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ACUTE SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR





Category: Diseases of The Eye and Ear

This inflammation of
the middle ear is one in which, at an early stage of the disease, the free
liquid poured out assumes a pus-like character. At the onset the mucous
membrane of the eustachian tube and middle ear becomes first congested and
afterward oedematous (watery swelling). Then a serous or a bloody-serous
fluid is poured out into the middle ear; and finally this assumes all the
outward characteristics of pus. In a few exceptional cases this pus fluid
will find a sufficient passage through the eustachian tube; but in the
great majority of cases this passageway becomes closed almost at the very
beginning of the attack, and then the free exudation; under an ever
increasing pressure and on account of the softening and breaking down of
the tissues of the drum forces an opening for itself directly through the
drum membrane.

Causes. The same causes that produce the acute variety will produce this
variety of the disease. It occurs more frequently during the spring and
fall months as the result of changes in the climate. Acute and chronic
catarrh of the nose and pharynx are causes. It frequently occurs in
connection with scarlet fever and measles. It complicates nose and
pharyngeal diphtheria.

Symptoms. Pain in the ear is the most striking symptom noticed by the
patient. In infants and young children of two or three years of age it may
appear and not be recognized until a slight discharge appears at the
opening of the external ear. The child is feverish, fretful and peevish,
seemingly suffering great pain, and the parents think it is, not very sick
or has only an earache. Sometimes physicians fail to recognize the trouble
until the discharge appears in the external ear. The symptoms are more
severe at night. Any physical or mental exertion increases the plain. The
pain is sometimes very severe, and a spontaneous or artificial rupture of
the drum eases the suffering very quickly in some cases, and a bloody,
serous, pus-like discharge escapes into the external ear canal. Often a
patient will say: "I felt something give away in the ear, a watery
discharge appeared, and the pain soon subsided." In many cases the rupture
of the drum gives little or no relief from suffering. This is due in some
cases to the small and insufficient size of the opening in the drum. If
the pain persists, after a free opening has been made, it may indicate
that pressure exists in some cavity or cavities other than the middle ear
proper. A sensation of fullness and sometimes of throbbing or pulsation in
the affected ear; roaring, singing, whistling, etc.; impairment of
hearing; increased pain, when the jaws are opened and shut, are symptoms
of minor importance. If there are no complications after free discharge
sets in the pain disappears, the fever gradually returns to the normal
point, and the patient drops to sleep. In the course of a week or two the
discharge subsides and if the rupture is not too extensive the wound will
close and the patient will soon be well. Frequently, however, on account
of disease of one or more of the bony parts, the wall of the middle ear or
the mastoid cells, the discharge continues for weeks and may become
chronic in its character.



Treatment. Apply heat or cold first. Open the bowels.

How to apply heat. With the patient lying on his side with the affected
ear turned upward, fill the external ear canal with hot water (about 105
degrees F.), then place immediately over the affected ear a hot flaxseed
meal poultice, five or six inches square and one-half inch thick, and
spread a folded blanket or shawl over the whole to keep it warm as long as
possible. Bread and milk with catnip, or onions will do if flaxseed is not
at hand. The flaxseed holds the heat longer. Water is a good conductor of
heat, and that which fills the external auditory (ear) canal may rightly
be considered as an arm of the poultice which extends down to the drum
itself.

Leeches also can be applied in front and below the tragus (front of the
opening). If the symptoms do not improve under this treatment and
especially if the drum is bulging, an opening should be made at the
bulging point of the drum. The canal is now syringed with a warm
antiseptic solution--like one part listerine, etc., to twenty parts of
warm boiled water, with a clean syringe, or warm boiled water can be used
alone. If there is any odor carbolic acid one part, to fifty or sixty of
water can be used. A strip of sterile gauze is put into the canal for
drainage and protection. This syringing can be done from two to four to
five times a day, and gradually decrease the number of times as the
discharge lessens. It must be syringed and dressed often enough to allow a
free discharge and produce cleanliness.

Recovery. The result of this disease cannot be told at the outset. The
majority of such attacks end favorably, with care and treatment; this in
persons of good constitution and health. It may run ten days to three to
six weeks. In tuberculous patients the result is not so favorable.
Recovery follows as a rule in this disease following scarlet fever and
measles, but not so quickly, and there may be a discharge for some time,
due to chronic disease of the ears, etc.

Complications and results. In the majority of cases, in ordinarily
healthy persons, this disease runs its course without doing any great
amount of damage to the organ of hearing, and without involving any
structure lying outside of the middle ear proper. In scarlet fever,
measles, la grippe, or nasal diphtheria, actual destruction of tissue
often takes place in some part of the middle ear before it is recognized.
Sometimes it results the same way even when it is discovered in time.

Caution. A person who has had this disease should be very careful not to
take cold. The patient should take plenty of time to get well and strong.
The diet should be liquid mostly.





Next: CHRONIC SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR

Previous: CHRONIC CATARRHAL INFLAMMATION OF THE MIDDLE EAR



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