The general and functional signs of otitis in the newborn and sucklings are restlessness at night, the frequent placing of the child's hand to the affected ear, the cry, and the symptoms of meningitis. Broncho-pneumonia is the most frequent cause of death (24 out of 37 cases). Hart mann (Revue Men. des Mal. de l'Enfanec, Aug., '05).
The physical appearances of acute in flammation of the membrane in infants are usually of no help. for they are fre quently absent, and as frequently as not the most that can be seen to be abnormal arc the appearances. which show a closed Eustachian Babe and perhaps some con gestion of the vessels. The main symp toms we have to rely upon are pain and restlessness. W. Dalby (Brit. Med. Jour., July 24. '97).
The following early symptoms suggest the ear as the cause of the illness in in fancy: 1. The child constantly endeav ors to rub the affected organ. 2. It utters a sharp cry of pain when pressure is made below the meatus. 3. It refuses to rest its head on the affected side. J. H. Marsh (Brit. Med. Jour., July 24, '97).
Etiology.—Acute catarrhal otitis me dia is caused most frequently by acute coryza. It is rarely, if ever, due solely to any form of inflammation of the fauces without concomitant nasal disease.
It is also caused by the naso-pharyngitis excited in the exanthemata: typhoid fever and influenza.
Of 2000 cases of aural disease, 97 of the patients attributed the condition to in fluenza. The attic was exclusively or • chiefly affected in a remarkably large number. In cases in which the inflam mation was confined to the attic, Shrap nell's membrane was intensely congested and swelled, sometimes bulging in a sac eular form. Kosegarten (Zeit. f. Obrenh., Dec., '92).
Analysis of 122S cases of typhoid fever showing that 2S were complicated with acute otitis media. Hengst (Amer. Laryng., Rhin., and Otol. Soc., Apr., '96; _Arch. of Otol., May, '96).
Severe cases of measles rarely run their course without involvement of the middle ear; the inflammatory process usually runs its course without subjective, and often without objective, symptoms, and only perforation occurs. Pfingst (Pediatrics, Feb. 1, '98).
If fluids are forcibly injected into the nares of a child in the course of diph theria, otitis will almost surely result.
If the child dreads the injection, then irrigation from a fountain-syringe should be substituted, or, still better, the wash ing should be done with the aid of the nasal cup. It is personally believed that an infant's nose should be daily irrigated with normal saline solution. A. Jacobi (Pediatrics, Aug. 15, '99).
Possible relation of acute otitis media to pneumonia. Both seem frequently as sociated with the same micro-organism, —the pneumococcus,—and a number of eases of pneumonia have been personally seen beginning apparently with an acute otitis media. Case in point. Thomas Barr (Glasgow Med. Jour., June, 1900).
The acute otitis media cominu on in r, about the third week of typhoid fever is due to the accumulation of secretions, food, etc., and the decomposition thereof in the naso-pharynx of the weak and re cumbent patient. Sepsis is thus con veyed to the Eustachian tube and mid dle ear. An acute catarrh is set up in these cavities, and a simple catarrhal otitis media is soon followed by an acute suppurative otitis media.
In pers.onal experience, covering a quarter of a century and embracing nearly 5000 eases of the exanthemata, especially scarlet fever and measles, otitis media has been met with as the most frequent of the various cam plicatio»s which may occur during the course of the exanthemata. lf the attack be treated immediately upon its appear ance, it is not necessary to call in the aid of an otologist. J. H. Fruitnight (Med. _News, July 1. '99).
Penfiek, with his associates, has ob served carefully the condition of the ear in 100 autopsies of children under three years of age. These 100 autopsies he has divided under two heads: Non-infectious diseases, and those from infectious proc esses, and subdividing these into groups according to the disease. In most of these eases the actual condition, or rather the condition of the middle ear, preceding death 1N-as not suspected, and the cause of death is given by the at tending physician who had charge of the case at the time of the child's death. In only a few of these cases is the his tory of the case during lite obtained.