Dangers. As a result of opening up the labyrinth, one would expect considerable risk of infecting the internal ear. Judging from recorded cases, this, however, seldom occurs.
Results. The chief advocate of the removal of the stapes is Jack of Boston (Boston Med. and Surg. Journ., January, 1895), who again in 1902 (Archives of Otology, vol. xxxi, p. 407) stated: (1) that removal of the stapes did not destroy the hearing but sometimes improved it; (2) that the operation upon cases of moderate deafness might give brilliant results but was also attended with some risk to the hearing; (3) that the operation on the profoundly deaf was not advisable, as usually the stapes could not be removed owing to surrounding adhesions, and even if it were, no improvement was likely to occur owing to the sound-perceiving apparatus having probably already undergone irremediable changes.
Blake (Archives of Otology, vol. xxii), on the other hand, states emphatically that stapedectomy is harmful rather than beneficial.
The question, therefore, of removal of the stapes from the point of view of hearing is purely experimental. If there be bony ankylosis, it will be found impossible to remove the bone, and an attempt to do so will result in fracture of its crura. If, on the other hand, it be not ankylosed but movable, probably massage or, in cases of perforation of the tympanic membrane, direct mobilization of the bone will give results as good as those following stapedectomy.
The most favourable results are to be expected in those cases in which the operation is performed to relieve symptoms the result of previous middle-ear suppuration. In otosclerosis no benefit is ever obtained, and therefore the operation is absolutely contra-indicated.
On the other hand, there is ample evidence that the hearing power, in spite of removal of the stapes, may be retained. As an example may be quoted a case in which the stapes was removed accidentally in curetting out the ear after the removal of the malleus and incus, and in which I afterwards performed the complete mastoid operation owing to the continuance of the middle-ear suppuration. In spite of this, whispering could be heard at a distance of 20 feet (Journal of Laryngology, &c., vol. xxii, p. 33).
CHAPTER IV
OPERATIONS UPON THE EUSTACHIAN TUBE
Under this heading may be considered manipulations requiring special technical knowledge and skill: (1) Catheterization; (2) passing of bougies; and (3) washing out the tympanic cavity through the Eustachian tube.