. Diseases of the ear : a text-book for practitioners and students of medicine. the course followed by the cathe-ter. The Eustachian orifice is well marked. (Authors specimen.) sort to several as soon as difificulties arise, it being more easyto become expert in the manipulation by the constant use ofone method, Loewenberg ^ modifies the technique in the following man-ner : When the pharyngeal extremity of the catheter is felt toimpinge upon the posterior wall of the naso-pharynx the in- * Arch, fiir vol. 120 PHYSICAL EXAMINATION. strument is rotated upon its long axis so that the
. Diseases of the ear : a text-book for practitioners and students of medicine. the course followed by the cathe-ter. The Eustachian orifice is well marked. (Authors specimen.) sort to several as soon as difificulties arise, it being more easyto become expert in the manipulation by the constant use ofone method, Loewenberg ^ modifies the technique in the following man-ner : When the pharyngeal extremity of the catheter is felt toimpinge upon the posterior wall of the naso-pharynx the in- * Arch, fiir vol. 120 PHYSICAL EXAMINATION. strument is rotated upon its long axis so that the guide ringshall be directed toward the opposite ear; the catheter isthen drawn forward until its concavity is felt to engage theposterior margin of the nasal septum ; it is then rotateddownward through an angle of one hundred and eighty-degrees, until the guide points toward the ear to be inflated,while at the same time the catheter is carried toward thisside. According to the writer quoted, when rotation has beencompleted, the beak of the instrument will be found to lie in. 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. loi. f Annal. des mal. de Ioreille, 1877, vol. iii, p. 69. METHODS OF CATHETERIZATION. 121
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