One of the most difficult problems that face the otologist, from a standpoint of both diagnosis and of treatment, is that presented by the case in which signs of sepsis occur after a double mastoid operation has been performed. It is difficult because even after all the means at one's command, including inspection of the sinuses, have been used, it is often impossible to tell with any degree of certainty which sinus may be the offender. If after one jugular vein has been ligated and the sinus obliterated the symptoms still persist, the problem of proper procedure is further complicated.
That bilateral thrombophlebitis with or without complete thrombosis, diagnosed ante mortem, is not a common condition is attested by the facts that few cases are on record and that many competent observers with wide experience, working in large centers, have not encountered the condition.
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