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ACUTE OTITIS MEDIA                                317

When the ear is discharging, either after a myringotomy or because the
•umhead has perforated, dry mopping is required at frequent intervals in
Idition to the administration of the appropriate antibiotic as determined
t sensitivity tests. Mopping is performed with sterile cotton-wool as
equently as appears necessary from the amount of the discharge. The

scharge must be cleaned as thoroughly as possible, and this is best achieved
/ a trained nurse. Some surgeons advise gentle syringeing with warm sterile
Lline solution to remove the discharge, and this may have to be repeated
>veral times daily. Syringeing or mopping is continued until the ear is dry.
he use of drops is not likely to be helpful in the presence of copious dis-
large, and they should not be used until all the mucopus has been cleared,
[ydrocortisone and neomycin drops are less likely than chloramphenicol
rops to cause sensitization reactions. Should the discharge be sterile on
jlture, e.g. when myringotomy is performed because of a delayed response
> antibiotics, boric acid ear drops may be sufficient.

In cases where copious discharge persists for a period of 4 weeks, where
eafness becomes more progressively marked, and if the perforation is
nail, it may be advisable to drain the mastoid at a cortical operation. This

more urgently necessary if there is a diminution of discharge and a return
f pain.

Systematic inflation of the Eustachian tube may be carried out, after the
cute phase has passed, if the hearing does not rapidly improve.

It is important to ensure that the upper respiratory tract does not require
•eatment, especially if the discharge persists. Adenoids may have to be
smoved or sinuses washed out in such an event.

It is necessary to be certain that there is a complete resolution of an acute
titis media or the condition may become chronic. If the drumhead is intact
nd remains congested myringotomy is called for. If discharge persists in
pite of energetic treatment radiography of the mastoid processes should
>e done to ensure that there is not a reservoir of infection in the cells, and
? this is discovered the mastoid should be opened.


during the first 2 years of life aural suppuration is more frequent than at
ny subsequent age. Whilst infants may not often be affected by the common
old, which is a frequent cause of the disease in older children, there are
rther factors such as lack of immunity, the short, wide Eustachian tube,
>ottle feeding while lying in a cot or pram, vomiting or regurgitation and
eething which predispose to middle ear infection. An otoscopic examina-
ion should be made in all cases in which an infant is feverish at night with-
>ut any other obvious cause. The drumhead is thicker in infancy than later
n life, so that there is less obvious bulging and less tendency to spontaneous
upture. The prognosis in acute otitis media is favourable, most infants
ihowing no discharge and no deafness later in life. Failure of an infant
o respond to antibiotic therapy given for an upper respiratory tract infection
>r gastro-enteritis should focus attention on the ears where changes in the
ympanic membranes may call for myringotomy. A swab of the discharge
nust be taken at operation or from any mucopus in the ear so that appro-
priate antibiotic therapy can be started. Not infrequently the original