Mishaps. 1. Rupture of the tympanic membrane. With a normal membrane this is difficult to produce, in spite of even forcible inflation. Such an accident usually occurs at the site of some previous scar or atrophic patch in the membrane. If it occurs, there may be a temporary feeling of giddiness, noises, and pain in the ear. Inflation, of course, should be stopped at once and the ear protected for a day or two by plugging the meatus with a piece of cotton-wool.
2. Severe epistaxis. This is usually the result of trying to force the catheter through an obstructed nose, but it may also take place, though rarely, when manipulations have been carried out in a gentle fashion.
3. Syncope. This is fortunately of rare occurrence and usually only happens on the first occasion that the catheter is passed. For this reason the patient should always be in a sitting posture, and on the slightest appearance of pallor or faintness the catheter should be withdrawn. The attack invariably passes off, but for the moment it is very unpleasant.
4. Surgical emphysema. If the point of the catheter lacerates the mucous membrane, the air may be forced into the submucous tissue. This mishap, however, rarely occurs as the result of simple catheterization, but is more likely to follow forcible attempts to pass a bougie into the Eustachian tube.
PASSING OF THE EUSTACHIAN BOUGIE
Indications. This may be done for the following reasons:—
(i) As a means of diagnosis, to demonstrate the existence and position of a stricture.
(ii) To dilate a stricture.
(iii) As a therapeutic measure, to treat the mucous membrane of the Eustachian tube by means of a medicated bougie.