Results. If the stricture or point of occlusion of the auditory canal is limited and composed of membranous and fibrous tissues, a good result can be usually obtained, and there is no reason why complete recovery of hearing should not take place if the labyrinth and tympanic cavity are normal.
Unfortunately, as in all cases of stricture, there is a tendency for it to recur.
OPERATIONS FOR AURAL POLYPUS
In this section only the aural polypi which project from the tympanic cavity into the external auditory meatus will be considered; whereas the treatment of granulations, and with them the minute polypi which are still limited to the tympanic cavity, will be discussed in the chapter on operations within the middle ear.
Indications. An aural polypus should always be removed because, apart from the fact that it is a symptom of underlying disease, it may obstruct free drainage of the purulent discharge, and therefore become a source of danger.
Operation. The simplest and the best method is removal by the snare.
In the case of small and soft polypi, the polypus is removed by traction—formerly called avulsion—after the snare has been tightened round its pedicle; with a large, tough, fibrous polypus considerable force may be required to tear through its pedicle. This procedure in the case of polypi arising from the region of the tegmen tympani has been known to give rise to fatal meningitis. In such cases the pedicle of the polypus should be cleanly cut through by the snare—so-called excision.
As aural polypi are always associated with suppuration, it is especially necessary that the ear should be thoroughly cleansed before operation.
A local anæsthetic (see [p. 310]) is sufficient in the case of smaller polypi, but if the polypus be large and tough, it is wiser to give a general anæsthetic, such as gas and oxygen. Or a 3% solution of cocaine may be injected into the growth, which, according to Frey of Vienna, renders removal absolutely painless; this, however, has not always been my experience.
