MEDIA

In chronic draining ear associated with a tympanic membrane perforation, cholesteatoma, or both, the infection i s that of bacterial contamination. Both aerobic and anaerobic organisms are found, notably pseudomonas, staphylococcus, and en-teric organisms, particularly bacteroides. The disease exists because of a structural defect in the middle ear cleft, which requires surgery as definitive treatment. Medical therapy is valuable as a temporary measure in preoperative preparation, and in preven-tion and management of intracranial extension. Topical therapy with antibiotic ear drops is often helpful, but also important is local care with cleansing, drying, and an-tiseptic solutions or powders. Therapy i s usually directed toward the pseudomonas organisms with aminoglycoside-polymyxin combination otic drops. However, Bacteroides fragi l is now looms as an important pathogen in 73 % of affected patients. Chloramphenicol otic drops are indicated when such an infection is suspected or iden-tified. EAR infections are one of man's most ancient afflic-tions, and the ototopical remedies for these injections have their origins in antiquity. Physicians of Beethoven prescribed tea for his ears, and Americans around the turn of the century used "rattlesnake oil " ear drops (Fig I) , which were actually composed of turpentine, camphor, menthol, and sassafras. Even ear drops with effective ingredients such as boric acid were often used for nonspecific ear disorders, including al l varieties of deafness (Fig 2 and 3). Ototopical agents are available to treat disorders such as the following: (1) acute diffuse external otitis, Submitted for publication Dec 1,1980