Acute Purulent Otitis Media is the result of the admission of pyogenic organisms more dangerous than those causing simple catarrh, and should at first be treated as if a case of acute simple catarrh of the middle ear, from which at first it cannot be distinguished. If perforation of the Is membrane has already occurred, there may be afterwards difficulty in getting the opening to close. It is better for this reason to incise the membrane early if the case comes under notice before perforation has occurred. Midler strongly advises early paracentesis; he succeeded in 23 out of 24 cases, and no after-treatment was required. Constant syringing with warm weak antiseptic solutions (2o grs. Boracic Acid to oz. water) must be carefully done at least twice daily, and oftener when possible, after inflation by Politzer's method, but early inflation before perforation of the tympanum should be avoided.
The naso-pharynx will require antiseptic treatment; a gargle of i in 8o Carbolic Acid, Chlorate of Potash (r in 40), or a swab of Carbolic Acid and Glycerin (1 in ro), Tincture of Iron and Glycerin (1 in 2) or Argyrol solu tion (r in 4) may be employed.
Mastoid swelling and tenderness may occasionally be relieved by one deep incision, but when pus is found the more radical operation men tioned later on must be carried out.
Chronic Purulent Otitis Media with its suppurative discharge is nearly always a sequel to an attack of the acute disease with perforation of the tympanum. The majority of cases follow scarlatina and measles. The treatment is tedious and often unsatisfactory, especially as regards the degree of the power of hearing which may remain, but the chief object to be attained is the prevention of the grave conditions which are liable to supervene, such as cerebral abscess, sinus infection, mastoid and meningeal troubles. These can only be avoided by the most scrupulous and persever ing attempts at disinfection.
The Eustachian tube must be kept open by Politzer's inflation daily practised, and the patient may supplement this by Xralsalva's method of closing the nostrils with the fingers, shutting the mouth and puffing out the cheeks while he swallows air.
Antiseptics should be employed to disinfect the naso-pharynx as a gargle of r in So Carbolic lotion, or a swab of 1 in to Carbolic Acid and Glycerin, r in 2 Tincture of Iron and Glycerin, or 25 per cent. Argyrol.
The ear should be syringed out repeatedly with warm saturated Boric solution, 1 in 5,000 Perchloride of Mercury, z per cent. Lysol or 5 per cent. Carbolic Acid. Peroxide of Hydrogen is the most effectual disintegrator and cleanser, the to vol. solution being instilled when there is choleste atomatous tendency or solid debris in the middle ear, and the warm lotion used to flush out afterwards. The meatus may then be lightly packed with cyanide gauze after drying, or dry boric acid may be in sufflated.
When the discharge is not very profuse an instillation of r part of Boric Acid in 30 of strong Rectified Spirit is very efficacious, and this may be employed in most cases after the profuse discharge has been checked by syringing and when the aperture in the drum is extensive.
An artificial tympanum may be extemporised by inserting during the daytime a small tampon of cotton-wool moistened with boric solution or liquid paraffin, which should be inserted as far as the tympanum by forceps, an operation which the patient soon learns to perform himself.
Granulations or small polypoid growths springing from the margins of the tympanic aperture should he cauterised by a fine probe with a little cotton-wool twisted round its extremity, which is then moistened with saturated solution of Chromic Acid or the solid stick of Nitrate of Silver may he applied. Large polypi springing from the inner surface of the tympanum must be dealt with by the snare or curette when these project into the meatus.
Illastolditis.—When in spite of the above routine suppurative mastoid itis occurs, the surgeon should not wait for subperiosteal pointing of the abscess, but proceed at once with the performance of Schwark:s operation in order to prevent sinus and intracranial complications. This consists in cutting down on the mastoid through a curved incision behind the ear, and by means of the gouge and chisel the cells of the antrum are freely opened up and all diseased tissue removed, after which the bony cavity, being thoroughly flushed and dried, is to be packed with gauze or drained on ordinary surgical principles.
In many cases the more radical operation will be found necessary, and this is also indicated for the removal of the condition known as Cholesleatoma. It consists in opening the mastoid, and by chiselling and gouging the mastoid antrum, middle ear and attic are converted into one large cavity, out of which all diseased tissue with the remains of the tympanum and the ossicles are completely cleared, after which efficient drainage is to be established, or the cavity being lined with Thiersch's grafts as practised by lIallance, it may be gently packed with gauze.
Necrosis of the Temporal Bone, Extradural Abscess, Sinus Thrombosis and Cerebral Abscess are to be treated by the evacuation of pus through an extension of the last-mentioned operation, according to the anatomical conditions of each case.
For the deafness remaining after middle-ear suppuration causing fixation of the malleus or oto-selerosis the chief measures are oto-massage (20,00o vibrations per minute) and injections of Fibrolysin subcutaneously. This treatment should only be commenced after the discharge has been stopped by antiseptic measures.