There are three acute affections of the ear which may usually be
diagnosed from their points of tenderness or pain. Pain upon moving the
lobe or pinna indicates furunculosis. Pain on pressure posterior to the
angle of the jaw or externally in front of the ear indicates middle
ear infection and pain on pressure over the mastoid region suggests
mastoiditis.
Probably the most common of the painful diseases of the external meatus
is furunculosis, which is a subcutaneous infection of the lining
membrane of the meatus. The point of swelling may usually be seen but
in some cases the entire canal is closed.
=Treatment.=—In all cases of occluded pus, drainage must be obtained,
but in the early stages of furunculosis, it is not always possible
to determine the place of “pointing” or the most desirable point
to lance. As soon as the place of “pointing” can be located it is
advisable to lance deeply by means of a curved paracentesis knife.
The parts are thoroughly cleansed and anesthetized by applying phenol
and neutralizing with alcohol. The external parts are first painted
with alcohol to prevent “burning” from any phenol which may be
dropped upon them. A small cotton applicator is used, applying the
concentrated solution of phenol or the crystals (using only a small
amount of phenol) to the affected parts and immediately neutralizing
with alcohol. Care must be observed not to apply any phenol to the drum
membrane and the operator must be sure that the action of the carbolic
acid is completely neutralized by a liberal application of alcohol.
The knife blade is placed beyond the furuncle, its curved point turned
outward and quickly drawn forward through the furuncle, cutting
deeply. The canal is then packed with a pledget of cotton dipped into
phenol-glycerine.
If the place of pointing cannot be seen, palliative treatment may
be applied by thoroughly cleaning the meatus, drying and applying a
phenol-glycerine pack. Heat may be applied by means of a therapeutic
lamp. Any electric light bulb or the dry electric pack will do. The
external parts are well lubricated with paraffin oil and the heat
applied continuously or intermittently until the pain is relieved.