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5 of the cases were acutely ill with middle ear disease at the
first attendance. In 2 of these cases the infection had already
spread to the mastoid and an immediate operation was necessary.
These cases were referred to the family Doctor, and through him to
Hospital, where they were operated on. The other 3 cases were
sent home, and the parents advised to call in a doctor. All these
cases were cured.
The remaining cases were all cases of middle ear disease
and there was a perforation in the drum head. Our method of
dealing with these cases needs a little explanation.
We are convinced that the most important point in the
treatment of these ear conditions is the attention given to the
external auditory meatus during the first week of the discharge.
The influence that care of the external auditory meatus has upon
the middle ear is indirect.
(1) The removal of discharge from the meatus leaves room
for fresh discharge to take its place.
(2) The toilet of the meatus prevents the secondary infection
of the middle ear by the organisms present in the external ear.
Inflammation of the middle ear becomes chronic when a
second microbe gets in, and the most frequent source of this
secondary infection is from the skin of tthe external ear. The
organisms require moisture in which to grow, and their growth is
prevented by keeping the skin of the external ear dry and free from
discharge. This part of the treatment then, depends on getting the
ear dry and keeping it so.
It was decided to make each child over 7 years of age take
a part in the treatment of his ear disease. It was uphill work and
occasionally disheartening, but the results have justified our faith
in the intelligence of the school child, and confirmed our views on
the cause of the chronicity, in many cases, of middle ear disease.
58 cases were referred to the Clinic for treatment. Each
child over 7 years was taught to make mops for himself by twiddling
pieces of cotton wool firmly round special sticks, and then by means
of these mops to dry his ear thoroughly. He was also told to do
this at home at least 4 times a day, scrubbing his hands before and
after dealing with his ears, and burning the mops after they had
been used.
There was a little difficulty in getting the scheme to work
at first, chiefly because the children did not want to be bothered,
and in some cases because the parents were afraid of the child
doing some damage to his ears.