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"The treatment of otorrhæn adopted at the Clinic
depends on recognising that sepsis is the essential factor in
the cause of both acute and chronic suppuration. The
essential difference between these is that in the former there
is infection by one species of micro-organism and the tissues
usually show signs of considerable inflammation. In 'chronic
otorrhæa' the discharge is infected by several varieties, and
the tissues are irritated, but not acutely inflamed. Factors
in addition to sepsis may aid in keeping up the suppuration,
Such factors are granulations, polypi, caries, etc. The area
of sepsis is important. It may be limited to an accessible
place, the tympanum is usually such, or it may extend into
the mastoid antrum, which is nearly always beyond the reach
of treatment without operation.
From what has been said it is plain that where sepsis
alone is responsible the treatment should be antiseptic in
nature, but where another factor is present, such as a
polypus, this should first be removed and the sepsis dealt
with subsequently. Occasionally inflammation in a neighbouring
organ, such as the nose or throat, may be mainly
responsible for the continuance of the discharge. If so, the
neighbouring area, as well as the ear, is treated. In
moderate or severe cases of discharge from the ear due to
sepsis in the tympanum zinc ionization is the mainstay of
the treatment adopted, while in slight cases or cases nearly
well the blowing of boracic powder into the ear is found to
be sufficient. Where the sepsis involves an area difficult of
access an effort is made by the use of special instruments
to bring the ionizing fluid and the electric current into contact
with the surface involved, but in many cases this is
impossible unless an operation is done to make the part
involved accessible. This necessitates the child being sent
to hospital. It is important that a child should not be discharged
from treatment at a hospital until quite well, as
secondary changes are in time likely to develop, which make
the case almost, if not quite, incurable.
Treatment is given to the children once a week or once
a fortnight. Daily treatment is not prescribed except in an
acute case. Every effort is made to avoid re-infection of
the ear by asking the mother to take care that water does not
enter it.