After the gauze has been removed, the ear is mopped out with pledgets of cotton-wool. To relieve the pain a few drops of a sterilized 1% solution of cocaine may be instilled and left within the ear for a few minutes.
Under good illumination, the largest possible speculum is inserted into the meatal orifice. The cocaine solution is mopped out, and the cavity dried, in order that careful inspection of the deeper parts may be made. The chief point is to see that the flaps are in position. There may be slight oozing from the surface of the wound, but as a rule the bone appears almost white, owing to the fact that granulations have not yet begun to form. The wound is then packed gently and evenly with gauze and the ear protected again with an external dressing and bandage.
Until the first dressing has taken place, the patient should be kept in bed. After this, provided the condition be satisfactory, he may be allowed to get up for a few hours every day, the period being gradually increased; by the tenth day or so he is practically well. In an uncomplicated case there is seldom any shock or discomfort after the operation, so that frequently the patient is anxious to be up and about even before the first dressing has been performed. It is wiser, however, to insist on rest for the first few days.
The subsequent dressings should be done every second or third day, depending on the condition found. If the wound cavity be clean, and if there be no odour, it is sufficient to irrigate it with a simple saline or boric lotion. Granulations begin to cover the bone about the tenth day, when there may be some purulent discharge necessitating daily dressings. To keep the parts sweet, an ear-bath of hydrogen peroxide (10 vols. %) may be given, the ear being subsequently irrigated with a 1 in 5,000 solution of biniodide of mercury.
Provided the patient be doing well there should be no temperature, pain, nor headaches. If any of these symptoms occur, or if the patient feels ill, or has attacks of sickness and becomes drowsy, the surgeon should at once be suspicious of some impending intracranial complication.
If the case be progressing favourably and all the diseased area of bone has been completely removed, granulations do not become exuberant, but form a fine smooth layer over the wound surface, the last portion to become covered being the region of the external semicircular canal and the ridge forming the remains of the posterior wall of the bony meatus. Exuberant granulation tissue is significant of underlying bone disease. If patches be observed, a 10% or stronger solution of cocaine should be applied to the part, which should afterwards be curetted. This process may have to be repeated on several occasions until, perhaps, a small spicule of bone is removed, after which granulations usually cease. As a rule the bone is completely covered with granulations by the fifth or sixth week. Meanwhile, owing to the growth of epithelium from the edges of the flaps, the raw surface within the wound cavity gradually becomes smaller, and with this there is diminished secretion.
The gauze packing can usually be discontinued about this period, or considerably earlier, perhaps even by the third week. In its stead an aqueous solution containing 50% of rectified spirit with 10 grains of boric acid to the ounce may be instilled into the wound cavity after it has been cleansed and dried.
Complete cicatrization of the cavity should take place within two or three months, depending on the size of the cavity.
If the posterior wound has been left open, the first dressing should be done on the second or third day.
The subsequent treatment depends on each individual case. If the wound has been left open on account of its septic condition, or owing to the dura mater having been exposed and found covered with granulations, its edges may be brought together by sutures after a period of ten days or so, when the wound cavity looks clean, and the packing carried out through the meatus.