DISEASES OF TIIE M.UsTOID PROCESS. Inflam mation of this process may result from extension of a similar process from the middle ear. A chronic suppurative otitis media is the most fre quent cause of acute mastoiditis. It may follow exposure to cold, a traumatism. or general tuber cular or syphilitic infection. A destruction of the osseous tissue results. The most prominent symptom is intense pain over the mastoid bone, especially at night. a temperature of 99.5° to 101.5', difficulty in moving the head front side to side, and tenderness upon deep pressure over the tip of the mastoid. But slight constitutional dist Urbanee is present. Involvement of a venouS sinus with the production of an infectious thrombus may occur: emboli may develop and lodge in various viscera; diffuse meningitis may complicate the disease, with resulting paralysis: or the r.irer cerebral abscess may diagnosis of mastoid disease is a matter of diffi culty for any but an expert observer. although two signs are very reliable. These are, local tenderness upon deep pressure over the mastoid region: and a depression or sagging of the supero-posterior wall of the canal. close to the tympanic ring. Besides these signs, a localized tumefaction of the postern-superior canal wall (if it occur) is very indicative of mastoid in vol•ement. Many other symptoms present them selves. similar to those enumerated in the con sideration of other diseases alllicting the ear. The prognosis is always grave. The treatment consists in rest in bed, fluid diet, catharsis. ex tensive incision of the drum-membrane. if seen early, together with irrigation of the canal and the employment of the Leiter coil. by which cold
is applied to the whole mastoid portion of the temporal bone. Certain drug, are given to re lieve pain. After 4S hours have passed without amelioration, operative interference is necessary. In such a case. the surgeon makes an incision through the soft parts hack of the ear, eonnnenc ing over the middle of the mastoid insertion of the sterno-cleido-mastoid muscle, about one-half inch below the tip of the mastoid process, cutting upward and forward close to the line of inter Lion of the and following this line to a point directly above the meatus. This incision is carried down to the hone, and the soft parts are retracted. and the periosteum is raised from the hone. With mallet and chisel an opening is made through the cortex into the mastoid cells, and all softened honedissIle is removed with the sharp spoon. The mastoid antrum is entered and the entire pneumatie strueture of the mai.
teid is then obliterated. Drainage is secured by means of a tube passed into the bony meatus, and the external incision is closed up and a Applied.
t'onsnIt: Gray, Anatomy, Descriptirc and Sur gical I Philadelphia, I900) Gerrish (editor). .t Tt.rt-Book of .1 mt ()my by _I In( rican Authors ( Philodendra ia. 1 09 ; I1alliburton, k irke's Hand book of Physiology ( Philadelphia, 1901) ; ')ench, Diseases of the Ear (New York, 1699) ; Bacon. Ilanual of Otology (New York, 1:100) ; Article in Ref( rf uer Ilundbook of the Medical IterS (New York, 1900). See AUDITION ; COUSTI CS.