Manual of diseases of the ear : including those of the nose and throat in relation to the ear : for the use of students and practitioners of medicine / by Thomas Barr and J. Stoddart Barr.

  • Barr, Thomas, 1846-1916
Date:
1909
Catalogue details

Licence: In copyright

Credit: Manual of diseases of the ear : including those of the nose and throat in relation to the ear : for the use of students and practitioners of medicine / by Thomas Barr and J. Stoddart Barr. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    i.] APPEARANCES OF TYMPANIC MEMBRANE. different persons, and is often broken up into several parts or reduced to one little spot ; these varieties have but little significance. From the short process a narrow, more or less distinct fold, passes backwards—the posterior fold—and a less distinct one in front, the anterior fold. The small area above the short process and these two folds is known as the membrana flaccid a, or ShrapnelVs membrane, which occupies the Rivinian segment, and varies in size. When the tympanic membrane is specially transparent (Coloured Plate I., Fig. 2), we may see the long process of the incus through it as a whitish streak, slightly behind and parallel with the upper part of the handle, and from its lower end the posterior crus of the stapes may be observed passing backwards, forming with the incus an elbow- shaped appearance ; even the tendon of the stapedius may in some cases be discernible. Occasionally there is also visible below and behind a dark semilunar area—the depression of the fenestra rotunda on the inner tympanic wTall; while, behind the umbo, a yellowish-grey colour may be reflected from the promontory. Abnormal Tympanic Membrane without Perforation (see Coloured Plates). We note the colour, polish and transparency of the drum-head. We may observe one or other of the following changes—hyperaemia, especially along the manubrium or on the membrana tfaccida—a yellowish-green moist appearance indicating secretion in the tympanum—local or general opacities or calcareous deposits—a dark depressed area indicating a cicatrix—bulgings which may be reddish, bluish or yellowish, frequently above and behind,—a foreshortening of the handle of the malleus, with increased prominence of the short process and folds, indicating the indrawn membrane—the incus, stapes or promontory seen through an atrophied or transparent membrane—an abnormally prominent and large manubrium or a thin atrophied one. Abnormal Tympanic Membrane with Perforation (see Coloured Plates). If a perforation exists we should note its size, shape and situation ; the presence or absence of secretion ; the state of the mucous membrane on the inner tympanic Avail, Avhether it is pale and dry, or secreting, congested and swollen, or the seat of granulations or polypi. Observe if the handle of the malleus is shortened, absent or adherent to the inner tympanic wall ; if the incus or stapes is exposed by the perforation above and behind ; if we can see the bulging promontory or the niche of the fenestra rotunda. We should observe the appearance of the remnant of the membrane. Is it greyish, white or congested ; thickened, opaque or the seat of a calcareous deposit; or does it adhere to intra-tympanic structures ? III. EXAMINATION OF THE MIDDLE EAR THROUGH THE EUSTACHIAN TUBE. This consists mainly in observing the effects produced when com- pressed air is forced into the pharyngeal mouth of the Eustachian tube, termed inflation of the middle ear. We shall consider, first, the methods of inflating the middle ear; and, second, the information derived from these methods. The therapeutic value of inflation will be considered elsewhere (see p. 76). There are three methods of inflation usually practised : (a) Catheterization. (b) Politzer’s method. (c) Valsalva’s method.