The Evaluation of Roentgen Irradiation as an Adjunct in the Treatment of Acute Otitis Media

Abstract

IN many acute inflammatory conditions, roentgen therapy is now recognized as a valuable therapeutic aid, particularly in pyogenic infections. Such recognition is well founded upon experimental and clinical bases. This preliminary study deals with a series of 30 cases of acute otitis media treated with encouraging results by roentgen therapy as an adjunct to the routine care of such cases. Numerous articles have appeared in recent literature discussing the use of roentgen therapy in the treatment of furunculosis, carbuncles, parotitis, cellulitis, erysipelas, gas gangrene, unresolved pneumonia, and even acute lobar pneumonia. However, comparatively few papers have appeared concerning its use in nfections in the field of otology, although important contributions have been made by Granger (2), Schillinger (3 and 4), Crain (5), Cherniak and Gorodetzky (6) in the treatment of mastoiditis; Lucinian (9) on the treatment of otitis media and mastoid tis; Butler and Woolley (7), and Rathbone (8) on the treatment of certain types of paranasal sinusitis. The rationale for the use of roentgen therapy in acute otitis media is the same as that for other pyogenic infections. Desjardins (1 and 10) has pointed out a factor which is common to all infections, namely, leukocytic infiltration. He believes that the variation in response to different infections may be due to the degree of this infiltration; that the greater the amount of infiltration, the quicker and more likely a favorable response to radiation therapy. Among others, Warthin (11) has demonstrated experimentally the extreme sensitivity of leukocytes, especially lymphocytes to roentgen irradiation. He noted lymphocytic disintegration within 14 minutes after the exposure. With the destruction of the leukocytes, there is probably an immediate release of antibodies and ferments contained within these cells. This liberation makes these substances more easily available for defense at the site of the local lesion. Certainly in therapeutic doses, roentgen rays have no direct bactericidal effect. A secondary increase in phagocytosis seems well established on experimental grounds (12). A decrease in the swelling and the congestion at the site of the local lesions, following radiation therapy, relieves pain and facilitates drainage. A temporary increase in the swelling and in the pain not infrequently follows roentgen-ray therapy in furuncles and carbuncles. This has not been experienced by us in the treatment of acute otitis media; however, it seems possible that this could also occur in this disease. The character of the discharge in otitis media either remains thin or becomes so, following radiation. This results in adequate drainage of the middle ear cavity.