pharyngitis or sinuitis or root abscess are often a cause, and not much will be accomplished in improving the otitis media until these focal infections are found and properly treated. The original cause of these focal infections may have been some bony lesion, but to successfully correct such lesion now does not mean that the source of infection will be removed. Auto-intoxication from gastro-intestinal disease is common. In my cases, 80% of the third stage have chronic constipation or other chronic gastro-intestinal affection. In many severe acute affections of the nasopharynx the inflammatory process has left the Eustachian tube occluded or stenosed and the pharyngeal fossa filled with adhesive bands. It is not uncommon to find the epipharynx and pharyngeal fossa filled with partially atrophied adenoid tissue or if the curet method has been used for removing adenoids, there is often connective tissue adhesions and any or all of these may prevent the normal ventilation of the tympanic cavity by way of the Eustachian tube. In such cases surgical removal of these obstructions and dilation of the tube is necessary. My practice has been to give a general anesthetic (nitrous oxide or somnoform will be sufficient in many cases) and by means of an adenotome (La Force or Cradle, I never use a curet) remove all adenoid tissue. Then by means of the finger I carefully remove any adenoid tissue in the posterior nares and pharyngeal fossæ that the adenotome may have failed to get and also dilate the pharyngeal portion of the tube by inserting the finger. This operation if carefully and thoroughly done and if preceded and followed by the proper surgical cleanliness and supportive treatment, will when indicated, accomplish excellent results. The after treatment is even more important because if this is not well done, no results or even unfavorable results may occur. The after treatment consists of daily irrigations of the nasopharynx, thorough attention to upper thoracic, cervical and mandibular lesions, aspiration of the Eustachian tubes and other local treatment to the nasopharyngeal membranes. After the operation has been done it is best to do no digital manipulation of the pharynx for from three to six days. After this time digital treatment, gentle dilation of the Eustachian orifice to maintain its patency, stretching of the soft palate to reestablish proper nerve function and the application of deep pressure in the pharyngeal fossæ to stimulate the otic ganglion is important. This treatment is not massage in any sense but definite, purposeful, manipulation and if carefully done will be followed by excellent results.