Progress in the Treatment of Mastoid Infection and Some of its Complications

"I believe the opportunities for mastoid surgery are gradually decreasing in proportion as the prophylactic measures against the incidence and spread of aural disease increase. Indeed, the time may not be far distant when intracranial complications of otitic origin will be considered rare phenomena." My introduction to mastoid surgery was in 1920 in Edinburgh, where I worked for two years under Mr. J. S. Fraser. His method of treating the acute mastoid cavity, after a most thorough removal of all infected bone, was to cleanse it with hot hydrogen peroxide and to pack the wound with iodoform gauze, leaving an adequate drain at the lower end after closure of the rest of the wound. The pack was removed on the third day, the wound was repacked and continued to discharge more or less for three to four weeks before healing took place. This ideal was not always attained: often the wound broke down, when eusol syringing was carried out twice daily. An infected, broken-down wound meant prolonged treatment, sometimes of many months' duration. Going to Bradford in 1922, for four or five years I tried other methods then practised, such as the blood clot method-closure without drainage. This was very unsatisfactory, as the wound usually broke down. Then there was the method of leaving the wound almost entirely open, packing it, and allowing it to heal by granulation tissue from the bottom. This was a tedious method, but it certainly obliterated the cavity, and there were no recurrences. The subsequent depression over the mastoid is unsightly. Nevertheless, it is a method practised even to-day in certain clinics. Next came the use of various antiseptics with packing. Of these T.C.P., first produced about 1922, was the most successful in my hands. It was in 1928 that I discarded bipp and reverted to the Carrel-Dakin method of flushing the wound with eusol and drainage by rubber tubes. This method was employed almost exclusively until early in 1933. It was a safe method-took time to do the dressings, but obliterated the cavity. T.C.P. was used as a final lotion for dressing the wound.