Tympanic Abscess 99 



The pus may be absorbed, or may happily escape along the in- 

 flamed Eustachian tube ; but, if it be allowed to remain uninterfered 

 with in the tympanum, it may take its time in bursting through the 

 membrane, and may, but not necessarily so, leave the ear permanently 

 deaf. 



Complications. The abscess may burst through the roof of the 

 tympanum and cause meningitis, and an intra-cranial abscess, in the 

 neighbourhood of the petrous process and of the temporo-sphenoidal 

 lobe. Sometimes the matter burrows into the mastoid cells, in which 

 case its prompt escape may be helped by drilling behind the pinna, 

 or by cutting through the inflamed and softened mastoid process with 

 a gouge. 



In the case of a boy who was recently under my care, the in- 

 flammation had extended from the tympanum throughout the entire 

 petromastoid bone, which came away as a large sequestrum without 

 implication of the internal carotid artery (which passes through it, 

 p. 13), but with, of course, total destruction of the portio dura, per- 

 manent facial paralysis resulting. 



Extension of ulceration from the tympanum may involve the 

 carotid, or the jugular vein, fatal haemorrhage occurring through the 

 external meatus. 



Suppuration from the petro-mastoid bone may reach the neck 

 and cause cervical abscess. If the inflammation extend downwards, 

 it may cause phlebitis in the internal jugular, and if downwards and 

 backwards to the neighbouring lateral sinus it may there set up an in- 

 flammation ; in both cases coagulation of the blood supervenes, and, 

 pieces of the septic thrombi being carried into the circulation, pyaemia 

 and metastatic abscesses result. 



Cerebellar meningitis and abscess may follow extension of the 

 inflammation from the back of the tympanum and the mastoid cells. 



The treatment of acute otitis demands the free application of 

 leeches behind the pinna and in front of the tragus, with subsequent 

 fomentations. If the membrane be found congested and bulging, 

 paracentesis must be promptly resorted to. If the mastoid cells be 

 apparently involved they should be freely opened. 



The Eustachian tube, i^ inch long, leads into the pharynx from 

 the middle ear, at the level of the inferior meatus ; its direction 

 is forwards, inwards, and slightly downwards. Its posterior part is 

 osseous, being at the junction of the squamous and petrous portions 

 of the temporal bone. The anterior part is fibro-cartilaginous, and 

 ends by a trumpet-shaped expansion, from the lower aspect of which 

 the tensor and levator palati arise. Contraction of these muscles 

 during deglutition opens the tube and allows air to enter the tym- 

 panum. A 'singing in the ear' may often be made to disappear by 

 setting the tensor palati in action by swallowing, the inrush of air 

 causing the membraae to yield r with a eHght? crack.- ;- - 



H 2 



