Fig. 193. Sexton’s Instrument. A, For removal of a foreign body; B and C, For removal of the malleus; D, Scissors.
Many methods have been devised to prevent recurrence of adhesions, but few are successful. Amongst these are daily inflation of the ear by means of Politzer’s method or the catheter; the injection of oil into the middle ear; and the insertion of small pieces of celluloid between the malleus and inner wall of the promontory according to the method of Gomperz. Another method is to resect the handle of the malleus ([Fig. 195]). After being freed from the promontory as above described, the manubrium is cut through with a pair of fine scissors ([Fig. 174]) just below the processus brevis, and the lower fragment is removed by means of Sexton’s forceps (Fig. 193).
(ii) Adhesion between the membrane and the inner wall of the tympanic cavity. Siegle’s speculum should be used to determine the position and extent of the adhesions (Fig. 194).
Fig. 194. Method of using Siegle’s Speculum.
There are two methods of operation:—
(a) In the case of bands forming a bridle between the tympanic membrane and inner wall, an attempt may be made to cut through them. This is done by incising the membrane with a paracentesis knife in front of or behind the adherent portion, and then inserting through this incision the sickle-shaped knife. By rotating it upwards or downwards, as the case may be, the bands forming the adhesions are cut through. If this has been successfully performed, and if the retraction of the membrane was solely due to these bands, the tympanic membrane will be found to be freely movable on diminishing the pressure of air within the external meatus by means of Siegle’s speculum.
(b) If the adhesions be extensive, the only method affording a chance of success is to separate the free portion of the tympanic membrane from the part adherent to the inner wall, leaving the latter in situ. To do this the membrane is incised with a paracentesis knife just beyond the margin of the adherent portion, the incision being carried right round the affected part. A tiny spatula, bent at right angles to its shaft, is then inserted through the incision and passed round beneath the movable portion of the membrane so as to free it completely ([Fig. 192]).