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In a material of healthy ears and ears with chronic otitis media the distribution of the air cell system has been measured with a direct volumetrical method and a planimetrical-roentgenological method. A high correlation between the two methods of measurement has been established.

A report of a case of atypical mastoiditis with Bezold’s abscess has been given. X-ray examination of the mastoid has been found to be very helpful. After exenteration of the diseased mastoid air cells and clearing the middle ear of the granulations a tympanomyoplasty has been performed which imparted significant improvement in hearing.

Teleological reasoning would conclude the existence of a destined function of the mastoid air cells. The function is alleged to be well established in man. The demonstration of its existence is attempted in different ways. Hypothetically, functions of varying nature may be ascribed to the mastoid air-cell system. A weight-reducing effect in birds is obvious. An insulating effect against differing climatic conditions may plausibly be considered. This may be of importance for all elements of the inner ear or for only one of them. Furthermore, the addition of the air cube to the middle-ear spaces may serve for an adjustment of air-pressure variations caused by the exchange of air through the open or partially closed tubal canal and by resorption. This may be of importance for the movement of the drum membrane and the hearing. Judging from the otological literature, a sound-silencing effect has been ascribed to the mastoid air

FLUID WHICH has accumulated in the mastoid and middle ear cleft, behind an intact tympanic membrane, theoretically, might find an escape from the confines of these spaces by two possible routes: down a patent eustachian tube, or by absorption into the submucosal plexus of lymph and blood vessels. The method whereby the eustachian tube may serve as a channel for the egress of fluids which have accumulated in the middle ear cleft has been studied. 2 It was noted that in order for the tube to act as an escape route, the pressure within the mastoid and middle ear spaces must be at least equal to the pressure in the nasopharynx. If, however, the pressure within the mastoid air cells and tympanum is lower than the pressure in the nasopharynx, then any fluid which is partially filling these spaces may remain for an undetermined period of time. Some authors feel

Carcinoma of the middle ear is rare, arising in association with chronic suppuration. It may begin in the altered epithelium of the middle ear, in the mastoid air cells, or deep in the external auditory meatus and, with a ruptured tympanic membrane, finds no difficulty in spreading to the middle ear (1). Cases of carcinoma of the external auditory canal which are limited to the canal are not included in this discussion. For a time the disease is confined by the bone which it later invades and has a tendency to spread into the middle cranial fossa. By more superficial extension, it perforates the cartilaginous canal and spreads on the exterior surface of the skull. The patient presents with an exacerbation of his discharge which may be blood-stained, or with continuous deep boring pain from bone invasion, or with facial paralysis. The lymph nodes in the neck become involved, and finally, if the patient survives, uncured, distant metastases to the liver and lung become apparent. The diagnostic problem is on...

In the course of routine autopsies we have observed occasional cases of subdural suppuration (figs. 1 and 2) which is apparently secondary to an underlying leptomeningitis. We wish to eliminate from this discussion all cases of subdural infection secondary to causes other than underlying disease of the leptomeninges. Specifically, we exclude subdural suppuration secondary to extension from diseased paranasal sinuses, mastoid air cells and the middle ear. Similarly, we exclude from consideration subdural infection arising from a penetrating cranial injury, infected subdural hematoma and osteomyelitis of the skull. REVIEW OF LITERATURE A diligent search of the literature failed to reveal any papers on this subject except for a single article by Bateman, in 1929. 1 In this report there is a passing reference to subdural suppuration secondary to involvement of the pacchionian granulations in cases of purulent leptomeningitis. PRESENTATION OF CASES In a series of 95 consecutive cases of leptomeningitis