Penicillin in Diseases of the Ear, Nose, and Throat
نویسنده
چکیده
Otitis externa. Penicillin drops applied to the external meatus appear to me to have no value at all. In otitis externa it must be almost impossible by such means to maintain a sufficient concentration of the drug in contact with the infected tissues. At all events, among some thirty cases I have seen none in which it has given any good result : and in several I had the impression that the applications were actually irritating. Otitis media, acute. Still less can penicillin drops be expected to achieve anything in otorrhea due to otitis media. Consider for a moment the anatomical features. In the normal ear there is an open passage, the aditus, between tympanum and mastoid antrum , in otitis media, by the time there is sufficient pus in the former to bulge the membrane it is inevitable that the infection has already reached the antrum?all clinical experience supports this expectation. Once this has occurred, or at least before perforation takes place, the mucosa of the aditus, antrum and cells swells up, obliterating the air spaces. How can it be possible that any bactericidal agent placed in the meatus can penetrate the perforation, often minute, pass up between the folds of swollen mucosa to the attic, and back through the aditus to the antrum and cells ? Still less, how can it possibly reach the bacteria in the mucosa of these cells, and in effective concentration ? On the other hand the bacteria responsible for otitis media are almost without exception penicillin-sensitive. Penicillin given by intra-muscular injection will abort otitis media in a manner simply
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