Causes.—­Troubles (lesions) located in the upper pharynx, the naso-pharyngeal (nose-pharynx) vault and the nasal passages.  Adenoids may cause it.

The course of this disease has of recent years been growing more favorable, because the causes are being removed more and more.

Symptoms.—­Symptoms of the acute inflammation would be present, and impairment of hearing which sometimes comes so gradually as not to be noticed by the patient.  It will be better and then worse.  A harassing, hissing, blowing, ringing, usually accompanies it.  Pains soon or later add to the discomfort.  One side is usually affected first.

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Treatment.—­It must be devoted to removing the causes just mentioned.  Restore the general health.  Abstain from alcohol, tobacco and excess of all kinds.  Active outdoor exercise, horseback riding, mountain climbing, rowing, walking, etc., are great health producers.

Acute suppurative inflammation of the middle ear.—­This inflammation of the middle ear is one in which, at an early stage of the disease, the free liquid poured out assumes a pus-like character.  At the onset the mucous membrane of the eustachian tube and middle ear becomes first congested and afterward oedematous (watery swelling).  Then a serous or a bloody-serous fluid is poured out into the middle ear; and finally this assumes all the outward characteristics of pus.  In a few exceptional cases this pus fluid will find a sufficient passage through the eustachian tube; but in the great majority of cases this passageway becomes closed almost at the very beginning of the attack, and then the free exudation; under an ever increasing pressure and on account of the softening and breaking down of the tissues of the drum forces an opening for itself directly through the drum membrane.

Causes.—­The same causes that produce the acute variety will produce this variety of the disease.  It occurs more frequently during the spring and fall months as the result of changes in the climate.  Acute and chronic catarrh of the nose and pharynx are causes.  It frequently occurs in connection with scarlet fever and measles.  It complicates nose and pharyngeal diphtheria.

Symptoms.—­Pain in the ear is the most striking symptom noticed by the patient.  In infants and young children of two or three years of age it may appear and not be recognized until a slight discharge appears at the opening of the external ear.  The child is feverish, fretful and peevish, seemingly suffering great pain, and the parents think it is, not very sick or has only an earache.  Sometimes physicians fail to recognize the trouble until the discharge appears in the external ear.  The symptoms are more severe at night.  Any physical or mental exertion increases the plain.  The pain is sometimes very severe, and a spontaneous or artificial rupture