An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall.

Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    705/1336 (page 673)
    abscess, forward to the external auditory canal, to the periosteum, to the underlying bone, to the interior of the petrous bone, to the groove for the lateral sinus, or into the cranial cavity. The presence of cicatrices may throw light on the nature of previous troubles. IV. OTOSCOPY. Now that we approach the examination of the ear itself, it should be remembered of the external auditory canal that it is somewhat oval in sec- tion, about 1^ inches in length, its general direction inward, forward, and upward, and that it is somewhat angled at the junction of the cartilaginous with the bony portion. Hence to straighten the canal for purposes of exam- ination the auricle must bo pulled outward, backward, and upward, except in infants and young children, in whom, owing to the absence or shortness of the bony portion, it should be pulled downward instead of upward (see Plate 10). The relation of the tympanic membrane to the inner end of the canal should also be borne in mind, the plane of the membrane being from above and behind in a direction downward, for- ward, and inward, in the very young approaching more nearly the horizontal than in the adult (? Ed.), so that the posterior superior quadrant is nearest to the outer end of the canal, and may easily be in- jured, particularly in children, by the careless in- troduction of a small speculum. Illumination.—To examine an ear it is neces- sary to have some means of illuminating it, and, since direct illumination is for various reasons unsat- isfactory, we now use altogether the reflecting mirror, preferably so fixed with a band as to be used as a head-mirror, which may, if desired, be used as a hand-mirror. It should be provided with a double ball-and-socket joint (Fig. 473); may vary in size from 2 to 4 in diameter; should have a hole in the center, through which the examiner may view the ear; should be concave, and, most important of all in making a selection, should have a focal length of not less than 6 nor more than 10 inches. Of next importance to the mirror is the speculum. This may be made of metal (German silver, aluminum), hard rubber, glass, or celluloid; it may be round or oval in section, with or without a curve between the large and small ends, may be long or short, and made up in sets or nests of three or four different sizes. The choice of material may depend largely upon personal preference. Each kind has its advantages and disadvantages. My own preference is for the hard rubber, or, still more, for the pinkish (flesh-colored) cel- luloid, which I have now used for two years with great satisfaction. ^^i Other instruments needed for the fig. 474.-Angiedsyringe-tip. routine examination of the ear are such as are used for the removal of the frequently-found obstructions in the canal—cerumen, hairs, epithelial flakes, Fig. 473.—Forehead mirror.