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operation. Where one hesitates to advise operation, prolonged
conservative treatment without benefit makes operation easier to
recommend and more acceptable to the parents.
There are several children attending the Clinic at present
with otorrhoea continuing after the conservative mastoid operation.
Perseverance in an effort to obtain a dry ear is made, but if the
ear does not heal soon after operation the chances of success without
recourse to the radical operation seem slight. In two cases
this further operation has been recommended.
As regards the type of case now attending for the first time,
many give a short history of otorrhoea, but on careful inquiry it
is usually found that there was otorrhoea in infancy and sometimes
at intervals afterwards. Ionisation is applied in all cases
where benefit is though likely to accrue and where it is safe to
apply it, but in assessing the value of any treatment regard must
be had to the figure shown above of 11 drying up without any
special treatment.
Most of the cases, of course, were subjected to much more
frequent cleansing after starting to attend the ear clinic. The use
of iodine and boric powder has been extended, and a very favourable
opinion formed of its antiseptic, astringent and healing
properties. Especially in old-standing cases or ears failing to heal
after the conservative mastoid operation, it effects a remarkable
improvement in reducing the granulations and lessening the
amount of discharge. In less complicated cases it seems to be
instrumental in completely drying up the ear. It is easily applied
and its application is especially suitable where the dry method is
desired. Greater success would be attained by the co-operation
of the mother in obtaining and using the insufflator at home, but
this is seldom possible.
Four children with a relapse after previous ionisation applied
for further treatment during the year. One of these had mastoiditis
and was referred for immediate operation.
The value of this Clinic becomes more manifest each year.