Otologic Observations in Cases of Intestinal Intoxication in Infants

Abstract

The interest of my associates and myself in the subject of intestinal intoxication in infants was first aroused by the statement of various writers that a definite causal relationship exists between this condition and the clinical and pathologic findings in the middle ear and mastoid antrum, the latter being the primary factor. From the start, we were opposed to the view expressed that the otologist should disregard the otologic findings and be guided by the pediatrist in deciding for or against operative intervention. We were reluctant to accept without further substantiation the statement of a number of otologists that the indications for operative intervention could be determined in each instance by definite findings in the ear. In other words, we were rather skeptical that a clinical entity had been established, and that there existed definite reasons for operation on these desperately ill infants.These little patients were admitted to the pediatric service of Dr. Schick and examined by members of the ear service of Dr. Friesner within twenty-four hours. The general condition of the patients conformed with little variation to the clinical picture described by various pediatrists. Jeans described the pediatric features of this condition by saying:The symptoms in general consist of a marked and rapid loss of weight, fever, diarrhoea, dehydration and the appearance of intoxication. The intoxication is characterized by drowsiness or stupor and pallor with a grayish hue; it may appear simultaneously with the fever or follow it in a few hours. The temperature curve is inconstant; when fever existed previously, a secondary increase may occur. Diarrhoea usually parallels and coincides with the dehydration and weight loss. Sometimes the onset of diarrhoea is slightly delayed, and in a few otherwise typical cases diarrhoea has been absent. Usually there are from eight to twenty mucuscontaining foul smelling stools daily. The dehydration is reflected in the weight loss and the loss of skin elasticity; it is sometimes of such a marked degree as to cause the appearance of extreme emaciation. The leucocyte count has varied from 13,000 to 30,000 or more. Vomiting may occur throughout the course of the illness, with varying degrees of severity. Refusal of food is a fairly constant feature. Marked degree of acidosis has been noted.In the best interest of a thorough study of this subject, we decided that the ears were to be examined by the same otologist daily, the findings to be recorded by him. The pediatrists were in full accord with