A text-book of the diseases of the ear / by Josef Gruber.

  • Gruber, Josef, 1827-1900.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of the diseases of the ear / by Josef Gruber. Source: Wellcome Collection.

    468/618 (page 434)
    It must be specially noted, however, that neither a local tuberculosis of the bone, nor a perhaps further advanced co-existent pulmonary tuberculosis, is per se an absolute reason for not operating. On the contrary, recovery from the caries after operation is in certain cases observed to be followed by gradual improvement in, or even cessation of, the pulmonary disorder. In corroboration of this view, the author can adduce cases in his hospital practice in which recovery took place after operation. Wolf1 operated with good results in cases of caries necrotica tuberculosa of the mastoid process and of the hip-joint. Schwartze showed in the otological section of the German Society of Naturalists in Berlin, the case of a man who was cured by operation of tuberculosis of the temporal, parietal, and occipital bones; and Gilctte'2 likewise brought about recovery in a patient, the mastoid process of whom he opened up on account of violent pains, and who suffered from pulmonary tuberculosis with already developed cavities. The presence of symptoms which usually precede or accompany the dreaded secondary results of a suppurating process in the temporal bone—e.g. rigors, vomiting, vertigo, cervical pain, and high fever—furnish reasons for, rather than against operating. Focal symptoms on the other hand, such as aphasia, unilateral contraction, or paralysis of the extremities or clonic spasms, are good grounds for relinquishing it, as insisted on by Schwartze, unless extraordinary circumstances should enjoin otherwise. It will scarcely be too much to say that the symptoms mentioned as contra-indications for operation will in the course of time be probably held to be of less significance in this respect. Nevertheless, caution in this direction must always be advisable, in order that the procedure may not be brought into discredit. Methods of operation.—It must in the first place be noted that perforation of the mastoid cells is at the present day performed almost invariably from without—i.e. behind the auricle in the region of the mastoid process; and but very seldom from the external auditory canal, as recommended by Wolf and others. The latter method is indicated only in those extremely rare cases in which, with extensive destruction of the tympanic membrane, the mucous membrane of the cavity of the tympanum is dry, while pus oozes through a carious fistula on the posterior wall of the auditory canal; or when under similar circumstances the posterior wall, as a result of in- flammation, appears considerably swollen up, thus narrowing the canal very much, and the swelling resists ordinary treatment for an unusually long while. The operation through the canal is especially indicated when the morbid changes there are associated with long-continued pains ; 1 Zur Eröffnung des Warzenfortsatzes. Berliner klinische Wochenschrift, 1877. 2 Ann. des mal. de For., etc.,'' v., p. 249.