RT Journal
A1 STAPLER MM
T1 DEaf-mutism, with report of cases
JF Journal of the American Medical Association
JO Journal of the American Medical Association
YR 1909
FD February 6
VO LII
IS 6
SP 468
OP 469
DO 10.1001/jama.1909.25420320040003f
UL http://dx.doi.org/10.1001/jama.1909.25420320040003f
AB There is much evidence to prove that occlusion of the Eustachian tubes is the primary cause of deafness in the majority of cases among children who retain their speech. An attempt to point out why occlusion of the tubes is probably the primary cause also of deafmutism is one of the purposes of this paper. To do this I must first call attention to those conditions in the middle ear which are the prompt results of complete and partial occlusion of the Eustachian tubes.CAUSES OF DEAF-MUTISM 
    When the occlusion of the tubes is complete the surrounding tissues absorb the gases in the air which is pent up in the middle ears. A vacuum is thus created and the atmospheric pressure of fifteen pounds to the square inch is brought to bear on the occluded openings of the tubes and tympanic membranes. We may expect such a pressure to rupture