The next step was the making of post-meatal skin flaps, with closure of the posterior incision and packing of the wound through the auditory canal; and the names most prominently associated with this are Panse, Körner, and Stacke.
Still more recently, in order to shorten the after-treatment, the wound cavity has been skin-grafted by the method first suggested by Siebenmann and afterwards amplified by Charles Ballance.
The operations which will be considered are:—
1. Wilde’s incision.
2. Opening of the mastoid process and antrum.
3. The complete or radical mastoid operation.
Although definite indications for the above operations will be given, it must be remembered that in many cases the extent of the operation will depend very largely on the pathological condition found during the course of the operation itself, as frequently the clinical symptoms are not sufficient to determine beforehand what operation is indicated.
In comparing the simple opening of the mastoid cells and antrum with that of the complete or radical operation, the fundamental difference is that in the former the tympanic cavity and its contents are not interfered with, whereas in the complete operation the middle ear, antrum, and mastoid cells are converted into one large cavity. In consequence, complete recovery of hearing may take place in the former case; in the latter, however, this is not possible.
Although these operations, especially in the more acute conditions, are performed from the point of view of saving the life of the patient, due regard must also be given to the preservation or restoration of the hearing power, if this indeed is possible. If the hearing power be very poor, that is, if conversation cannot be heard more than 12 feet off, and especially if the deafness be partially due to changes having already taken place within the labyrinth, then the complete operation is to be preferred if it be doubtful whether Schwartze’s operation will be sufficient to eradicate the disease. If, on the other hand, the hearing power of the affected ear be fairly good, and with this there is deafness of the opposite side, then, unless it is absolutely essential that the complete operation should be performed, an attempt should be made to effect a cure by the simpler operation, provided it is first explained to the patient that it may perhaps be necessary to perform the complete operation afterwards.