A text-book on diseases of the ear, nose and throat . ; but when the perforation is elsewhere in the flaccid mem-brane, a perforation-whistle is not likely to be produced. This can read-ily be understood upon reflecting that, except in anterior perforations,the head and neck of the malleus and the body of the incus intervenebetween the cavity of the tympanum and the perforation. Anotherpeculiarity of these cases in which a wide perforation is in the mem-brana flaccida is the absence of perforation in the membrana tensa belowthe folds. Even when disease in the atrium exists, with purulency inth
A text-book on diseases of the ear, nose and throat . ; but when the perforation is elsewhere in the flaccid mem-brane, a perforation-whistle is not likely to be produced. This can read-ily be understood upon reflecting that, except in anterior perforations,the head and neck of the malleus and the body of the incus intervenebetween the cavity of the tympanum and the perforation. Anotherpeculiarity of these cases in which a wide perforation is in the mem-brana flaccida is the absence of perforation in the membrana tensa belowthe folds. Even when disease in the atrium exists, with purulency inthe attic, the perforation in the membrana flaccida is often the only out-let. Doubtless there are cases in which purulency in the antrum, with aperforation in the membrana tensa, is associated with purulency in theattic and a perforation in the flaccid membrane, but the more completedrainage of the drum-cavity offered by the lower perforation renders itvery unlikely that the perforation in the flaccid membrane will be largeor even continue to 180 DISEASES OF THE EAR. The deafness in cases of attic purulency is explained by the nearness oftlie suppuration to the ossicles of hearing and their impaired motility thusbrought about. Patients with attic suppuration are more apt to suffer fromdizziness than those with purulency in the atrium, because in the formerinstance the suppuration is more likely to irritate the stapes in the ovalwindow, and thence the labyrinth through the tissues of the vestibule. Perforation in the membrana flaccida always means necrosis in themalleus and perhaps in other of the ossicula auditus. It is fortunate if this is not attended by necrosisin the margo tympanicus andother parts of the surroundingattic walls. Treatment. — There are fourmethods of treating chronic puru-lent inflammation of the drum-cavity,—viz, : 1. By injection offluids through the perforation inthe membrana by means of a tym-I)anic syringing or by insertingthem on slender mop
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