Deafness is any impairment of normal hearing and is that symptom next to pain and chronic discharge that causes the patient to visit the doctor. If acute diseases of the ear, nose and throat could always be successfully treated, there would be little trouble from the symptoms of chronic pathology. It must be understood that catarrhal deafness is a symptom of chronic otitis media and is, therefore, seldom of recent origin. =Etiology.=—Chronic otitis media is nearly always the result of the extension of infection through the Eustachian tube and has come from some acute or chronic nasopharyngeal infection. Chronic colds, pharyngitis, tonsillitis, sinuitis, etc., resulting in acute or chronic otitis media either with or without suppuration, constitutes the beginning of catarrhal deafness. =Symptoms.=—There is seldom any pain with this disease. Some cases have an occasional acute attack with pain and other symptoms of acute otitis media. Deafness, varying with the progress of the pathologic changes, is always present. The patient in the early stages will seldom admit that he suffers from deafness and often he is honest because he may not realize that he cannot hear normally until his otitis media has progressed to the second or third stage. Most patients, in fact, do not become alarmed about their hearing until it is too late to restore normal hearing. For this reason, physicians should be on the lookout for such conditions and should advise special treatment early. The human species in its present environment, depends much less upon the organs of special sensation than do the animals of the wild, and they may therefore be very deficient in sight, hearing, smell, etc. without actually realizing this loss. In addition to deafness there are other symptoms such as occasional or constant fullness or feeling of “stuffiness” as the patients express it, due to partial or complete occlusion of the Eustachian tubes. Tinnitus aurium or head noises is very common and often the most annoying symptom. Autophony, or the loud sound of the patient’s voice to himself, which often causes him to speak low and indistinctly, occurs in the later stages. Presbyacusia, or the inability to adjust the hearing apparatus to variations in pitch, commonly occurs in the second stage and is evidenced by the fact that the patient does not hear when more than one person is talking. Paracousis or perverted phenomena of hearing, such as the better hearing of some persons in a noisy environment, is a symptom of the third stage of otitis media and often means an unfavorable prognosis, so far as marked improvement in hearing is concerned. =Pathologic Stages.=—For convenience of discussion we may consider chronic otitis media in three stages.