. Diseases of the ear : a text-book for practitioners and students of medicine. seen from these statistics that the greatest im-provement has followed those operations performed under 51-4 MIDDLE-EAR OPERATIONS. cocaine anaesthesia, and where the design has been to securea permanent opening into the tympanum. This seems to bethe most rational procedure in all cases where the membranatympani is intact; and since it can be done without generalanaesthesia, we are certainly warranted in recommending atleast an exploratory tympanotomy in all cases w^here the hear-ing has failed to improve under les
. Diseases of the ear : a text-book for practitioners and students of medicine. seen from these statistics that the greatest im-provement has followed those operations performed under 51-4 MIDDLE-EAR OPERATIONS. cocaine anaesthesia, and where the design has been to securea permanent opening into the tympanum. This seems to bethe most rational procedure in all cases where the membranatympani is intact; and since it can be done without generalanaesthesia, we are certainly warranted in recommending atleast an exploratory tympanotomy in all cases w^here the hear-ing has failed to improve under less radical measures. In nogiven case can we state the amount of improvement which weshould expect, and it is always our duty to inform the patientof the experimental character of the measure. From the fact,however, that the procedure is followed by no discomfort,that it can be performed without pain, and that, humanlyspeaking, it will not injure the organ, we certainly fail to ful-fill our entire duty to the patients if the subject is not pre-sented to them fairly. PLATE The Mastoid Operation. CHAPTER XXVIII. THE MASTOID OPERATION. The instruments required are a medium-sized scalpel (), thumb forceps (Fig. 142), scissors (Fig. 143), retractors,either sharp or blunt (Fig. 144), a periosteum elevator (, 146), a rongeur forceps (Fig. 147), sharp spoons (, a, and 148), a silver probe, a wooden or rawhide mallet,and chisels or gouges of various sizes (Fig. 149). It is alsowell to have a small trephine at hand. The usual supply ofartery clamps (not less than six), needles, and silk and catgutsutures will naturally form a part of the armamentarium. The ear should be first thoroughly cleansed by syringingwith i-to-i,ooo bichloride solution, or with a dilute (i to 10)solution of peroxide of hydrogen, after which the meatus is Fig. 141.—Scalpel for incising the soft parts in the mastoid operation. The handleis of metal, and the extremity is useful in elevat
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