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The etiology, symptoms and pathologic changes of an ordinary case of acute suppurative inflammation of the middle ear are more or less familiar to us all. The formation of pus in the tympanic cavity is usually followed by rupture of the drumhead and the discharge heralds an approaching sure and speedy recovery if drainage is free enough to permit the early exit of the pus. Such a case, free from complications, pursues a regular course and tends under careful hygienic and rational treatment, to spontaneous cure. Often, however, we meet with cases when for some reason the tympanic membrane does not yield to the pressure and the pus after invading the mastoid antrum and cells, may have to seek another outlet. The Eustachian tube, the natural ventilator of the middle ear, rarely serves as a drainage tube on account of the closure of its small lumen from inflammatory swelling, originating
PARKER EF. REMARKS ON OTITIS MEDIA AND OTITIC SYPHILIS, WITH REPORT OF A RHINOLITH AND AN ACCESSORY TOOTH IN THE NOSE.. JAMA. 1897;XXIX(15):729–730. doi:10.1001/jama.1897.02440410017002f
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