Suppuration in the petrosal pyramid is found to occur in two forms. In one, an osteomyelitic lesion develops in the bone, and in the other, coalescent osteitis is present. The symptoms which present themselves differ essentially in the two types of lesion; and in order to make a diagnosis it is necessary to differentiate these forms clinically. It is therefore necessary to touch on the pathologic entities of these infections so as to comprehend their varying clinical courses and differing clinical pictures. Both these lesions are found to accompany or follow an infection of the tympanic cavity.
According to Ramadier, one deals with two forms of osteomyelitic lesions in the petrosal pyramid. One form is termed hematogenic, and the second form, otogenic. The former is most frequently present in the very young patient. The clinical picture is one of general infection. There is marked prostration; there are gastro-enteritic disturbances,
KOPETZKY SJ. DIAGNOSIS AND DIFFERENTIAL DIAGNOSTIC DATA ON SPECIFIC TYPES OF SUPPURATION IN THE PETROSAL PYRAMID. Arch Otolaryngol. 1935;22(4):403–409. doi:10.1001/archotol.1935.00640030419001
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