The purpose of this report is to present two cases in which the patients carried virulent diphtheria organisms in the middle ear and mastoid without clinical signs referable to the ear, and showed obscure but persistent general reactions. Alexander1 observed the destruction of tissue in the tympanic and epitympanic spaces, without evident involvement of the drum membrane. In a recent thorough review Drury2 cites briefly the facts in every case of diphtheria of the ear in the medical literature; the earliest reported depend on clinical signs for determination as virulent diphtheria; the later ones on guinea-pig inoculation, which is the absolute proof of the virulence of the organism. The two cases described here were selected from a group of cases of diphtheric infections of the mastoid, the remaining four being either secondary diphtheroid infections from wound contamination or infections not clearly primary in the middle ear space.
COSTEN JB. DIPHTHERIA INFECTION OF THE MIDDLE EAR AND MASTOIDREPORT OF TWO CASES. Arch Otolaryngol. 1927;5(2):119–121. doi:10.1001/archotol.1927.00600010131002