After-treatment. There is usually a slight effusion of blood within the tympanic cavity, but no special treatment is required beyond keeping the ear aseptic. Absorption takes place rapidly.
The result of the operation is disappointing. There is seldom any improvement with regard to hearing; a few cases, however, have been reported in which the attacks of vertigo have diminished in intensity.
TENOTOMY OF THE STAPEDIUS
Indications. They are limited.
(i) As the result of middle-ear suppuration the malleus and incus may become exfoliated. The theory has been advanced that the unopposed action of the stapedius muscle prevents free movement of the stapes in these cases, and for this reason tenotomy of its tendon is advocated.
This operation, however, should only be performed provided that the edge of the membrane is not adherent to the inner wall of the tympanic cavity, and there is no internal-ear deafness.
(ii) The operation is also performed as a preliminary measure to removal of the stapes (see [p. 361]).
Operation. The operation is simple, as the head of the stapes and the tendon of the stapedius muscle are usually within view in consequence of the destruction of the tympanic membrane. The ear is cleansed and dried, and the part rendered insensitive by the previous application of a pledget of cotton-wool soaked in cocaine solution. The tiny tendon is severed with a snick of the paracentesis knife, cutting through it from above downwards under good illumination.
Results. These vary; usually there is no improvement, but sometimes marked increase of hearing occurs. As the operation can do no harm and can be done without any inconvenience to the patient, it may be attempted subject to the restrictions given above.