Acute infections of the middle ear result from acute nasopharyngeal
affections such as colds, influenza, measles, mumps, whooping cough,
etc. Bathing in contaminated water often results in infection to the
middle ear through the Eustachian tube.
=Diagnosis.=—Earache, pain on pressure under the angle of the jaw and
sudden deafness are the symptoms. (There are also the common febrile
symptoms.) The chief physical signs are: redness and bulging of drum
membrane, and contraction and tenderness of upper cervical muscles.
=Treatment.=—If the patient is seen before the drum has ruptured it is
seldom necessary to lance the drum if the proper treatment is given
promptly.
Drainage must be obtained and maintained by catheter aspiration through
the tube irrigation of the nasopharyngeal cavity, irrigation of the
meatus by means of the continuous ear irrigator and application of
dry heat over the affected part. Heat is best applied by means of a
therapeutic lamp. (Any lamp with reflector that will furnish proper
heat is efficient as there is no virtue in colored light.) The skin
surface over the ear, side of face and mastoid region is first well
lubricated with some mineral oil to prevent blistering and the heat is
applied either constantly or intermittently. A pledget of absorbent
cotton dipped into phenol-glycerine is placed in the meatus and forced
loosely against the drum. This should be removed every few hours and a
fresh pledget put in.
The neck and upper dorsal muscles should be kept relaxed and adjustive
treatment given frequently.
Under this treatment the pain should be relieved and the bulging of
the drum should disappear in from two to twelve hours. If this is
not accomplished or if the condition grows worse, the drum should be
lanced. See some text on otology for technique. In my experience, very
few cases have required paracentesis.
It must be remembered that treatment should be continued regularly and
for some time after the pain and other symptoms have been relieved or
a recurrence is probable. Patients should have daily treatment until
the physician is sure that no complication or recurrence is likely to
result.
If the patient is not seen until after the drum has ruptured, the same
treatment may be applied except the irrigation or syringing of the
meatus. This, in case of ruptured drum, may force pus into the mastoid
cells resulting in mastoiditis. Instead of syringing, the auditory
meatus is cleaned by means of a cotton applicator or by aspirating with
a catheter. At all times drainage through the meatus must be maintained
until the drum begins to heal.