The hearing is unlikely to be involved except temporarily; but the condition should not be too lightly regarded or the sufferer may seek a more sympathetic attendant. Leeching may greatly re lieve the painful tension and abort or limit the lesion; heat, dry or by douche, is generally more convenient and as effi cacious. The temperature should always be hotter than pleasant and the douche should be followed by drying, to avoid maceration. Pouhieing is to be eon demned, unless done for very brief inter vals and only at the hottest bearable. Granulations about the mouth of an open furuncle are almost as certain evidence of abuse of poultices as is a "tea-leaf eye." Disinfection by mopping with hydrogen peroxide gives the benefit of massage, and should be followed by rubbing in of ung. hydrarg. ox. flay. This should not only be rubbed in as vigorously as can be borne, but should be inserted on a conical wad of cotton wedged in as firmly as can be tolerated. If the patient will bear this for the first few minutes, it generally reduces the congestion and brings relief; and it can even be pushed in more and more so as to maintain pressure. A per sistent inunction and massage is thus obtained at every motion of the jaw; and a canal that was wholly closed one day with a furuncle that threatened days of suffering may be found open and well on toward resolution next day. In the deeper form of the involvement such pressure cannot be endured. Heat will here have a limited value, and instilla tions of atropine, cocaine, morphine, carbolic acid, or a thousand vaunted remedies may avail as little. Morphine in full dose must be called in, therefore, to supplement the resolvent effect of heat by douche and hot-water bottle. Bags of salt retain heat well and can be used to good advantage, as can the Japanese hand-stove if its fumes are avoided. In cision of the swelled tissue, whether pus has formed or not, is in theory unim peachable; in practice it can be generally avoided with moral and physical relief to the patient and an impression that the healing has been better without it. Diag nosis of the conditions beyond the swell ing may be impossible, and tympanic in volvement had better be assumed until it can be disproved; hence swellings in the bony canal, where glands are few and furuncle rare, should be earlier incised; and the possibility of underlying bone disease never lost sight of as a cause rather than a consequence of the visible lesion.
Good results in the treatment of fu runcles obtained from the use of solu tions of menthol. Ten-per-cent. solution of menthol is sufficient to stop the de velopment of staphylococci. For clinical use a solution of 20 per cent. recom mended. A wad of cotton, moistened in this solution, is to be placed in the audi tory canal so as to cover the diseased parts. These wads should be renewed once in twenty-four hours and the treat ment continued until the affection is overcome. R. Cholewa (Then Monats., June, '89 ) .
When the parts cannot be incised in furunculosis, the auditory canal is to be cleansed with an antiseptic wash. A small layer of cotton is then soaked in a 20-per-cent. solution of the subacetate of alum, and is placed as deeply in the canal as possible. This is covered with a layer of dry cotton, and one of rubber outside so as to maintain the heat and moisture of the inner pledget. Grtin wald (Munch. med. Woch., Mar. 3, '91).
The opening of furuncles in the ear, which is one of the most painful of small operations in the whole of minor sur gery, can be made absolutely painless by eataphoresis. Use is personally made of the street-current, 2 to 4 milliamperes being used for ten to fifteen minutes.
Joseph Icenefick (Med. News, Dec. 30, '99).
Early incision of the furuncle is advo cated and the application of an oint ment which Dr. Barr recommends—iodo form, 4 grains; menthol, 2 grains; vaselin, 1 drachm—smeared on cotton plugs, and introduced into the canal of the ear twice or thrice daily. Gruber's gelatin bougies containing morphine are also of service, more especially in the earlier part of the illness or if the pa tient will not allow the boil to he in cised. Poultices generally do harm.
If the furuncle is not a primary con dition, but occurs associated with some other lesion—suppurativc middle-ear mischief, eczema of the canal, or plugs of cerumen—these conditions would de mand appropriate treatment. In a furuncle associated with purulent otitis media, one is occasionally surprised to note how quickly the middle-ear dis charge dries up after the inflammatory condition in the outer canal has been remedied.
The constitutional treatment of this affection is of prime importance. The dietary must be carefully regulated: starchy and sugary foods should be withdrawn. Tonics and aperients may be necessary. The aim in view should be a plain, wholesome, nourishing diet, with plenty of out-door exercise.
The tendency of bromides and iodides to produce a pustular eruption must be borne in mind. Alum and nitrate of silver applied locally are also said to favor their development. J. G. Connat (Glasgow Med. Jour., July, 1901).
Granulation-masses may be found in the canal, arising from its wall. Unless fringing the opening of a poulticed furuncle, these generally mark a sinus leading to or into the bone. There may be a burrowing out of tympanic pus along the periosteum by a track which a bristle could hardly follow; but generally a fine probe will find its way to bare and carious bone. A superficial lesion should be laid open and curetted, as cocaine will generally enable us to do with sufficient vigor. A deeper lesion will belong to the field of middle-ear surgery, not here treated.
The tendency of perforations of the drum is to heal by granulation, but in some cases the formation of an overlying epithelial tissue acts as a restraint to the granulating process. In all such cases Okuneff recommends to simply burn off the epithelial tissue with trichloracetie acid. The subjacent granulating tissue then readily closes the breach. Five complete recoveries in seven personal cases, the remaining two being still under treatment, recorded. Peltesohn (Berliner klin. Woch., Apr. 17. '991.
Inspissated cerumen constitutes about one-seventh of the aural disorders. It is rarely a condition that can be regarded as merely an incidental retention of normal ear-wax, nor does the dirty occu pation of even the coal-heavers who are affected with it more than partially ex plain its occurrence. There is generally more or less involvement of the middle ear behind it; and the decreased amount and greater consistence of the excretion is often, as in the pharynx, the reason for the apparent increase of its amount. Wax is generally wholly lacking in sup purating ears, although brownish in spissated pus is easily mistaken for it; and in the chronic tympanic catarrhs it is generally a very good omen when wax begins again to form in the usually empty canal. Faulty configuration sometimes hinders its natural escape; but generally this is associated with an eczema which acids much exfoliated epidermis to the collection. The wax-glands are situated only in the outer two-thirds of the canal; so any wax found deeper is a foreign body, generally pushed there by meddle some attempts at its removal.