Causes.—­It occurs as a primary or secondary disease.  The first condition is rare and the result from injury, exposure to cold and dampness, or from syphilis or tuberculosis.  Secondary disease is catarrhal or pus-like in form.  This results from an extension of middle ear disease through the antrum, as a rule.  The disease may develop at any time and endanger the life of the sufferer.

Symptoms.—­Dull constant pain behind the ear and tenderness on pressure, more severe at night, the tenderness is very apt to be followed in a short time by redness and swelling of the skin in the same region.  The pus may drain from the mastoid into the middle ear cavity.  If this does not happen it may swell behind the ear and break through some other place.  It may involve the structures within the brain.  If meningitis develops, the patient has headache and later it becomes very severe.  Lights hurts the eyes, The patient is restless, sleepless, may have nausea and vomiting and a constant high temperature.  The neck is stiff and rigid.  If there is more brain involvement (phlebitis) there will be sudden rise of temperature, followed by a rapid fall of temperature and attended by profuse sweating and chills,—­a dangerous condition.  There can be abscess of the brain also.  In abscess of the brain symptoms are less severe and localized; the rigid neck and fear of light and vomiting are absent.

[366 Mothers’ remedies ]

Treatment.—­If seen early it may be aborted.  If an examination of the drum shows bulging, an incision of the drum head should be made.  If an opening is there it should be enlarged, if necessary.  Cold applications are valuable and should be applied directly over the mastoid behind the ear.  Sometimes hot applications are better, hot poultices, cloths, etc., syringing the canal with hot water.  These applications, etc., should be constantly used for a day or, so, unless unfavorable symptoms set in, when if a marked improvement, especially in the local tenderness and pain, has not occurred, an operation should be done and the mastoid opened.

The diet should be liquid (milk), nourishing and sustaining.  Bowels should be kept open.

This disease must be carefully watched.  It is not only dangerous to life, and very quickly, but it is full of disagreeable and dangerous possibilities, lifelong discharge from the ear, an external fistulous opening, a permanent paralysis of the facial nerve, abscess in the brain.  Brain symptoms, paralysis and pus symptoms do not now preclude an operation on the mastoid for mastoid disease.  The patient should be closely watched and an operation performed as soon as called for.