98 Hie Ear 



panic abscess the wound in the membrane may obstinately refuse to 

 close ! Paracentesis should be performed through the lower part of 

 the membrane, so as to avoid the risk of wounding the handle of the 

 hammer and the chorda tympani, which are above the equator. 



The instrument must be thrust through with great care, as the 

 inner wall is but y^-inch beyond the membrane. I once had a man 

 under my care whose child had roughly practised the operation on 

 him with a pair of scissors, and with such violence as to cut through 

 the facial nerve as it ran in the substance of the inner wall. The man 

 had complete facial paralysis (p. 67). 



Polypi growing from the inner wall of the tympanum may cause 

 great local disturbance, and in due time may make their way through 

 the membrane and up the meatus ; they are usually associated with 

 much suppuration. Having been removed by snare or forceps, their 

 base must be kept down by astringents. 



When there is a hole in the membrane, and the Eustachian tube is 

 clear, the subject can force air through it by blowing his nose hard. 

 But the existence of an opening by no means implies deafness. In- 

 deed, though the hammer and the anvil have escaped with the puru- 

 lent discharge, hearing may persist, provided that the plate of the 

 stirrup remains to close in the vestibular perilymph. 



When the membrane has a large opening in it, and the Eustachian 

 tube is clear, the tympanum may be washed out into the pharynx by 

 sending a full stream of warm water down the auditory meatus, and in 

 cases of chronic suppuration this treatment may be advantageously 

 resorted to. 



Artificial membrana tympani. When the destruction of the 

 membrane has been so great as to lay the meatus into the tympanic 

 cavity, the hammer and the anvil having probably escaped, hearing 

 may be improved by passing a delicate plug of cotton-wool against 

 the inner wall of the tympanum, so that it presses against the head of 

 the stirrup, and conveys the sound-waves to the perilymph of the 

 vestibule. 



Acute inflammation of the middle ear may be an independent 

 disease, or may be secondary to a < sore-throat.' As the muco-purulent 

 fluid collects in the chamber with unyielding walls the effect of pres- 

 sure becomes extremely serious : the first result may be noises in the 

 ear, because the stapes is driven against the vestibular perilymph ; 

 then come intense headache and pains of a bursting character, which, 

 increasing, may cause convulsions, delirium, and may be followed by 

 death. 



There is tenderness around the meatus and over the mastoid pro- 

 cess. Swallowing causes pain by opening the inflamed Eustachian 

 tube and causing air to enter the tympanum. Movements of the jaw 

 also cause pain by disturbing the engorged tissues between the condyle 

 and the tympanum. 



