DISEASES or THE 'MIDDLE EAR. (1) Tubal catarrh is a congestive condition of the Eusta chian tube, leading from the throat to the middle ear. The result of this affection is closure of the tube, with deafness and eonstant noises heard. with a, sense of fullness in the head. Infla tion of the tulle is the treatment, with possibly subsequent dilatation and treatment with medi cated vapors. (2) Joule catarrhal inflammation of the middle car is an affeetion of the superfi cial structures that line the middle ear, with the production of sero-pus in such quantity that often the ear-drum bulges and may even burst. Inci sion is necessary to prevent bursting and to secure drainage. The malady may complicate measles or catarrh of nose and throat, or may be caused by the introduction of fluid through the Eusta chian tube chile bathing. In young children the disease may appear suddenly at night, with a temperature of 102' to 10W, and a period of in tense suffering, relieved by rupture of the drum, and pouring out of a little serous discharge that stains the pillow. Rise of temperature may con tinue on the following day, together with deaf ness and noises in the ear. As a rule, the cases terminate favorably without treatment. Sup puration may occur involving the mastoid cells. The treatment i- directed first to relief of pain, by using a saline cat hartie and an opiate. Local bloodletting by means of the artificial leech and the application of dry heat may abort an attack. If these measures fail to abort it. incision of the drum must be made, and the ear must be syr inged. and dressed antiseptically. (3) Chronic catarrhal infianinal 1 ion of Mr middle ear is either of the hypertrophie or of the hyperplastie variety. in the hypertrophic variety there is a swelling of the lining mendmane of the tym panum due at first to chronic venous conges tion, after which occurs hypertrophy of the ele ments of the tissue lining the cavity. Fibrous layers appear and calcareous deposits may en sue. The drum-membrane. the ossieles, the liga ments and the Walls of the Eustachian tubes share these changes. Exudate of serum or sero mucus collect; in the cavity. Among the causes for this condition are repeated attacks of acute rhinitis, the presence of adenoid tissue in the vault of the pharynx, impairment of the gen eral health. and the abuse of alcohol. The results are impaired hearing, whistling or buzzing or crackling noises in the ear, and occasional neu ralgic pains, especially upon swallowing. Entire recovery can never be promised in these cases, but treatment by the aural surgeon. of a tech
nical and intricate nature, may cause vast im provement. and avert total deafness. Chronic hyperplastie otitis media may develop from the hypertrophie form, and is characterized by an appearance of tiro and fibrous new tissue, di minished secretion. thickening of the walls of the suppling blood-vessels. with a resulting sclero sis. The symptoms resemble closely those of the hypertrophie variety, with h t he addition of gid diness in the early stages and a marked neur asthenic or even melaneholi• condition. due part ly to the temperamental state which invited the attack. partly to the fatigue of the higher cerebral centres resulting from repeated efforts to hear conversation. The prognosis for recovery is very grave, and the disease is less amenable to treatment than any other aural trouble. Treat ment is directed by the aural surgeon toward the relief of the rigidity of the ossi•ular chain. by inflation, exercise of the tubal muscles. the use of the Eustachian hoagie, and of the myringotome and several operative procedures. lIydrobromic acid or pilocarpine may he desirable for internal use. (41 purult al Wilk media most fre quently follows an infections disease. such as scarlatina, la grippe, smallpox, cen•bro-spinal meningitis, pneumonia. etc. Pus forms behind the drum-head and may dissect its way into the neighboring soft part; or may invade the mas toid. The prominent symptoms are very severe pain deep within the ear. a temperature of 101° or 103°, severe general headache. and great de pression. Invasion of a sinus may ensue, and pyaania may result. accompanied by a higher temperature, deliriuw, convulsions. and paral ysis. Immediate and vigorous operative meas ures employed by an aural surgeon constitute the only treatment. (3) Ch•wiic purulent otitii aiMia occurs as a sequel to the acute form. and, like it. is due to tissue necrosis. Discharge front the cal' is the only prominent symptom, and One which should suggest the necessity competent medical advice. (6) Otitis media purulent(' residua is a term applied to a class of cases in which a former purulent inflammation has resulted in :t permanent destruction of some of the tympanic structures. It may be either acute or chronic. The aural surgeon alone can differentiate this condition and advise regarding the antiseptic irrigation necessary or the re moval of dead bone which may have become im perative.