Treatment.—The fluid can be evacuated by an opening made into the drum, but it usually accumulates again. The proper treatment is to treat the diseased condition of the nose and throat, as described in other parts of this book.
CHRONIC CATARRHAL INFLAMMATION OF THE MIDDLE EAR.—The expression, acute inflammation of the middle ear, is rightly employed when it is applied to a case in which the underlying cause is of a temporary nature, as for example, a cold in the head, and mild attack of influenza, perhaps also in an attack of hay fever. But when the causes are of a more permanent character and the middle ear continues for an indefinite period to be the seat of all sorts of disturbances the combination of these different diseased phenomena receives the name of chronic catarrhal inflammation of the middle ear.
Causes.—Troubles (lesions) located in the upper pharynx, the naso-pharyngeal (nose-pharynx) vault and the nasal passages. Adenoids may cause it.
The course of this disease has of recent years been growing more favorable, because the causes are being removed more and more.
Symptoms.—Symptoms of the acute inflammation would be present, and impairment of hearing which sometimes comes so gradually as not to be noticed by the patient. It will be better and then worse. A harassing, hissing, blowing, ringing, usually accompanies it. Pains soon or later add to the discomfort. One side is usually affected first.
[EYE AND EAR 363]
Treatment.—It must be devoted to removing the causes just mentioned. Restore the general health. Abstain from alcohol, tobacco and excess of all kinds. Active outdoor exercise, horseback riding, mountain climbing, rowing, walking, etc., are great health producers.
ACUTE SUPPURATIVE INFLAMMATION OF THE MIDDLE 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.