The treatment of chronic purulent inflammation of the middle ear / by James Erskine.

  • James Erskine
Date:
[1887]
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of chronic purulent inflammation of the middle ear / by James Erskine. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    otitis media purulenta : a number of them have been re- ferred to in the course of the paper. Periostitis, abscess, and caries or necrosis of the mastoid call for treatment according to ordinary surgical principles. Periostitis over the mastoid is most radically dealt with by Wilde's incision made down to the bone. This incision is generally directed to be made about one-third of an inch behind the .attachment of the auricle and parallel with it. Politzer advises that the incision should be made where the infiltra- tion is greatest, and where examination suggests an accumu- lation of pus in the deeper parts. When there are no surer signs of pus under the periosteum he makes the incision •close to the place of attachment of the auricle, in order to use it in case Wilde's incision should be unsuccessful for the operation of opening the mastoid antrum. There need be no hesitation in incising an abscess over the mastoid pro- cess, for it is sometimes found communicating with the mastoid antrum. The operation of trephiningthe mastoid pro- cess is performed for the purpose of removing purulent material which has been pent up in the interior of the bone, and also for the removal of sequestra or carious bone. By its means a communication may be effected between the tympanic cavity and the external opening over the mastoid process through the antrum mastoideum. Through the channel formed in that way it is possible to wash out the middle ear and the inastoid antrum and cells, and to remove any stagnating and putrid secretion contained therein. By this means the development of serious affections of the brain and sinuses may be prevented. Extirpation of the malleus is practised for the cure of disease in Shrapnell's membrane, and is attended with suc- cess, the hearing in many cases being improved. Everything that acts as an obstruction to the free discharge of pus in chronic otitis media should be as early and as effectually removed as possible. The tympanic membrane itself may form such an obstruction. It may have been noted that the perforations in that membrane were small in the cases of cerebral abscesses recently operated upon, and reported in the medical journals. The complete removal of the mem- brana tympani in cases of otitis media purulenta is an operation calling for immediate adoption. The preservation of a limited power of hearing is of little consequence com-
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