. Diseases of the ear : a text-book for practitioners and students of medicine. he insertion of theinstrument. Very frequently, at an early stage, this tender-ness may be the only evidence suggestive of the local this examination is made before the speculum is inserted,a very slight tumefaction may be observed encroaching uponthe lumen of the canal, from one of its walls. This area maynot differ in color from the surrounding parts, or it may be of a slightly pinkish or red-dish hue. This alterationin color is seldom notice-able, and the insertion of thespeculum may entirely ob-litera
. Diseases of the ear : a text-book for practitioners and students of medicine. he insertion of theinstrument. Very frequently, at an early stage, this tender-ness may be the only evidence suggestive of the local this examination is made before the speculum is inserted,a very slight tumefaction may be observed encroaching uponthe lumen of the canal, from one of its walls. This area maynot differ in color from the surrounding parts, or it may be of a slightly pinkish or red-dish hue. This alterationin color is seldom notice-able, and the insertion of thespeculum may entirely ob-literate the local deeper parts should betested, after the speculumhas been introduced, bymeans of the probe in themanner already described,and the presence of one ormore tender points belooked upon with the local process is moreadvanced the areas of tume-faction are easily recognized(Fig. jf), if the inflammatory process is located near theorifice of the canal, the introduction of the speculum may bepainful. As many patients, however, wince slightly upon. Fig. 77.—Otitis externa acuta circumscripta,at the entrance of the canal involving thesuperior and posterior walls. (Naturalsize.) DIAGNOSIS. 223 the introduction of any instrument into the meatus, this signshould be accepted with considerable caution. As has beenstated, circumscribed inflammation of the canal is usuallylocated in the movable portion, and although occasionallyoccurring in the osseous segment, any localized tumefactionin this region should be looked upon with great suspicion,especially if situated upon the superior posterior wall, sincein this locality the mastoid antrum is separated from themeatus by a comparatively thin plate of bone, and an inflam-mation within the mastoid cells often causes an encroachmentupon the lumen of the canal in this locality. When this isthe condition otoscopic ex-amination gives the impres-sion of a canal which rapid-ly becomes narrow at thefundus, the line o
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