. Diseases of the ear; a text-book for practitioners and students of medicine. Fig. 50.—A section made in the same manner as that shown in Fig. 49, showing theconformation of the parts in a child of five years. The pharyngeal vault is filledwith adenoid vegetations, and the tubal orifice is less marked and lies fartherforward than in the adult. (Authors specimen.) the mouth of the Eustachian channel. The prolonged manipu-lation is rather prone, in my experience, to cause a contractionof the muscles of the soft palate, and therefore constitutes. asource of discomfort to the patient. The variati
. Diseases of the ear; a text-book for practitioners and students of medicine. Fig. 50.—A section made in the same manner as that shown in Fig. 49, showing theconformation of the parts in a child of five years. The pharyngeal vault is filledwith adenoid vegetations, and the tubal orifice is less marked and lies fartherforward than in the adult. (Authors specimen.) the mouth of the Eustachian channel. The prolonged manipu-lation is rather prone, in my experience, to cause a contractionof the muscles of the soft palate, and therefore constitutes. asource of discomfort to the patient. The variations in the ex-act position of the tubal orifice and in the transverse diameterof the naso-pharynx, detract much from the special value ofthis method. The same technique had previously been advo-cated by Frank.* Boyer f prefers to rotate the instrument * Lehrb. der Ohren., 1845, p. 101. f Annal. des mal. de loreille, 1877, v°l- ™, p. 69. METHODS OF CATHETERIZATION. 121. upon its long axis, as soon as the tip passes the choanae, asrecognized by the diminished sensation of resistance to theentrance of the instrument, until its extremity points to theaffected side. Itsexact insertion intothe tubal orifice iseffected by pressingthe beak outwardtoward the later-al pharyngeal method is oc-casionally of servicewhen the parts areirritable, and the op-erator knows, fromprevious experience,the exact location ofthe tubal opening. Triquet* followsalmost thesameplan,but rotates the cath-eter before it leaves the inferior meatus, so that it may be arrest-ed by the tubal prominence as it is pushed farther backward. Wolff f and Gruber J advise that after the instrument,with the pharyngeal extremity directed downward, has beenpassed through the inferior meatus until the pharyngeal wallis reached, it shall be drawn forward until it is arrested bythe soft palate ; it is then advanced slightly toward the pos-terior pharyngeal wall, after which the angular port
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