Fig. 181. Aural Probe.
The size of the polypus and the origin of its pedicle should be determined before operating, if necessary by using a probe (Fig. 181); also it must be diagnosed from a bulging congested tympanic membrane, or from the inner surface of the tympanic cavity, which may be exposed to view owing to complete destruction of the membrane having already occurred.
| Fig. 182. Wilde’s Aural Snare. The snare is held in the usual position for extraction of a polypus. | Fig. 183. Wilde’s Snare being passed round an Aural Polypus. (Semi-diagrammatic.) |
A Wilde’s snare is generally used. It is a fine angular snare fitted with soft copper wire. The loop of the snare should be bent downwards and forwards and should be of such a size as to just surround the growth. The snare is held between the thumb and the first and second finger of the right hand (Fig. 182). Under good illumination, and using the speculum and reflected light if necessary, the shaft of the snare is passed along the upper portion of the auditory canal until the edge of the polypus is reached. The loop is made to encircle the polypus (Fig. 183), the snare is gradually pushed inwards with a gentle sinuous movement until it reaches the point of attachment of the growth. The loop is then tightened until it firmly grasps the neck of the polypus (Fig. 184). The friable tissue is torn through by gentle traction and the polypus is withdrawn in the snare. Care must be taken not to injure the tympanic membrane through which the polypus may be projecting; it is for this reason that the loop is bent at an angle to the shaft of the snare so that it may lie parallel to the tympanic membrane whilst in the act of grasping the polypus. If the polypus be very small its pedicle may be clearly defined before operation, and the snare passed round it directly (Fig. 185).
| Fig. 184. Wilde’s Snare gripping the Neck of Polypus. (Semi-diagrammatic.) | Fig. 185. Polypus arising from the Attic Region. The snare is in position for the extraction of the polypus. (Semi-diagrammatic.) |
If the polypus be very large and tough, the snare is made to cut clean through its pedicle as near to its attachment as possible, instead of employing traction. The snare is then withdrawn, the polypus being afterwards grasped and removed by means of forceps. In this latter case it may be necessary to use a stronger snare fitted with piano steel wire instead of the ordinary copper wire. On removal of the polypus there may be considerable hæmorrhage. After it has ceased the ear is syringed out and dried. The auditory canal is then inspected, and if it is found that the growth has not been removed completely, this can be done now by reapplication of the snare.
After final cleansing of the meatus, a strip of gauze is inserted, and the ear protected with a pad of cotton-wool and a bandage.
After-treatment. The dressing should be removed within twenty-four hours, and the ear cleansed by syringing. After mopping it dry drops of rectified spirits should be instilled.
On removal of the first dressing, any polypoid tissue which remains may be cauterized under cocaine anæsthesia by the actual cautery, or by a bead of chromic or trichloracetic acid (see [p. 348]).
Further treatment consists in keeping the ear clean and dry. For the first few days it should be syringed daily, dried, and spirit drops instilled. As the secretion becomes less the syringing should be diminished. If the perforation be large, instead of instilling drops, some finely powdered boric acid may be puffed in.