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290                                          THE EAR

otitis externa. The wick consists of a suitable length of narrow (12mm)
ribbon gauze which is either soaked in a prescribed lotion such as aluminium
acetate, 8 per cent in water, or ichthyol, 10 per cent in glycerine, or is impreg-
nated with one of the anti-inflammatory ointments or creams. Packing
should be done under direct vision with good illumination. Angled forceps
are used to place the leading end of the wick well into the external meatus
which is straightened by traction of the auricle upwards and backwards
(Fig. 160). An adequate length of gauze is gently packed into the meatus

Fig. 160. Packing the external meatus with medicated gauze.

to ensure that contact is achieved with the meatal walls, which also derive
some support from the pack. Medicated ear wicks are usually changed daily
or on alternate days.

Minor per-meatal procedures, such as removal of granulations or an
aural polypus, may be made easier in a patient with a narrow meatus by the
preliminary insertion of a gauze wick which has been soaked in a solution
of 1 : 1000 topical adrenaline hydrochloride, excess solution being expressed
from the gauze.

Ear Drops. Solutions should be slightly wanned before use. The method
of instillation is simple. The patient bends his head to one side, the affected
ear being uppermost, the auricle is pulled upwards and backwards and up
to ten drops are instilled into the meatus from a dropper. The tragus is
pressed immediately afterwards to drive the fluid inwards and to expel air
bubbles. After a lapse of 2 minutes the fluid is allowed to escape and the
ear is dried. If a more than temporary action is required, the fluid is retained
by a pledget of wool in the meatus.

Insufflation of Powder. Some cases of otorrhoea are benefited by the use
of powder, which is insufflated into a dry ear. Any discharge must be mopped
out, or if it is syringed out the ear must be thoroughly dried before the
powder is blown in through an insufflator with a fine straight nozzle. Only
sufficient powder to form a thin film should be used.

Ctatstics. These may be employed to destroy small granulations or the
stumps of polypi. Copper sulphate, a bead of chromic acid fused on a probe,