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288                                             THE EAR

Inflation of the Eustachian Tube. To complete the examination of the ear
it is often necessary to try the effect of inflation of the middle ear cavity
by driving air through the Eustachian tube into the tympanum. This proce-
dure is important in diagnosis and prognosis, and as a method of treatment.
It is of importance in diagnosis in that it gives information as to the patency
of the tube, it demonstrates the presence of abnormal secretions within the
tube or the middle ear cavity and it gives information as to the site of the

Jife. 159. Syringeing the ear.

lesion by its effect on the acuity of hearing. It is of value in prognosis as
this depends largely upon the immediate improvement of hearing after
inflation, and upon the length of time such improvement lasts. Inflation
may be performed by Valsalva's method, by Politzer's method or by the
Eustachian catheter.

In Valsalva's method the patient pinches both nostrils and makes a forced
expiration with his mouth shut. If the Eustachian tubes are patent air
passes into the tympanum and the patient feels a crack or a sense of fullness
in the ears. If the drumhead is inspected during inflation it is seen to move
if there is nothing to interfere with its mobility. Valsalva's method is not
always successful, even when the tubes are patent.

Politzer^s method is carried out by means of a Politzer bag. This is a rubber
bag about the size of a large orange, and is connected to an olivary nozzle
which is inserted into the nostril. Both nostrils are then tightly closed by
the finger and thumb of the surgeon's left,hand, the bag being held in his
right. The patient is given a sip of water and is told to swallow, and the
moment he does so the bag is forcibly squeezed. The most effective moment
at which to compress the bag is that at which the larynx rises at the beginning
of deglutition. Part of the air thus driven into the nose will pass into the
middle ear on each side through the Eustachian tubes, unless they are very
blocked. In the case of children the bag may be compressed during the act
of crying.