Thursday, October 1, 2009

Historical Tx of Otitis Media

I want to share this section of the old textbook, A Text-Book of Minor Surgery by Edward Milton Foote, MD (1908) mainly because I want to share the photo of the “angular knife for incision of the tympanic membrane” with you.
Otitis Media
This is a common disease of childhood, usually following a cold in the head. The prominent symptom is earache. Every physician ought to be able to recognize the bulging outward of the membranum tympani and to relieve the pressure by incision of the membrane at the most favorable situation – viz., the inferior and posterior portion. The introduction of warm olive oil into the external meatus will sometimes relieve pain, and the application of external heat may also be tried; but the pain of a severe earache, unless relieved by puncture of the membrane, usually demands the internal administration of morphine. The membrane usually ruptures spontaneously in the course of a day or two. Pain is then relieved, and a muco-purulent discharge begins and continues for a time. After it ceases the membrane soon heals over. While the discharge continues, the treatment consists in cleanliness. The ear should be syringed gently once or twice a day with warm normal salt solution, and wiped dry with absorbent cotton.
Unfortunately, this simple termination is not the only one which is possible, for inflammation of the middle ear may extend to the mastoid cells, and result in abscess within the cavity of the mastoid bone. If prompt drainage is not instituted, the suppuration may extend into the lateral sinuses and to the membranes of the brain, causing the death of the patient. Hence the necessity of early recognition of the disease and prompt treatment before these serious complications have arisen.
The external ear should be cleansed by washing it with small cotton swabs wet with a warm antiseptic solution, and the membrane anesthetized by the instillation of a few drops of a ten per cent solution of cocaine. An ear speculum should then be introduced, the membrane inspected by reflected light or a headlight, and incised in its lower and posterior portion by means of a long slender scalpel bent in the handle at an angle.
Figure 18 shows the normal membrane, and the correct size of an incision, which should be sufficient length to permit the escape of the pus and mucus. Figure 19 shows a good knife for making the incision.
When the incision has been made through the bulging membrane, a few drops of pus and mucus and often a little blood will escape. Irrigation is not necessary, but the auditory canal should be sponged clean with cotton-tipped probes dipped in a warm antiseptic solution. In the case of a nervous or restless child, it is best to perform this operation in general anesthesia. The incision can then be more accurately made.
The after treatment consists in cleanliness. The canal should be wiped or washed clean, and the inner ear protected from temperature changes by a small cone of dry absorbent cotton introduced after each cleansing and as often as the previous cone becomes moist.

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