The best treatment is to make the patient suck ice and to forbid all attempts at blowing the nose and coughing. Sometimes it is also necessary to scarify the pharynx and soft palate with a small bistoury. Recovery may be hastened by gentle massage of the neck and face. Inflation should not be attempted again for at least a week.
(b) The bougie may be pushed in too far and cause injury to the contents of the tympanic cavity.
(c) The tip of the bougie may break off whilst in the Eustachian tube. With a gum-elastic bougie this is very rare, but it is more likely to occur if the brittle celluloid bougies are used. To prevent this unfortunate disaster the bougie should be carefully examined before passing it, to see that it is not cracked nor broken. If such an accident does happen it is wiser to do nothing, because as a rule the fragment is afterwards expelled spontaneously.
Results. If the obstruction be fairly recent and limited to the pharyngeal end of the Eustachian tube, excellent results may be obtained by using either the simple bougie or the catgut variety moistened with a 5% solution of silver nitrate.
Owing to the general thickening of the tube, there is a marked tendency for further stricture to take place in the more chronic cases, even if a temporary improvement is obtained, and for this reason the use of the bougie is seldom to be recommended.
WASHING OUT THE TYMPANIC CAVITY THROUGH THE EUSTACHIAN TUBE
Indications. (i) In chronic middle-ear suppuration in which the perforation is situated in the anterior inferior quadrant and the continuance of the otorrhœa is apparently due to the secretion not being able to drain from the tympanic cavity. This method may be employed to effect drainage and in order to cleanse the tympanic cavity thoroughly before the instillation of medicated drops. In these cases the floor of the tympanic cavity is usually at a considerable depth beneath the lower limit of the membrane ([Fig. 186]).
(ii) In order to remove a small foreign body lying on the floor of the tympanic cavity which cannot be expelled by syringing. The operation is only tentative and is seldom successful.
Contra-indications. (i) If there be acute middle-ear suppuration; (ii) if the perforation be very small, as there will be a considerable risk of the fluid being driven into the mastoid antrum and further infecting it.