INFLAMMATION OF THE EXTERNAL ACOUSTIC MEATUS 305 days will clear this carrier area. In more resistant cases the whole body requires to be washed in a bactericidal liquid soap and dried with a fresh clean towel. Artificial sunlight baths and a reduced carbohydrate diet may be included in general measures. Diffuse Otitis Externa. This condition occurs in acute or chronic stages in which the skin of the external meatus varies from an acute exfoliative and exudative reaction to a chronic granular or proliferative state. Acute Stage This presents usually as a feeling of heat in the ear, soon changing to pain which is often severe and is increased by jaw movements. The appearance of a thin serous discharge is accompanied by easing of the pain. Later the discharge becomes thicker and purulent and in some infections foul-smelling. On examination the meatal skin is inflamed, swollen and very tender. Deaf- ness of conductive type is usually present due to accumulation of discharge and epithelial debris. Enlarged tender periauricular glands are palpable and surrounding oedema may displace the auricle. Wax is noticeably absent. Chronic Stage The features of this stage are discharge and constant irritation or itching. The desire to scratch is great and severe at night-time resulting often in re-infection and exacerbations of the acute stage. Thickening of the meatal skin with narrowing of the lumen may be present, or oedema and desquama- tion with superficial ulceration of the skin may occur. The drumhead is often congested, with a granular surface, and intermittent deafness results from accumulated debris. TREATMENT. The treatment of both stages requires thorough and gentle cleansing of the external meatus, keeping the ears dry, avoiding trauma by scratching, attention to personal hygiene and the treatment of associated skin conditions. In the acute stage local treatment may begin with gentle irrigation of the meatus with warm isotonic saline followed by dry mopping. An attempt should be made to see the drumhead and to clean the antero-inferior meatal recess. Provided that regular toilet of the meatus can be carried out treat- ment with ear drops may give satisfactory results. Preparations containing an anti-inflammatory corticosteroid and a broad-spectrum antiseptic are effective in many patients, e.g. drops containing triamcinolone acetonide and halquinol (Remotic) may be instilled twice daily. Alternatively, after cleansing, the meatus may be packed with a 12mm ribbon-gauze wick impregnated with a cream containing triamcinolone acetonide 0-025 per cent and hal- quinol 0*75 per cent (Remiderm) this treatment being repeated on alternate days. Antibiotic drops and .ointments should be employed circumspectly because of the risk of sensitization or secondary fungus infection, and should be related to results of bacteriological examination. In the wet stage packing of the meatus with 12 mm ribbon gauze soaked in an astringent solution such as 8 per cent aluminium acetate may produce a dry meatus. Packing should be done daily and the patient provided with a quantity of the solution so that the wick can be kept moist by applying a few drops to it three or four times a day.