MIDDLE EAR, Diseases of.
Acute Catarrh of the Middle Ear, if severe, will be best relieved by a smart purge and the application of 2 or 3 or 4 leeches to the auricle or over the mastoid, and hot fomentations will encourage the bleeding from the bites, and give further relief. The Cocaine and Carbolic solution mentioned on a previous page may be instilled, but if the pain be severe and the tympanum found bulging, an incision with a fine, sharp, double-edged knife or needle should be promptly made, but this will be seldom needed.
When the symptoms are not very acute, the case often yields to a few inflations of the tympanum by Politzer's bag. By inserting the nozzle of the apparatus well up into the nostril of the affected side, and forcibly injecting air at the instant when the patient is in the act of swallowing a little water, the au is driven through the Eustachian tube, and ob structions caused by accumulations of mucus may be easily overcome, but in acute severe attacks inflation should be postponed till the exclusion of pyogenic infection is decided.
As the disease originates in catarrh of the naso-pharynx creeping up the Eustachian tube, the naso-pharynx should be douched with weak saline solutions--Boracic Acid, Chloride of Sodium, Borax, or Bicarbonate of Soda (too grs. to pint tepid water). It is a good practice to paint the naso-pharynx with a 25 per cent. Argyrol solution daily after flushing with the alkaline solution, and the Chloride of Ammonium inhaler is a valuable adjunct to treatment. Dry Boracic Acid in fine powder may be blown up the nostril by means of an insufflator.
Should the catarrh resist the above treatment, and show signs of passing into the chronic form, the Eustachian catheter may be passed, and a weak astringent solution, if there be evidence of much mucous secretion, should be injected. The strength of the solution varies, hut generally speaking about the strength of an eye lotion suffices--viz., 4 per cent. Boric Acid in warm water. If the tympanic cavity contain thickened mucus—the remnants of an acute attack—some experts make a linear incision in the tympanic membrane, and, through the Eustachian tube by means of the catheter, wash out the cavity by a stream of weak alkaline solution injected into the external meatus. Effused products in the
middle ear may sometimes be removed by blistering over the mastoid.
Chronic Catarrh of the Middle Ear is to be dealt with on the lines laid down for the acute catarrhal affection; the Eustachian tube being gener ally blocked, constant inflation of the tympanum by Politzer's method. or the Eustachian catheter, must be frequently resorted to. The condition of the naso-pharynx will also require constant attention, local antiseptic and astringent applications being employed after flushing with saline or alkaline solutions. The Chloride of Ammonium Inhaler may be used several times a day with advantage. In very bad cases the incision of the membrane and the injection of alkaline solutions, as just mentioned, may be tried, or Leil's operation for division of the tensor tympani muscle may be suggested. Bronner advocates intratympanic injections of 20 or 3o mins. of a 3 per cent. solution of Bicarbonate of Soda, with equal quantities of glycerin and water or paroleine, injected by a Pravaz syringe through the Eustachian catheter, air being blown in afterwards. An other form of treatment is the injection through the Eustachian catheter of a few drops of a solution of Menthol 20 grs., and Thymol 5 grs., in I oz. Liquid Paraffin.
The presence of adenoids tends to keep up this condition, and their removal is essential to prevent recurrences.
The hygienic surroundings of the patient should be carefully examined and rendered as ideally perfect as possible. The use of alcohol and tobacco in every form is objectionable in both acute and chronic ear catarrh.
Eustachian Catarrh and Obstruction must be treated in the same manner by continual inflation and by the use of the Chloride of Ammonium Inhaler; this condition is responsible for many of the cases of dry deaf ness. The deafness following chronic catarrh causing fixation of the malleus should be treated by Oto-Massage and the hypodermic admini stration of Fibrolvsin.