The Schilling Haemogram in Otitis Media and Mastoiditis of Infancy

Abstract

In 1938 a survey of the incidence of otitis media and mastoiditis in infancy was published from Alder Hey Children's Hospital (McConkey and Couper, 1938). A clinical classification of such cases was suggested and conclusions were drawn regarding the relative merits of conservative and operative treatment. Simultaneously a second and more detailed investigation was in progress, with certain aspects of which this present communication is concerned.This second series consists of fifty infants under the age of one year, suffering with an illness characterized by otitis media (sometimes with mastoiditis), and varying degrees of diarrhoea and vomiting. More than half of these children were judged to be suffering from the so-called latent mastoiditis, i.e. they all suffered from otitis media but there were no external signs of involvement of the mastoid process. Four cases, presenting the classical clinical picture of mastoiditis, were also included. The question of diagnosis and treatment is one of great difficulty and importance and briefly resolves itself into two major problems (a) to decide if infection has spread to the mastoid process, and (b) to decide if operation is advisable, and if so, the best time for this treatment.In an endeavour to find some reliable indication of prognosis, of whether the mastoid antrum was involved or not, and of the optimum time for operation, a series of Schilling counts was performed on each case. There is a great mass of literature on the subject of these counts and their application to all sorts of conditions. For the present purpose it is sufficient to state that the Schilling count is a modification of Arneth's