Acute Otitis Media in Infancy.

Anatomy.-The tympanic membrane is the same size in the new-born as in the adult. It lies almost horizontal in the plane of the base of the skull, so that its lateral border is almost in the same plane as the superior wall of the meatus. Thus the postero-superior quadrant, the region in which bulging is usually detected, is very near the surface and next the inner limit of the superior wall of the meatus. The meatus is cartilaginous, and runs upwards from its attachments to the tympanic ring, so that to straighten the meatus and enable a view of the tympanic membrane to be obtained, the lobule must be pulled downwards. For examining the membrane and deep reaches of the meatus, the use of an electric otoscopel, with a small speculum, is essential. The mastoid process developes only towards the end of infancy. The aditus and antrum are present at birth. The latter lies above and somewhat behind the tympanic ring. I have frequently operated upon infants of six months of age for mastoiditis, and found an extensively pneumatized mastoid process.