. Diseases of the ear; a text-book for practitioners and students of medicine. ne of the membrane is nearly horizontal, andunless particular attention is given to this fact the operationwill be inefficiently performed. It is well in operating upona young child, and even upon an adult where the canal is nar-row, to employ a curved knife (Fig. 87) rather than a straight one, as an extensive incision ismore easily made if this is myringotomy is per-formed for depletion alone inthose cases where the acute in-flammatory process has begunin the vault of the tympanum,the atrium remaining f
. Diseases of the ear; a text-book for practitioners and students of medicine. ne of the membrane is nearly horizontal, andunless particular attention is given to this fact the operationwill be inefficiently performed. It is well in operating upona young child, and even upon an adult where the canal is nar-row, to employ a curved knife (Fig. 87) rather than a straight one, as an extensive incision ismore easily made if this is myringotomy is per-formed for depletion alone inthose cases where the acute in-flammatory process has begunin the vault of the tympanum,the atrium remaining free, oursuccess in aborting the attackwill depend largely upon thethoroughness with which wedivide the connective-tissuestructures lying in the tym-panic vault. In such a case theknife should be introduced withthe blade lying in the horizon-tal plane, the cutting edge look-ing backward (Fig. 126). Thepoint punctures the drum membrane just above and behind theshort process of the malleus, the knife being passed upwardand inward and a little backward, to avoid the body of the. Fig. 126. — Incision of Shrapnells mem-brane in the early stages of acutepurulent otitis. (The continuationof the incision upon the superiorwall of the canal is indicated by thedotted line.) EXPLORATORY MYRINGOTOMY. 489 incus. The incision is then carried horizontally backward tothe periphery, when the cutting edge of the knife is turnedupward and the incision extended for a short distance alongthe superior wall of the canal (as shown by the dotted line inFig. 126). This severs the numerous reduplications of mucousmembrane and efficiently depletes this region and the liningmembrane of the mastoid antrum. Exploratory Myringotomy.—When it seems desirable toexplore the interior of the tympanum, the end is most easilyattained by reflecting a flap ofthe membrana tympani. As theregion demanding particular in-spection is that occupied by theincudo-stapedial articulation andthe niches of the oval and roundwindo
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