In both fauns of acute otitis media the condition of the membrana tympani must be watched carefully and constantly throughout the progress of the disease, because only by an intelligent tion of its varying conditions can its treatment be properly conducted.
After either spontaneous or artificial perforation of the membrana there is usually a free discharge of muco-pus, and a cessation of pain, especially after prompt spontaneous opening of the mem brane. If this has not occurred and para centesis has been obligatory, the inspis sated secretions escape more slowly at fir.st and tbe pain gradually diminishes. After any form of perforation of the membrana in acute otitis media a dis charge must be regarded as beneficial, as it carries off pathogenic germs. There fore little or no local treatment of the ear should be applied for fear of secondary irritation of the outer ear and the per foration of the membrana. If this latter condition is established the escape of se cretion from the middle ear is prevented, s.e.condary infection of this cavity ensues, and chronicity of the purulencv is immi nent with mastoid complications. Hence the outflow of pus from the acutely-in flamed ear must be favored. The ear should not be syringed at all at such a time, unless the discharge is ver3- thick and not escaping readily. The time to syringe the ear is before discharge sets in, in acute cases, for reasons already given, and not afterward, for fear of secondary irritation of the perforated rnembrana and infection of the drum-cavity.
In any case of acute purulent dis charge, once iu twenty-four hours is quite often enough to syringe the ear. Let the ear run and drain itself through the natural diainage-tube: the external auditory canal. Iieep the concha and meatus greased with cosmolin to prevent chapping, and mop with sterilized cot ton or gauze (do not swab) the meatus and concha as they get filled with se cretions. At the same thne all forms of inflation, aspiration, and syringing of the nares and naso-pharynx must be avoided. Under these conservative and rational procedures the ear will return to its normal condition in the course of two or three weeks, in most instances.
Good results obtained in the treatment of chronic suppurative conditions of the middle ear front the employment of ace tanilid or antifebrin as a dusting-pow der. It is best used in combination with equal parts of boric acid. The ear should be cleansed in the ordinary way, and then a fine layer of the combined pow ders insuffiated upon the part. Lewis Somers (Med. News. _Apr. 4, '96).
Pyrozone and dilute hydrochloric acid of value in the treatment of chronic sup purating inflammations of the middle ear, Ten drops of a mixture of 10 drops of dilute hydrochloric acid and 1 ounee of pyrozone should be put into the ear three times a day after cleansing it: the mixt ure should be left in for five minutes after having been forced in deep by firm pressure upon the tragus. In the primary stage of acute cases such medication is contra-indieated, but, after pain, throb bing, and swelling have subsided, and suppuration continues, notwithstanding ordinary treatment, the acid and pyro zone check it very promptly. W. Cheat ham (Med. Rec., Sept. 12, '97).
Of course, the general health and strength must be regarded and improved in this as in all forms of otitis media The nares and naso-pharynx may de mand either moderate spraying with Do bell's solution once or twice in twenty fonr hours, or with fluid cosmolin in which a few minims of eucalyptol or a grain or two of menthol are suspended. Oily sprays as well as watery sprays should be used sparingly, three puffs of the atomizer in each nostril being suffi cient at an application.
Acute Empyema of the Mastoid.— As has already been said, acute mas toiditis consecutive to acute otitis media in a previously healthy ear is usually, perhaps always, the result of improper management of the primary otitic affec tion.
A large percentage of cases of rims toiditis are the direct result of chronic purulent otitis media, but they are not produced in proportion to the frequency of the lattEr, and, therefore, there must be some existing condition or conditions that exert an influence in this direction. E. O. Sisson (Jour. Amer. Med. Assoc., Apr. 23, '98).