Technique. A catheter of wide calibre is passed in the ordinary manner. Inflation is practised to see if it is in the right position. The left hand fixes the outer extremity of the catheter at its entrance within the nose and keeps it in position. The patient inclines the head over to the affected side and holds a receiver beneath the ear. A small brass syringe whose nozzle accurately fits the outer extremity of the catheter is used. Slight force may be required during the act of syringing, but must not be sufficient to cause pain within the ear. A certain amount of fluid always escapes into the throat although the catheter is in its right position, and this may set up an attack of retching and coughing. To avoid this the patient should incline his head slightly forward as well as to the affected side and breathe gently with the mouth open. If the manipulation be successful the fluid will trickle out of the external meatus.

A foreign body is rarely expelled by this method, as the force of fluid syringed into the Eustachian tube is seldom sufficient, and it is not wise to use too great pressure. In order to expel all the fluid from the tympanic cavity, the ear is afterwards inflated by Politzer’s method, and at the same time the fluid is mopped out of the ear by means of pledgets of cotton-wool.

Results. If the continuance of the middle-ear suppuration has been chiefly due to the retention of the purulent secretion in the lower part of the tympanic cavity, this method of treatment is frequently most satisfactory. In other cases no benefit is obtained owing to the suppuration being due to other causes.

Dangers. The chief danger is the infection of the mastoid cells.

CHAPTER V
OPERATIONS UPON THE MASTOID PROCESS: WILDE’S
INCISION AND SCHWARTZE’S OPERATION

With few exceptions the conditions requiring operative procedures on the mastoid process are the result of some suppurative lesion which has originated within the tympanic cavity.

The object of such operations is to arrest or eradicate the disease which, by further extension through the bony walls of the temporal bone, might eventually cause death by giving rise to some suppurative intracranial complication.

For their successful performance a knowledge of the anatomical relationships of the mastoid process is essential. It is sufficient here to remind the reader of the main surgical points in this connexion (Fig. 215).

  Fig. 215. Left Temporal Bone, showing Anatomy of the Middle Ear and Mastoid Process. 1, Anterior wall of external meatus, partly removed; 2, Canal for tensor tympani muscle, ending in processus cochleariformis; 3, Attic; 4, Aditus; 5, External semicircular canal; 6, Posterior root of zygoma; 7, Tegmen tympani; 8, Antrum; 9, Fallopian canal for facial nerve; 9', Stylo-mastoid foramen; 10, Mastoid cells; 11, Fenestra rotunda; 12, Fenestra ovalis; 13, Promontory. Dotted line shows outline of sigmoid groove for lateral sinus.