The Journal of laryngology and otology . the bilaterality of the symptoms would causeone rather to think of a £:;eneral affection of the nasal or retronasal mucous mem-brane than of a localized focus of suppuration, the direct research of the pus is theonly means of diagnosis.*^ In fact, Ziem, Kaufmann, and ourselves owe our cases ofdouble empyema of the antrum to methodical exploration of this caty which eachof us has made by a different channel. Ziem, who first suggested methodical exploratory irrigation, thanks to whichhe was enabled to demonstrate the frequency of empyema of the antrum in
The Journal of laryngology and otology . the bilaterality of the symptoms would causeone rather to think of a £:;eneral affection of the nasal or retronasal mucous mem-brane than of a localized focus of suppuration, the direct research of the pus is theonly means of diagnosis.*^ In fact, Ziem, Kaufmann, and ourselves owe our cases ofdouble empyema of the antrum to methodical exploration of this caty which eachof us has made by a different channel. Ziem, who first suggested methodical exploratory irrigation, thanks to whichhe was enabled to demonstrate the frequency of empyema of the antrum in theabsence of the classical symptoms, practises it through an artificial orifice in thealveolar arch. Kaufmann irrigates through a canula introduced through the natural or acces-sory orifice, according to the method employed by Hartmann for the treatment ofabscess of the antrum. We ourselves reach the antrum through a puncture of the nasal wall of theantrum in the inferior meatus by means of a thin straight trocar (see figure) after. the manner we described in our first work on the subject. This process is, in fact,only the operation in miniature which Miculicz performs at the same place withhis lanciform perforator, Krause with his large trocar, and Tornwaldt with histrephine in order to open the sintis largely for the treatment of empyema by this channel. We have in the work mentioned previously already mentioned the reasons forwhich we prefer exploratory puncture through the inferior meatus to that madethrough the alveolar arch, and washing through the natural or accessory orifice, orrather by an artificial orifice created in the infundibulum. Dundas Grant, wholately spoke of our method of exploration before the Ikitish Laryngological andRhinological Association, said :— Nearly always the diagnosis of empyema is a little uncertain, until exploratory puncture has been made : that is a point uponwhich all conscientious observers will agree with me, I think. And afterdescrib
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Keywords: ., bo, bookcentury1800, booksubjectear, booksubjectnose, bookyear1887
