(ii) In the case of a hard substance, such as a piece of stone, coal, or a bead, blunt hooks may be used instead of sharp ones. They should be passed into the meatus beyond the foreign body in the manner already described.
(iii) In other cases, depending on its shape and position, the foreign body is better removed by means of a snare, the loop of which is manipulated round it and then drawn tight in the same manner as in the extraction of a polypus.
The chief points to observe in these manipulations are (a) not to push the foreign body farther in and (b) not to injure the walls of the meatus or the tympanic membrane.
Other methods of extraction are—(1) Drilling through the foreign body, if it is a hard substance, and then inserting a fine hook into the opening so made. (2) The agglutinative method, which consists in dipping a small paint-brush into a concentrated solution of seccotine or glue and then inserting it into the meatus until it comes in contact with the foreign body. The brush is left in this position for several hours in the hope that it may become adherent to the foreign body; if so, on withdrawing the brush from the ear, the foreign body should be extracted with it. This method can only be used provided the ear is kept dry.
These procedures, although said to be successful in a few cases, are not recommended.
After-treatment. If the tympanic membrane and auditory canal have not been injured, it is sufficient to dry the meatus and puff in a little boracic powder. If there be abrasions of the canal, a small strip of gauze should be inserted and changed as frequently as it becomes moist with secretion, the meatus, if necessary, being also syringed out with an aseptic lotion. If there be acute inflammation of the walls of the canal, accompanied by much swelling and purulent discharge, drops of glycerine of carbolic (1 in 10) may be instilled frequently. After the inflammation has subsided, an alcoholic solution of 1 in 3,000 biniodide of mercury may be employed. If the tympanic membrane has been injured, either from the presence of the foreign body itself or from the attempts at extracting it, the treatment is similar to that for an ordinary middle-ear suppuration.
Removal by operation. This may be done in the following ways:—
By means of a post-aural incision.
Indications. (i) If prolonged attempts to remove the foreign body by instruments have failed. This operation becomes imperative if there are signs of retention of pus within the middle ear.
(ii) If the foreign body has been pushed into the tympanic cavity and cannot be removed otherwise. In such cases, if the perforation is large and the foreign body is small, an attempt may first be made to dislodge the substance by injecting fluid into the middle ear through the Eustachian tube by means of the catheter and syringe (see [p. 372]). This method, however, is rarely successful.