It is generally accepted as a truism that the most frequent mode for propagation of an inflammation from the naso-pharynx to the middle ear is by direct extension along the mucous lining of the Eustachian tube. Any hindrance to drainage of the middle ear and tube occasioned by occlusion of the nose or pharynx is also recognized as a prolific cause of Eustachian salpingitis and otitis media. This is particularly marked in children, as their naso-pharynx is quite small in proportion to that of adults. Hence, the relatively greater number of acute aural affections in young people.
While these are the usual methods, a factor which may be overlooked is sometimes the actual cause, and in other cases an adjuvant of the inflammatory process. The recumbant position in any febrile disease, accompanied by inflammation of the upper air passages, leads to the accumulation of secretion from the nose and mouth
WÜRDEMANN HV. THE INFLUENCE OF THE RECLINING POSTURE IN FEVERS UPON THE PRODUCTION OF OTITIS MEDIA.Read at a meeting of the Milwaukee Medical Society, Dec. 22, 1891. JAMA. 1892;XVIII(3):77. doi:10.1001/jama.1892.02411070017001g
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