Reduction of otorrlima, existing from birth, in a woman of 30, after surgical exposui .e of the middle-ear cavities and the removal of granulations, pus, and sequestra, one of which was the modiolus and the lamina spiralis ossea of the coch lea. A. Politzer (Aust. Otol. Soc.; Ann. des Mal. de l'Or., Feb.. '97).
Of 61 cases operated upon for the re lief of otorrhcea, 35 were cured, 17 im proved, 1 was still under treatment, and in the result was unknown. In cases where there had been extensive caries, 10 were operated upon by the Schwartze Stacke method. Of these 6 were cured and 4 improved.
Twenty-six cases of chronic purulent otitis media were operated upon for the purpose of improving tbe function of the ear. In 22 cases the ossicles were re moved. The hearing was improved in 17 cases and unimproved in 5. In 4 cases the operative procedure consisted in the division of adhesions, and the hearing was improved in every case.
In 20 eases the condition was one of otitis media purulenta residua, the sup purative process having run its course. The local condition was one of rigidity of the ossicular chain, due to the develop. tnent of adhesions. In 18 of these cases synechiotorny was performed. The oper ation was followed by improvement in 17 cases; in I case the hearing was unim proved. In 2 of these cases the ossieles were removed, resulting in improvement in I case, while in the other instance the result was negative.
The total number of cases of non suppurative middle-ear inflammation op erated upon WaS 59, of which 52 were improved and 7 unimproved. E. B. Dench (Laryngoscope, Alan, '97).
Antiseptics can be applied to the meatus and intact membrane in the same way as in other parts of the body with similar results. An initial thorough purification of the middle car and meatus, followed by careful packing with double cyanide gauze, is an excellent method of treating certain cases of chronic middle-ear suppuration. Urban Pritchard (Otological Soc. of United King.Tdom; Lancet. Feb. 24, 1900).
lu chronic suppurative otitis media the removal of the necrotic ossicies and part or all of the tympanic membrane and curetting of the cavity recommended. Removal of the anterior attie-wall to give free drainage and open the way for remedial applications affords the follow ing advantages: It gives free drainage; it affords an opportunity to successfully combat the suppurative process; it is ft,e from dangir to life and health; in 1,irge percentage of eases the disease is Amsted, the hearing improved, only lait 11111d0 W or-e: there is no deformity or s,-.tr. Dry treatment is inadequate Lecause of the thimis collecting, around tLe os-ieles. J. A. :Stucky (N. V. .Mcd.
Jour.. :May 25. 19011.
Aural Polypi, Aural polypi, often miutiple. may form quickly, even in te otitis media, but, as a rule, they are the result of chronic purulent otitis media.
Symptoms.—Their size varies from that of a small shot to that of a large pea. After attaining the latter size if allowed to grow they become compressed by the canal-walls and elongated, and finally protrude at the external meatus. The nuter surface near the meatus in old polypi becomes pale and dermoid. Polypi are usually attached to the mucous lining of the drum-cavity. If attached to the mucous membrane of the osseous walls of the drum-cavity the growth obtains inore nutrition and grows larger than one attached to the mucous inner sur face of the membrana. Aural polypi are usually very vascular, but they contain no nerve-structures.
They are of inflammatory origin and constitute true tumors of a benignant nature. Their presence in the ear pre vents a cessation of the purulent dis charge. Sometimes an aural polypus. undergoes a spontaneous detachment.
Treatment. —In the majority of cases aural polypi can be twirled otT by means of a probe, under perfect illumination of the auditory canal. Or they may be removed from their pedicles by means of a hook, shown in Fig. 6.
Usually it will be necessary to remove them by means of a snare or polypus forceps. The best form of polypus-snare is that shown in Fig. 7. It is a Toynbee snare, modified by C. J. Blake, and then further modified by C. H. Burnett. Fine piano-wire (brass) should be used for the snare. T:nder perfect illumination of the ear by means of the forehead-mirror or an electric head-lamp (Fig. 3), the instrument can be inserted by an ex pert hand into the ear, the polypus encircled by the loop of the snare and removed with ease. If the walls of the auditory canal and the fundus of the ear are not touched, there will be no pain inflicted upon the patient, as the polypus has no sensation. A better way still to remove a small polypus from the ear is to seize it with a polypus-forceps made like the foreign-body forceps of Sexton (Fig. 5). In the author's polypus-for ceps the blades are perfectly straight, and without the teeth of Sexton's for eign-body forceps. After a polypus is removed from the ear its attachment should be touched with a little absolute alcohol, or a minute quantity of chromic acid. Only as much of the latter as will moisten the end of a probe a millhnetre in diameter shonld be used.