drainage in chronic suppuration of the antrum and
middle ear. As the outer wall of the mastoid is liable to be
perforated by cario-necrosis, the pus may find its way externally and
form an abscess over the mastoid process behind the ear. In some cases
the pus escapes into the external auditory meatus by perforating its
posterior wall; in others a sinus forms on the inner side of the apex
of the mastoid, and the pus burrows in the digastric fossa under the
sterno-mastoid--_Bezold's mastoiditis_. If the posterior wall or roof
of the antrum is destroyed, intra-cranial complications are liable to
ensue.

The _clinical features_ are pain behind the ear, tenderness on
pressure or percussion over the mastoid, redness and oedematous
swelling of the skin, and, when pus forms under the periosteum, the
oedema may be so great as to displace the auricle downwards and
forwards (Fig. 265). The deeper part of the posterior osseous wall of
the meatus may be swollen so that it conceals the upper and back part
of the membrane.

[Illustration: FIG. 265.--Acute Mastoid Disease, showing oedema and
projection of auricle.]

_Treatment._--When arising in connection with acute otitis, the
application of several leeches behind the ear, free incision of the
membrane, and syringing with hot boracic lotion may be sufficient. As
a rule, however, it is necessary to expose the interior of the antrum
by opening through the mastoid cells--_Schwartze's operation_. When
mastoid suppuration is associated with chronic middle-ear disease,
it is usually necessary to perform the complete radical
operation--_Stacke-Schwartze operation_. The operations are described
in _Operative Surgery_, p. 98.

CHAPTER XXV

THE NOSE AND NASO-PHARYNX[6]

Fracture of nasal bones--Deformities of nose: _Saddle nose_; _Partial
and complete destruction of nose_; _Restoration of nose_;
_Rhinophyma_--Intra-nasal affections--Examination of the nasal
cavities: _Anterior rhinoscopy_; _Posterior rhinoscopy_; _Digital
examination_. CARDINAL SYMPTOMS OF NASAL AFFECTIONS: Nasal
obstruction: _Erectile swelling of inferior turbinals_; _Nasal
polypi_; _Malignant tumours_; _Deviations, spines, and ridges of
septum_; _Haematoma of septum_--Nasal discharge: _Foreign bodies_;
_Rhinoliths_; _Ozaena_; _Epistaxis_; _Suppuration in accessory
sinuses_--Anomalies of smell and taste: _Anosmia_;
_Parosmia_--Reflex symptoms of nasal origin--Post-nasal