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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 52
LOCAL AURAL TREATMENT

In this chapter some instruction will be given in the commonly practised
treatments of diseases of the ear.

Syringeing. The most useful type of syringe for this purpose is made of
brass or plated or rustless steel. It is impossible for a patient to syringe his
own ear efficiently. Any competent person may, after a little training, learn
to carry out this simple procedure. Sterije saline splutjon^or JboracipJotioo
(1 : 40), or a solujtion-of sodium.bjcarbpn&te, wanned to blood heat, shojuldL
be employed forjjgingeing1 After filling the syringe, bubbles "of air must be
expelled by pressihg'on the piston with the point of the syringe raised. The
patient should be seated, a towel laid over his shoulder and a kidney dish
held either by the patient or an assistant immediately below his ear and in
close contact with the skin to catch the return flow of lotion. The patient's
head is inclined slightly downwards and towards the same side to prevent
the fluid from running down the neck. It is a natural reaction for the patient
to tilt his head away from the stream of fluid. The auricle is pulled upwards
and backwards to straighten out the meatus, and the fluid is injected along
the upper wall of the meatus (Fig. 159). It is essential to illuminate the ear
by direct or reflected light. Excessive force should not be exerted to remove
wax. If the wax is hard and does not come away easily, it is better to ask
the patient to instil drops ofluke\\^

B.P.C., for several days to sdffenThe wax7 ancTfhen return for "Syringeing.
When the wax has been removed, the ear should be inspected to ensure that
none remains. The meatus should be dried with cotton-wool mops after
syringeing. This is important because any abrasion of the skin during the
procedure may become infected if it is left in a moist condition. Some surgeons
advise that a few drops of spirit be instilled after syringeing to complete this
drying.

Suction clearance. Suction clearance of pus and debris is sometimes used
in hospital. Under observation with the operating microscope a fine aural
cannula is inserted and suction applied until the meatus, the mastoid cavity
(if one is present) and the middle ear are clean.

Removal of Wax. This may be carried out under vision with the aid of
wax^urettes and fine forceps^ This is essentially a specialist procedure, and
great gentleness is necessary-

Mopping the Ear. Discharge may be mopped from the ear using cotton-
wool on a"Bne wool carrier. Again, gentle handling must be observed, because
of the sensitive nature of the skin in the bony meatus. It may be done by
nursing staff who have been trained. Mopping of the ear by the patient or
his relatives must be confined to the outer part of the meatus, and is thus
rather social cleansing than curative or therapeutic.

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