Case of chronic suppurative otitis of tbirty-six years' duration. There was a fcetid discharge, Memorrhage and pain in both ears, found to be due to umltiple polypi and cholesteatomata. The polypi were removed, but recurred rapidly; al cohol and glycerin drops were used and all syringing prohibited. The choles teatomatous masses were also removed gradually with forceps, and these and the polypi finally ceased to reform under the alcohol treatment. The patient has now been free from discharge for a year. The case is an illustration of the value of alcohol and glycerin in the treatment of botb cholesteatornata. and polypi. Tre silian (Jour. of Laryn., etc., Dec., '07).
Ossiculectomy.—In performing ossic ulectomy in chronic purulent otitis media the patient should be etherized, in order to prevent his suffering and to keep him perfectly still,—movement of the head defeats the operation. Ossic ulectomy has been performed under lo cal applications of cocaine, but the thesia is not total and the patient flinches or moves more or less. Again, as a good deal of cocaine solution is required, there is some risk of toxic effects.
The patient being under ether, the ear lutist be illuminated by an electric lamp held on the surgeon's head (see Fig. 3).
The remnants of the membrana over the region of the incus-stapes joint should first be cut away (if not already eroded by disease and the nialleus in part or in whole is still present) and the incus looked for. Sometimes the entire incus will be found in position, with its long process in connection with the stapes head, and its body still in articulation with the head of the malleus. But this is the exception in chronic purulent otitis media. Most frequently the incus is en tirely destroyed by caries. Sometimes the body of the incus, without its long limb, is found fused with the malleus head, and is removed with the latter, when the malleus is seized with forceps and removed from the drum-cavity after severance of its suspensory ligaments, synechice, etc. In other instances the body of the inns is partly destroyed by necrosis, its posterior part being intact and the long limb still attached to the stapes. If the incus is present with the malleus, the former should be removed before the inalleus is disturbed. If the malleus is removed first, the incus, un less adherent to it, may fall into the lower, posterior part of the drum-cavity and be lost, or recovered only after con siderable, and probably irritative, grap pling. The incus being found and re
nio\LLI, the tuallens may then be excised.
nictinies the remnant of the incus is not found until after the malleus is re Then With an incus-hook passed into the attic the incus is thrown forward and downward into the atrium and re m) ed. The stapes in no case of chronic unlit nt otitis media should be removed, nor even mobilized. for fear of opening the oval window and inviting the en trance of pus into the internal ear and tlitnve into the cranial cavity.
Some of the most satisfactory results of excision operations have occurred in eases sutTering from chronic otorrlicea. Most frequently the walls of the attic are also carious. Where such is the case, it is of advantage to open this area freely. Having removed the =liens and incus, if no more necrosis exists, the operation is ended; but, if indications show the pos sible existence of more caries, the antrum ic to be opened, the lateral masses of bone between the tympanum and antrum re moved, as well as the entire posterior wall of the bony auditory canal. These spaces are thus all laid open into one space. The semicircular canals and facial nerve will not bc injured if the lateral Nvalls, only, of the antrum are chiseled av ay. Stacke (Inter. klin. Rund., Dec. 21, '90).
Extraction of the hammer and incus is only practiced if the greater portion of tl e drum-head is destroyed, and the ham er, therefore, ic of no value for the func tion of hearing; also, when there is cholesteatoma in the attic. In perfora tion of SchrapnelEs membrane, on the other hand. when suppuration is limited to the attic and the hearing-power is early normal, the hearing becomes di minished by extraction of the ossieles and. in sueh eases, operative interference ought to be limited to opening tile outer attic. Only after this treatment has proved ineffectual should extraction of the ossicles be practiced. In cases where extreme deafness existed there was ob served an improvement in hearing after extraction of the ossicles, but, when hearing wac very near normal, the oper ation diminished it very much. Politzer (Eleventh Inter. Congress, '94).