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

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LOCAL AURAL TREATMENT                       289

Eustachian catheterization is employed if Politzer's method fails, or if
one ear only is to be inflated. The Eustachian catheter is a metal tube, the
inner end of which is curved and blunt, while the outer end is expanded to
permit the insertion of the end of a Politzer's bag. There is a ring on the tube
which points in the same direction as the beak of the tube. Catheters vary
in calibre and in the amount of curve. The nose should be first examined
to see whether there will be obstruction to the passage of the tube. The nasal
cavity to be used is then sprayed with a 5 per cent solution of cocaine hydro-
chloride to reduce the discomfort of passing the catheter. After ensuring
that the lumen of the catheter contains no water by blowing through it
with the Politzer's bag the catheter is passed into the nose. The tip of the
patient's nose is tilted up, and the catheter is inserted point down. As soon
as it is within the nasal cavity the catheter is swung into the horizontal
position and gently pushed backwards along the floor of the nose until it
impinges on the posterior wall of the nasopharynx. The catheter is then
steadied at the anterior naris, and rotated through a right angle so that the
point passes medially. It is withdrawn slowly until it catches on the posterior
end of the nasal septum; then it is rotated through 180 when the beak will
He within the nasopharyngeal end of the Eustachian tube. Retaining the grip
on the catheter at the nose, the Politzer's bag is fitted to the outer end of
the catheter and squeezed. When the tube is patent air will be heard to
enter the middle ear. This is heard through an auscultation tube, one end
of which the patient holds in his ear while the other end is in the surgeon's
ear. If the Eustachian tube is patent, a blowing sound is heard; if partly
obstructed, the sound is less distinct; if there is fluid in the Eustachian tube,
crackling noises are heard.

There are many difficulties in the passage of the catheter. Should the
side of the nose be blocked, the catheter may be passed through the opposite
side, turned towards the ear to be examined and withdrawn until it meets
the posterior end of the septum, and inflation performed. Most beginners
fail to bring the catheter to the horizontal position quickly enough, and this
means that the catheter is passed above the inferior concha. Too much
handling of the catheter in the nasopharynx may cause a spasm of the soft
palate, and this locks the catheter. In such an event, one must wait until
the spasm has subsided. Sometimes there is difficulty in driving air into a
correctly passed tube, and in this event the patient should be asked to swal-
low, and the bag is compressed at the moment of swallowing. After inflation
has been carried out by one or other of these methods the hearing must
again be tested and the results noted.

The respective merits of inflation by politzerization and inflation must be
considered. Politzerization is easier to carry out, is less disagreeable to the
patient and is the only method possible in children. It has the disadvantage
that its effect cannot be limited to one ear, and it may have the unfortunate
complication, if repeated often, of stretching and slackening the healthy
tympanic membrane with resulting impairment of hearing. Catheterization
can be confined to one ear, the force of inflation can be more readily regu-
lated and the auscultatory phenomena can be more easily observed.

Packing the Ear. The insertion of medicated gauze wicks into the external
auditory meatus is a frequent and necessary method of applying local treat-
ment to the skin of the meatus, and is commonly used in the treatment of