ACUTE SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR

Categories: 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 fe 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.