Drainage tubes should be shortened and removed as soon as possible. The gauze within the wound cavity should be changed every second day, or daily if there be much secretion. If there be much discharge and the condition be very septic, an ear-bath of hydrogen peroxide may be given at each dressing and the cavity syringed out with a weak solution of biniodide of mercury; otherwise it is sufficient to use boric acid lotion.
If the operation has been successful, the purulent discharge from the tympanic cavity rapidly diminishes, frequently ceasing before the third day. The auditory canal is then firmly packed with gauze, especially in its outer part, in order to prevent stenosis of its lumen, which is liable to occur if the posterior fibrous portion of the canal has been separated from the bony meatus during the operation. Granulations very quickly block the aditus and so separate the antrum and mastoid cavity from the tympanic cavity. The wound can now be treated as an ordinary deep surgical wound, care being taken that it is packed from the bottom at each dressing.
If all the diseased bone has been removed, smooth healthy granulations will cover the wound. The continuance of pus from any spot, or the local growth of exuberant granulations, suggest the presence of an infected cell or a fragment of carious bone. Under cocaine anæsthesia, the part should be inspected carefully, and, if necessary, curetted freely. In other cases the local application of chromic or trichloracetic acid is sufficient.
After the second week the wound becomes shallower, actual healing of the wound depending on the size of the cavity.
Unless a very large amount of bone had to be removed, the resulting deformity is not great and usually only consists of slight sinking in of the skin. In some cases the final result is only a fine scar, which can generally be concealed by the hair.
The difficulties and dangers of the operation are considered in the next chapter (see [p. 412]).
Results. 1. If the operation has been successful (and this is usually the case), pyrexia and pain rapidly disappear, the patient experiencing remarkable relief from the head symptoms, so that within twenty-four hours he feels almost well. Healing of the wound is usually complete within six weeks, and before this date the hearing power will probably have been restored to normal.
2. The operation may not have been successful and the following unfavourable symptoms may occur:—
(a) The pyrexia may continue irregularly for a few days. If there be no other symptoms, this is probably due to septic absorption from the wound and need not cause very great alarm. If accompanied by pain, it may either mean that all the infected mastoid cells have not been opened, or suggest the onset of osteomyelitis of the temporal bone. If, in addition, such symptoms as rigors, delirium, optic neuritis, headaches, or vomiting occur, they indicate some intracranial complication.
In cases of doubt it is wiser to explore the wound under a general anæsthetic and then to determine what operation will be necessary.