Any condition which conduces to a chronic congestion of the upper air-tract and of the tympanum exposes the mid dle car to infection. The general pre disposing cause, which, without any lesion of the upper air-tract, may render the middle ear exceedingly susceptible to infection, may be any constitutimml condition which lowers the vitality of the entire system. The direct or excit ing cause of tlie inflammation—that is. the means by which the pathogenic bac teria are introduced into the tympanum —is throng]) the. external auditory meatus, whieh is the most siinple avenue of introduction, and, at the same time, the most unusual. The middle ear is most commonly infected through the Eustachian tube. One of the most com mon etiological factors is the direct in troduetion of pathogenic germs through the Eustachian tube by the instaation of water through the nares. When we have to do with a streptococcie and. in a great majority of cases -with a mien mococcie. infection, the upper part of the cavity is alnmst always involved. E. B. Deitch (Medical News, Jan. 17, 1903).
Symptoms.—In acute purulent otitis media the pain becomes more intense, the hearing dull, tinnitus louder and ing, and fever usually sets in if it be not already present. The membrana pani will be found congested and its features lost in the general swelling of its surface as the inflammation -within the drum-cavity advances.
ia middle-ear inflammation in early infancy in slight eases there is restless ness, ill humor, loss of appetite, and, in severe case.s, the rolling of the head from side to side, sleeplessness, calling out, continuous crying, vomiting, and a dis charge of pus. In weakly children the loss of weight is often the most strik ing symptom. In the most SCVCFC cases the temperature may rise to 104° F., or over, and depression almost amounting to unconsciousness, twitchings, and con vulsions may, in a short time, lead to the development of the appearances charac teristic of meningitis, all of which may disappear at once on the occurrence of otorrlioca. Very frequently there is swell ing, with tenderness of the lymphatic glands around the ear, and preauricular (-edema. Gomperz (,Tour. of Laryn., Apr., '96).
In children under four years of age great confusion in diagnosis often arises in the pmsence of a gastro-enteritis, symptoms of which inay be mingled with those of an acute otitis media. or which may depend more upon the otitis media than upon the gastro-enteritis, though the otitis media, may not be recognized promptly. Often, in facl, the latter dis ease is discovered accidentally, either bv observing a discharge from the ear and improvement in the symptoms of the g,astro-enteritis or by touching the atirick or the region near it, when the latter is found to be tender and painful to the touch. Treatment of the ear will
be (ollom ed by recovery in all respects, in itio.-t instances. if the aural treatment has not been deferred too long. E. Ponfick ( Berliner kiln. Woch., Sept. 20, '97).
Treatment.—In this form of otitis, as in the former, dry heat about the ear will do the most in allaying the pains and sometimes in causing resolution. Warm water or warmed watery solutions of car bolic acid (1 to 40) may be tried, but, as has been said, they may afford little or no relief, though the latter sterilizes the auditory canal and prepares it for either a spontaneous or artificial perforation of the drum-membrane.
In acute suppurative otitis media, pre vious to rupture of the membrane, leeches are applied over the mastoid and in front of the tragus to relieve pain. These are supplemented by warm, wet cloths, which promote bleeding. Instillations of mor phine. 2 grains to the ounce, or a 10-per cent. solution of cocaine, are dropped into the ear if necessary. When ear-drops are used they are warmed by first dipping the spoon that is to contain them in hot ater, and then pouring a small amount into the meatus. When the acute symp toms have subsided the ear is kept clean by syringing with a lotion composed of boric acid, 10 grains, to 1 ounce of water. For a time, daily inflation with the Polit zer bag is practiced. F. C. Ewing (Jour. Amer. Med. Assoc., Feb. 29, '96).
Case of facial paralysis which attended on an attack of acute otitis media, per in spite of revulsive and antiphlo gistie treatment, but completely disap peared on the performance of para centesis. Datnieno (Ann. des :Mal. de l'Or.; Treatment, June 23, '98).
Inflations, aspirations, etc., must be ..arefully avoided now, as in the acute catarrhal form, for fear of forcing the pathogenic germs from the middle ear into the antrum and mastoid cells. In fact, in this way the large number of cases of so-called acute mastoiditis con secutive to acute otitis media are caused. The naso-pharynx may be sprayed, not syringed, with Dobell's solution, in such cases, if the nares are filled with tough secretions; not otherwise. Ordinary gentle blowing of the nose will be quite sufficient to clear the nostrils. tinder the above conservative treatment the earache usually ceases in a few days, either with or without spontaneous rupt ure.