A text-book of the diseases of the ear for students and practitioners . Fig. 189.—An Exhausted Suppura-tion of the Middle Ear. LargeDefect in the Bone above the Ri-vinian Segment, which is closedby a very thin depressed mem-BRANE. Head of the malleus, body of the incus,and anterior ligament of the malleus dis-tinctly visible. From a woman, 26 yearsof age. Hearing distance : Acoumeter= 50 cm. Whispered speech = 5 Fig. 190.—A Large Defect in theBone above the Rivinian Seg-ment, THROUGH WHICH THE HEAD of the Hammer is visible. In a woman, 30 years of age, who hadsuffered from otorrhcea since


A text-book of the diseases of the ear for students and practitioners . Fig. 189.—An Exhausted Suppura-tion of the Middle Ear. LargeDefect in the Bone above the Ri-vinian Segment, which is closedby a very thin depressed mem-BRANE. Head of the malleus, body of the incus,and anterior ligament of the malleus dis-tinctly visible. From a woman, 26 yearsof age. Hearing distance : Acoumeter= 50 cm. Whispered speech = 5 Fig. 190.—A Large Defect in theBone above the Rivinian Seg-ment, THROUGH WHICH THE HEAD of the Hammer is visible. In a woman, 30 years of age, who hadsuffered from otorrhcea since 10 yearsof age. Whispered speech = 2J m. usually found that the disturbance of hearing is very slight. Thisis a very important point, as the author was the first to show,in aiding us to make a differential diagnosis between the primaryforms of attic suppuration and those complicated with diffusesuppurations of the middle ear. The sequela of this peculiar form of middle-ear suppuration,requiring special treatment, will be discussed in a later chapter. Pathological Changes in the External Auditory Canal inChronic Middle-ear Suppuration.—The lining of the externalauditory canal undergoes many changes through contact withthe secretion from the middle ear, and through extension of theinflammation from the tympanic cavity. The following are the most frequent changes : Follicular ordiffuse inflammation, hypertr


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