Inflations by either Politzer's method or the catheter or any other method is not only useless, but really dangerous in acute otitis media, as by such means pus may be forced into parts of the middle ear previously unaffected. W'alb (Archly f. Ohrenh., Sept., '93).
Inflation in acute otitis media should not be employed, and the wound should not be irrigated after mastoid chiseling. Hartmann (Archiv f. Ohrenb., Sept., '95). If pain continues over six hours in a child or twelve hours in an adult, out spontaneous rupture of the brana tympani, paracentesis of the hrana should be performed, because not only hearing, but life itself, may be at stake in many cases if the brane is not opened in some way. As the inflammation advances the brana tympani will be seen to bulge, especially in its posterior half. times the most prominent portion, ever, is in the membrana flaccida. As the inflammation in the drum-cavity creases, the pain becomes most intense, children being thrown into convulsions in some instances, and adults made to writhe and scream with pain. After cretion forms in the drum-cavity and the membrana bulges, no relief can be tained until an escape is offered to the pus by either a spontaneous or an cial opening in the drum-membrane. In time, a spontaneous opening will occur; but, as the tendency is for secretion in side the drum-cavity to inspissate, the longer perforation is deferred, the less likely it is to occur spontaneously, and then the retained secretions will burrow toward the meninges, sinuses, and brain cavity, especially in children. Hence the vital indication is prompt paracen tesis in a ease of acute otitis media with the membrana still imperforate after a few hours of great pain followed by bulg ing of any part of the membrane.
Early incision of the drum is indicated in purulent otitis. The use of opium and sweet oil and camphorated oil condemned.
The only useful local application is a so lution of carbolic acid in glycerin, and opium internally to control the pain.
The nasal douche is a prevalent cause of otitis. Gradle (Jour. Amer. Med.
Assoc., Mar. 30, 1901).
'laving sterilized the auditory canal and membrana tympani and illuminated these parts by means of the ordinary forehead-mirror, if the patient is not etherized, an incision must be made in the most prominent part of the mem brana. If the patient is etherized an electric head-lamp, referred to farther on, must be employed, as an open flame must not be brought near the patient. If daylight can be used, no artificial light is needed. For performing paracentesis,
or, rather, for incision of the membrana, a knife like that shown in Fig. 1 may be employed. Some prefer a knife the shaft of which is set at an angle to the handle, like the one in the illustration, while others prefer, for all operations of the membrana, a straight instrument. An incision 1 to 2 millimetres, or even 3 millimetres, long is far preferable to a mere puncture with the so-called para centesis-needle, as such an opening is not sufficient for drainage.
Before puncturing the membrane, the external auditory canal should be ren dered aseptic by cleansing it with cotton pledgets moistened in 1 to 1000 solution of sublimate, or 1 to 50 solution of phenic acid. AnEesthesia is produced by a 1 to 5 solution of cocaine hydrochlorate. The point in the membrane to be punctured should be in the postero-inferior quad rant. Mounier (Ann. des Mal. de l'Or., du Bar., du Nez, et du Phan, Oct., '92).
In the last five years 214 cases of acute influenza-otitis observed. In 64 of these the attic, or pars epitympanica of the drum-cavity, \\ as chiefly affected. The treatment consisted in paracentesis spontaneous rupture of the membrana did not occur promptly. Haug (Arch. f. Ohrenh., May, '96).
In acute otitis media in young infants paracentesis is necessary, followed by the use of Politzer's ba,g and evacuation of the pus. G. P. Field (13rit. Med. Jour., June 12, '97).
Recovery ensues sooner in cases in which paracentesis has been performed than in those in which the perforation is spontaneous.
ln a case of earache with congested and bulging drum-membrane the surgeon must be careful to differentiate between simple swelling of the outer surface of the inembrana as occurs in so-called myringo-dermatitis and bulging of the membrana from the outward pressure of s.. rtt:ot s on its inner surface. In thc f, mar the prontimnee is generally more nt tait. and sharply defined. often be 1.,,, in faL 1. a Yellowish. brownish, or 1.1111a. ln otitis media the protru .::,a from retained secretions compre 1,etils more of the surface of the mem rana, e4pecially in its lower and pos terior portions, Case of pure myringitis. Examination et a child revealed a normal external auditory canal, but the drum-head was intensely red and swelled. There was great pain in the affected ear, and the patient had slig.ht fever. Paracentesis waF. performed, but no discharge could afterward be forced into the canal by in tiation with Politzer's air-bag. Eitelberg 'Arch. f. Kinderh. vol. x, H. 1, '98).