATA: Oral toxin – poisonous due to high thujone content. Abortifacient.

AROMATHERAPY/HOME: USE None. ‘Should not be used in aromatherapy whether internally or externally.’.

OTHER USES: Occasionally used in herbaceous-type perfumes. The oil used to be used in alcoholic drinks – it is no longer used for flavouring.... tansy