A System of Operative Surgery, Volume 4 (of 4)

by Unknown

It is usually necessary to use an aural speculum, but if the foreign body be situated near the entrance of the meatus a sufficient view may be obtained by pulling the tragus forward and the auricle backward. Good illumination is essential.

(i) If the body be a soft substance, such as a pea, the core of an onion, or a fragment of wood, it is best removed by fixing into it some form of sharp hook ([Fig. 178], D). These hooks vary in shape. They may be curved, or shaped like a crochet-hook, or have the sharp point placed at right angles to the shaft of the instrument.

In the case of a round substance like a pea, especially if it is tightly impacted within the meatus, its removal is sometimes facilitated by first slicing it into pieces by means of a small bistoury.

As a rule, the foreign body is impacted at the junction of the cartilaginous and bony portion of the auditory canal; sometimes, however, it is more deeply situated within the osseous meatus, usually the result of previous attempts to extract it.

In the former case, the instrument is passed along the upper posterior wall of the canal between it and the foreign body, the point of the hook being kept upwards or downwards so as not to project into the auditory canal. The instrument is first passed well beyond the foreign body, and then the shaft is twisted round so that the hook projects into the auditory canal. With a quick movement it is drawn outwards a short distance so that the point of the hook pierces the impacted substance. Gentle traction is now used and in the majority of cases the foreign body can be extracted.

Fig. 180. Imray’s Scoop for extracting a Foreign Body.

If this fails, a slightly curved fenestrated scoop (Fig. 180) or curette should be passed, if possible, between the foreign body and the anterior wall of the auditory canal. The hook already fixed into the foreign body prevents it from being driven further within the meatus, whilst the scoop, if it can be got beyond the foreign body, can usually lever it out.

If the foreign body has been pushed in beyond the isthmus and lies deeply within the osseous canal, it is better to pass the hook along the anterior inferior wall of the meatus, because owing to the inclination of the tympanic membrane its anterior inferior margin is much more deeply placed than its upper posterior part.