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.

    710/1336 (page 678)
    diagnosis, should be the constant companions of the aurist. The first of these is the bent probe and blunt hook (see Fig. 475), whose use is to deter- mine the point of insertion, consistence and mobility of tumors or inflamma- tory new growths (polypi, exostoses, furuncles), to determine the presence of fistulous openings or of bone-caries, as well as by actual touch to investigate the surface of the membrane (perforations, etc.). The other instrument is Sieglefs pnewmatie speculum, or suction speculum (Fig. 478). Fig. 478.—Siegle's speculum, the small end made to fit air-tight into the canal, and the large end closed by a glass set in at an angle and fitted with means to condense and rarefy the air in the auditory canal. To the examiner illuminating the canal through the air-tight speculum will thus be disclosed whether the mobility of the malleus is impaired or whether the membrane is relaxed ; sunken cicatricial pouches can be distin- guished from open perforations, adhesions of the membrane or of depressed cicatrices, or of the malleus-handle to the inner wall of the tympanic cavity can be made out; and not infrequently collections of pus in the attic or antrum can be detected and emptied by this apparatus. V. EXAMINATION OF NOSE, NASOPHARYNX, AND PHARYNX. Since so many of the middle-ear diseases have their origin in the approaches to the Eustachian tube, the examination of the nose, naso- pharynx, and pharynx may well be made preliminary to an investigation of the middle ear. For the details of such examination the reader is referred to the appropriate chapters, special attention being given to the following points : 1. In the examination of the fauces, to the activity of the palatal mus- cles during phonation, these being also tubal muscles ; 2. To the appearance of the naso-pharynx, and especially of the mouths of the Eustachian tubes, by posterior rhinoscopy ; 3. To the patency of each nostril in relation to respira- tion, ventilation, and Eustachian catheterization. VI. EXAMINATION OF THE MIDDLE EAR. As preliminary to, and really a part of, investigation of the middle ear must first be considered the different means of determining the patency of the Eustachian tube. For the accomplishment of this, three methods may be used : 1. As giving a valuable preliminary idea of the condition of the tubes may be tried Politzer's experiment of holding a vibrating tuning-fork in front of the patient's open nostrils, when, during the act of swallowing, if the tubes are patulous, the vibrations are more distinctly heard by the patient. The rationale is of course plain : the act of swallowing opens the tubes when they are normally patulous, and the sound passes through them into the tym- panic cavity. Negatively, if under these conditions the patient hears the