Certain types of deafness are determined before birth. Some of these appear in early life, others with advancing years. Most deafness, however, is due to inflammatory conditions of the middle ear, to interference with normal nasal breathing, to foci of infection in sinuses, tonsils, teeth, gall bladder, or other organs of the body, to the toxins of scarlet fever, diphtheria, or syphilis, to accumulations of wax in the external ear canal, or to certain nutritional, glandular, or general diseases.

Inflammatory conditions of the middle ear are produced by infections which reach the middle ear from the throat by Way of the Eustachian tube. In children the is straighter and larger than in adults; hence, infection can traverse its course most easily in childhood. An acute infection of the middle car, even though the eardrum is ruptured or opened usually produces little or no impairment of hearing, but recurrent or chronic
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