Politzer's text-book of the diseases of the ear and adjacent organs : for students and practitioners / translated by Oscar Dodd ; edited by Sir William Dalby.

  • Politzer, Adam, 1835-1920.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Politzer's text-book of the diseases of the ear and adjacent organs : for students and practitioners / translated by Oscar Dodd ; edited by Sir William Dalby. Source: Wellcome Collection.

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    affection, from certain symptoms it is possible to conclude as to the presence of mastoid disease. As for example : persistent, septic, crumbling suppuration with perforation in the posterior superior quadrant of the membrana tympani, or a fistulous opening in Shrapnell's membrane. The diagnosis is scarcely questionable if the suppuration is accompanied by occasional boring pain and tenderness in the mastoid region. The probability that a protracted septic suppuration in the tympanic cavity is complicated with a suppuration of the mastoid antrum is more sure if, with moderate secretion in the tympanic cavity, a large amount of secretion can be aspirated from the posterior superior portion of the attic into the external meatus with the Siegle speculum. Frequently-recurring and long-continued boring pain in the mastoid process, without visible external changes and without the knowledge of pus-retention in the tympanic cavity offers no sure diagnostic point, as it occurs as well by deeply-seated secluded abscesses as from neuralgia in osteo- sclerotic mastoid processes. On the other hand, one can conclude with probability as to suppuration in the mastoid process when there are granulations and cholesteatomous formation in the tympanic cavity, or with narrowing of the external meatus symptoms of pus- retention (fever, chills, headache and vomiting) are present even when no pain occurs either spontaneously or upon pressure. Prognosis.—The prognosis of chronic disease of the mastoid process is frequently indefinite, as the extent of the disease in the mastoid process can only rarely be determined from the objective and subjective symptoms. In general the prognosis is better in inflammations which develop with reactionary symptoms, if after 2 to 3 days redness and swelling occur on the mastoid pro- cess, symptoms which signify a superficial location of the inflam- mation. The prognosis will also be better if a cario-necrotic process in the tympanic cavity and external meatus can be excluded by the examination with the mirror. The prognosis is unfavourable, on the other hand, with accompanying caries of the walls of the tym- panic cavity, with occlusion of the cavum tympani through granu- lations and cholesteatomous masses, with excessive narrowing of the meatus, and in cases which show at the first observation symptoms of intra-cranial complications, or sinus-thrombosis. In general, diseases of the mastoid process offer a better prognosis in healthy individuals than in cachectic and tuberculous persons. Treatment.—The treatment of affections of the mastoid process varies according to the duration and intensity of the inflammatory symptoms, and according to its complication with deeply-seated changes in the tympanic cavity, and in the external meatus.