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The discussion of primary mastoiditis may perhaps seem beyond the scope of this article; but since the middle ear condition accompanying it must be taken up, some note must be taken of the lesion itself. Heggie and Knauer,20 Wagers21 and Diehl,22 among others, have reported cases of acute mastoiditis, all of the coalescent type, in which there was no evident involvement of the middle ear at any time. The otoscopic picture showed at most nothing more than a slight discoloration of the drum. No aural discharge was ever noted; there was no bulging of the drumhead, no obliteration of the landmarks and no foreshortening of the light reflex. The advent of the mastoiditis was marked by local and constitutional reactions in the form of swelling over the mastoid process, fever, increased leukocytosis and definite destruction of the cellular structure, as noted
KOPETZKY SJ. PROGRESS IN OTOLARYNGOLOGY: A Summary of the Bibliographic Material Available in the Field of Otolaryngology: ACUTE AND CHRONIC SUPPURATIVE OTITIS MEDIA: INCLUDING ACUTE INFECTION OF THE BLOOD STREAM. Arch Otolaryngol. 1925;2(4):379–389. doi:10.1001/archotol.1925.00570010399009
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