Three hundred thirty-five cases of acute mastoiditis with complications due to extension of infection beyond the mastoid are reported. Two hundred twenty-four of those presented with intracranial sepsis. Meningitis occurred in 83 cases, brain abscess in 53, extradural abscess in 49 cases, and lateral sinus thrombosis in 39 cases. Intracranial complications are frequently seen in this group of patients with neglected otitis media. The complications occurred frequently in children and young adults (74%) with an overall mortality rate of 14%. Meningitis was the most common complication (37%); brain abscess had the highest mortality rate (36%). The overall mortality rate from intracranial complications was reduced in comparison with previous reported series. This is attributed to antibiotic treatment, the use of CT scan in excluding other intracranial complications, and close cooperation between the otologist and neurosurgeon.

Twenty-three cases of tuberculous mastoiditis are presented, nine of which were complicated by facial palsy. Six presented with acute mastoiditis, and two had meningitis. Surgery was required in 16 patients; in four cases the diagnosis was made by culture and in another four by biopsy of the granulations or polyp of the external canal. The response to antituberculous treatment was satisfactory in 22 cases. One patient, whose case was complicated by meningitis, died.

A review of 21 cases of complications of acute otitis media with a hyperemic, dull, bulging but intact tympanic membrane is presented. All cases had a retroauricular swelling. In 10 cases, a subperiosteal abscess was found, 1 of them complicated with a posterior fossa abscess, 2 had meningitis, 3 had Bezhold's abscess, 2 had thrombosis of the lateral sinus, 1 had a cerebellar abscess, 1 had cerebellitis, and 2 presented with facial nerve palsy. Ninety percent of the patients were below the age of 13. An incomplete course of antibiotic treatment was found to have been given in seven cases (30%) prior to admission. Surgical therapy consisted of a cortical mastoidectomy and a wide myringotomy. Ventilating tubes were inserted in three patients. The mastoid radiography demonstrated cloudiness, and CT scan was performed in six patients with suspected intracranial complications. The present study stresses that an intact tympanic membrane with minimal changes may be regarded by the medical profession with a low index of suspicion and can lead to severe otogenic complications. The disease can be masked by an improper antibiotic therapy.

A method of treatment of recurrent acute otitis media with polythene middle ear ventilation tubes in young children is presented. 56 ears in which infection had persisted for one to six months despite antibiotic therapy and multiple myringotomies were included in the study. The tubes were inserted under topical anaesthesia and cure within one week was obtained in 73 per cent of ears. In another 9 per cent the otorrhoea stopped within 3 weeks, but in 18 per cent reinsertion of the tube became necessary and in this latter group 11 per cent resolved in two weeks following adenoidectomy as well. In 7 per cent the problem remained unresolved. Therefore with this regimen a total of 93 per cent of recurrent infections settled. It is emphasized that the ventilation tube should remain 'in situ' for over 3 months.

A case of a mycotic aneurysm of the petrous portion of the internal carotid artery is presented. This entity is extremely rare and the problems associated with the diagnosis and clinical management are discussed.