In every case of acute purulent otitis media there is, in all probability, an at tendant empyema of the so-called mas toid antrum. It ought to be called the tympanic antrum, as it is really a part of the tympanic cavity. Sometimes the antrum communicates with the mastoid cells, and hence it has received the naine of mastoid antrum. 'When this cavity participates in the tympanic inflamma tion and becomes filled with secretion like the rest of the drum-eavity, it will clear itself as easily as the drnm-cavity does after an opening occurs in the mem brana tympani. This fortunate result in drainage is assured by a siplionic action which naturally sets in as soon as either spontaneous or artificial opening of the drum-membrane occurs and the outflow ing current of secretion is established, as anyone familiar with the regional anat omy of these parts must see upon reflec tion.
If, however, secondary infection of the perforation in the membrana and of the drum-cavity beyond takes place by in fectious treatment through the external ear, secondary infection of the antrum takes place and the patient is then in the first stages of acute mastoiditis. If the antritis is not speedily relieved, the suppurative process may descend into the true mastoid cells, or inward toward the lateral sinus, or forward toward the tegmen tympani and thence into the middle cranial fossa. Sometimes all of these unfortunate lesions occur in same case. My experience has been that,.
if an acute otitis media is treated prop erly from the outset, consecutive mas– toiditis will not occur.
In 16 cases of mastoiditis resultin,g from simple acute otitis media, the diplo coccus pneumonia= appeared in 9, the streptococcus pyogencs in 5 (once with the staphylococcus pyogenes albtts), the staphylococcus in 1, and a coccus of un certain classification in 1 case. Tri un complicated cases of otitis media, the streptococcus pyogenes, and next in fre quency the staphylococcus is most com monly present. Arno Scheibe (Zeit. f. Ohrenh., Apr., '92).
Mastoiditis is a most frequent com plication of otitis due to influenza. The main points of difference between the tnastoid inflammation of simple otitis and that caused by grippe are in the rapidity of involvement to be noted in the latter case and the destructive course of the disease. Adam Politzer (Ann. des Mal. (le l'Or., etc., May, '92).
Case of mastoid disease following an operation for the removal of adenoid t Set.' Ital.,. nit kilt i'Vellt Ittlity recov vied 1 lie aural inflammation may have r. stilt efl from the IlSe Of t Ile ealli011e Id ',Oita tell, \ II tell WtIS syringed through the nares as an antiseptic wash after the operation. Editorial Olostoif Med. and Surg. Jour.. Sept. 15, '92).
Case of atute mastoiditis following Itt lite OtittS media, productive of extra dural abscess in a man aged 50 years. Entire recovery ensued upon opening the astoid and draining the extradural abs,ess. There was entire absence of fever during the entire course of the dis ease. Pain and swelling in the mastoid, ith cerebral symptoms, led to the ex ploration and operation. liennebert (Ann. des ...Mal. de Jan., '98).
The mastoid is probably involved to some extent in every case of acute mid dle-ear disease. Local tenderness is pres ent in almost every case, with its maxi mum over the antrum. Both a profuse discharge and a diminution of diseharge are indicative of mastoid involvement, and any bulging of the upper portion of the tympanic membrane in middle-ear suppuration should be looked upon with suspicion. As soon as there is the slight est indication of mastoid disease the patients should be kept absolutely quiet and the bowels freely opened. In addi tion to this a free incision should be made through the drum-membrane. The value of local depletion is underesti mated. Cold is not applicable to all cases, and should never be kept up longer than forty-eight hours, since it masks the symptoms. When employed its use should be continuous. Review of 316 mastoid cases with but LI deaths, none of which were due to the operation. E. B. Dench (Jour. Amer. AIed. Assoc., July 27, 1001 .
Symptoms. -- If the surgeon is con fr n•rd with mastoid empyema in the f r,t or second week- of an acute otitis mpd'a. Ile g.enerally find three prom in( nt -ymptoms, viz.: pain, prolapse of tip. tipper posterior wall of the canal near t' •P membrana, and pyrexia. The pain is usually in the mastoid region, or on the same side of the head as the aural in ilanunation, aucl sometimes there is also earache, being either a continuance of' the original earache or a return of it.
There may or may not be tenderness on pressure upon the mastoid. If the latter occurs it is said to be usually near the point of the process; but this is not so at first. As the acute mastoichtis is ushered in by acute antritis, if there is mastoid tenderness on pressure at this time it is found over the region of the antrum: i.e., high up and in the front part of the mastoid region close behind the auricle. If acute antritis has taken place and an incipient mastoiditis is be fore us, we shall find, in addition to pain in the mastoid, a prolapse or prominence of the skin of the upper, posterior wall of the auditory canal, near the drum membrane over the position of the an trum. If these two symptoms are pres ent, the third one of the pathognomonic symptoms named above, fever, will also be observed.