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fore, to spend a little extra time to first gain the young patient's confidence, as well as taking pre- caution during the examination to avoid giving pain in the use of the speculum and applicator, for it is both disagreeable and difficult to examine the ears and throat of a struggling and frightened child. In examining the ears of children it is necessary to remember that the drum membrane is about as large at birth as in the adult, but the bony ring to which its margin is afterwards firmly attached being voltaren ec tablets 50mg undeveloped, the membrane is looser and more oblique in direction than in older persons. The canal is shorter and straighter for similar reasons, being largely composed of cartilage in early life, and instead of drawing the auricle upwards, backwards, and outwards, as one does to straighten the canal in examining an adult, it is better to draw the lobule of the ear somewhat downwards and backwards in the child. A small speculum is necessary, and care should be taken to first cleanse the canal of wax, which is otherwise likely to block the slender open- ing of the speculum and confuse the observer. In children the inflammation of the drum tissues IS often so intense and rapid that exfoliation of the outer layer of epithelium covering the drum head quickly occurs, and this white, opaque, layer voltaren topical of cells not infrequently covers a swollen, inflamed drum. It is then likely to be mistaken for the drumhead it- self and thus leads the examiner to a wrong diag- nosis. It is best to gently wipe off the surface of the drum membrane before making a final decision when acute voltaren in canada otitis is suspected, even in cases where there is no appearance of inflammation at first glance. The group of affections which we term " the dis- eases of childhood " and commonly accept as a mat- ter of course, are all accompanied by acute rhinitis, and if severe, this catarrhal condition extends throughout the mucous membrane lining the ear drums, the Eustachian tubes, and the throat gener- ally. I except from this the accessory sinuses of the nose which are responsible for so many of the acute and chronic catarrhal troubles met with in older persons, as these cavities have comparatively voltaren xr 100 little development before the age of puberty. Aside from bronchitis, and the occasional oc- currence of pneumonia, the importance of the exan- themata in children is practically limited in the ma- jority of cases to the ear cftnditions voltaren xr 100mg induced by them, and the practitioner's duty in all cases of this class of diseases is to keep close watch for the develop- ment of acute ear voltaren generic name affections. In some cases, es- pecially scarlet fever and measles, the intensity of the inflammation frequently leads to involvement of the ossicles as well as the mucous membrane, and in such event the case is likely to continue as a chronic otorrhoea after recovery from the illness, especially if treatment is neglected in the acute stage. Except for the exanthemata and mechanical in- juries, unhealthy adenoid growth is responsible generic for voltaren for practically all cases of middle ear disease in children. This hypertrophied lymphoid voltaren sr 100mg tissue lies in the nasopharynx, in close relation with the entrances to the Eustachian tubes, and provides numerous re- cesses for the harboring and growth of germ life. When abundant in quantity, it blocks voltaren 75 sr up the poste- rior narcs, interferes with proper nasal breathing and aeration of the ear drums, and usually gives evi- dence of its presence in the heavy, drooping, facial lines, the open mouth, and dull expression which are commonly recognized as the voltaren 50mg diclofenac adenoid facies. In such cases large, unhealthy, voltaren ec tonsils are also generally present, but it is a mistake to suppose that a child cannot be troubled with adenoid growths unless hypertrophied tonsils or obstructed nasal breathing are in evidence. A considerable percentage of voltaren in usa children who suffer f I om repeated " voltaren ec 75 mg colds " and attacks of earache owe this weakness to a pad of unhealthy adenoid tissue, insufficient in bulk to obstruct breathing under ordi- nary circumstances. I have several times made cul- tures from the recesses of such tissue, and had no July 27. lyOT.] GRAEF: EAR, NOSE, AND THROAT IX CHILDREN. 151 difficulty in obtaining growths of the commoner in- elicit tenderness in this class of cases, and on these fective flora. It is because of the presence of such two signs a diagnosis of mastoiditis may be safelv germ life in the voltaren 100 mg retard pharynx that many of these children based. voltaren for sale Bulging downwards of voltaren rapid 25mg the deepest part of take colds easily, a wetting of the feet, exposure to the upper wall of the ear canal is considered signifi- draughts, or digestive difficulties, furnishing voltaren sr 75 mg tablet the dis- cant as a voltaren xr 100 mg sign generic name for voltaren of mastoiditis, and in doubtful cases a turbance of circulation which permits the infective blood count may be of much help in settling the organisms to waken to activit}-. The passive con- question of operation.

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