SECTION III
CHAPTER I
EXAMINATION OF THE EAR: GENERAL CONSIDERATIONS
WITH REGARD TO OPERATIONS
In order to perform successfully the various operations upon the ear, it is essential that the surgeon should be familiar with the technique of its examination, which, for the sake of convenience, will first be briefly described.
EXAMINATION OF THE EAR
Fig. 171. Clar’s Lamp.
For this purpose it is necessary to make use of certain instruments in order to obtain a clear view of the deeper parts of the auditory canal and tympanic membrane. Most important amongst these are the following:—
Mirror. A head-mirror, such as the ordinary laryngological mirror with a focus of eight inches, is to be preferred to the hand-mirror, as it leaves both hands free for manipulation.
Sources of illumination. Although the light reflected from the sky on a bright cloudless day is excellent, it can seldom be made use of, and so for practical purposes the source of light is usually artificial. It is wiser always to use the same kind of light—for instance, electric—as in this way a more accurate comparison can be made of the various pathological conditions seen on examination. In the consulting room, the lamp recommended by Dr. Greville Macdonald, furnished either with a thirty-two candle-power frosted burner or with a Nernst light, is most suitable. As a portable lamp, it is useful to have an electric bull’s-eye lamp, run off from a dry-celled battery: it can be held in the position of the ordinary lamp, the light being reflected into the ear by means of the head mirror. The ordinary surgical head-lamp, although not well adapted for inspection of the deeper parts of the auditory canal, is eminently suited for obtaining good illumination during the performance of the mastoid operations; or in its stead a head-mirror with lamp attached may be used, as recommended by Clar (Fig. 171).