A text-book of the diseases of the ear and adjacent organs . only that in order to make the effect of the cocaine moresure and rapid a slight incision is made on the posterior insertion of themembrane and a 20 per cent, solution of cocaine then applied. By thismeans in a few minutes the anaesthesia will be so complete that the incisionmay be extended without the slightest pain. The stapedo-incudal articu-lation may be exposed in two ways : 1. By making an opening in the posterior superiorquadrant of the membrane 2 to 3 mm. in size,through which the stapedo-incudal connection islaid free : or 2
A text-book of the diseases of the ear and adjacent organs . only that in order to make the effect of the cocaine moresure and rapid a slight incision is made on the posterior insertion of themembrane and a 20 per cent, solution of cocaine then applied. By thismeans in a few minutes the anaesthesia will be so complete that the incisionmay be extended without the slightest pain. The stapedo-incudal articu-lation may be exposed in two ways : 1. By making an opening in the posterior superiorquadrant of the membrane 2 to 3 mm. in size,through which the stapedo-incudal connection islaid free : or 2. By cutting the membrane with a small bis-toury. This is preferred by Miot. as the largeropening allows the movements of the instrumentsto be better seen. The incision is made at the posterior periphery. Fig. 141. near the circumference of the membrane, in the form of a half-moon (Fig. 141). and the fold of membrane is laid forward with a small spatula in order to see the field for operation. The incision should be quite large, as it must be kept open for. MOBILIZATION AND EXTRACTION OF THE STAPES. 319 three to four weeks, in order that the rernobilization of the stapes may bedone without making a new incision in the membrane. Before one proceeds to the regular mobilization of the stapes the incisedmembrane and the exposed mucous membrane of the middle ear should betouched first with a sublimate solution (1 in 1,000), and then with a cocainesolution (1 in 15). After a few minutes, a small rounded spatula (palette) isinserted underneath the junction of the stapes and incus and parallel withthe crura, and by means of repeated delicate lever movements the stapes ismobilized. If the stapes proves immovable one tries to shove the spatulabetween the long crus of the stapes and the anterior edge of the niche of thefenestra ovalis, in order to move the stapes from before backwards by means-of slight pressure. The mobilization itself is accompanied by a whistling or ringing sensationin
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Keywords: ., bookcentury1800, bookdecade1890, booksubjecteardiseases, bookyear
