ely opened.
Pain may be allayed by repeated instillations of cocain and carbolic
acid (5 grains of each to a dram of glycerine). A few drops of
laudanum, hot boracic instillations, or the application of a dry hot
sponge, may prove soothing. Two or three leeches may be applied over
the mastoid, but should the pain persist or should rupture of the
membrane appear imminent, paracentesis must be carried out. After
spontaneous perforation or puncture, the meatus must be kept clean. It
is probably safer not to inflate through the Eustachian tube in the
acute stage. Attention must be paid to any affection of the nose or
throat that may be present.

#Chronic Suppuration in the Middle Ear.#--Acute suppuration may pass
into the chronic variety, which is characterised by a perforation of
the tympanic membrane, a persistent purulent or muco-purulent
discharge from the middle ear, and a certain amount of deafness.

_Various complications_ may arise in the course of chronic middle-ear
disease, and so long as a person is the subject of a chronic
otorrhoea, he is liable to one or more of these. The complications may
be extra-cranial or intra-cranial. Those affecting the middle ear
itself include granulations, polypi, cholesteatoma, caries and
necrosis of the temporal bone, destruction and loss of one or more of
the ossicles, facial paralysis, haemorrhage from the carotid artery or
jugular vein, and malignant disease. As mastoid complications may be
mentioned: suppurative mastoiditis, leading to destruction of the
bone, mastoid fistula, and sub-periosteal mastoid abscess. The
intra-cranial complications that may arise are: extra-dural abscess,
sub-dural abscess, meningitis, cerebral and cerebellar abscess, and
lateral sinus phlebitis with general septicaemia and pyaemia.

The _treatment_ of chronic middle-ear suppuration consists in keeping
the parts clean by syringing with antiseptic lotions. The installation
of hydrogen peroxide, followed by syringing with boiled water or
boracic lotion, and inflation through the Eustachian tube once, twice,
or thrice daily, according to the requirements of the case, constitute
a routine method. Packing the meatus with antiseptic gauze after
washing out may be practised.

#Suppuration in the Tympanic Antrum and Mastoid Cells#, or _Acute
Suppurative Mastoiditis_.--Acute suppuration may occur in the mastoid
cells in the course of an attack of acute otitis media, or as a result
of interference with