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
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.] passage. Occasionally it may be necessary to introduce the catheter through the opposite nostril. In this case an instrument is used having a very long beak and a pretty strong curve; it is passed in the way already described, and the point is then turned inwards and withdrawn till the beak is felt to be in contact with the posterior edge of the septum, when the point will be near to, or in the mouth of, the Eustachian tube of the opposite side, that is, the side upon which we wish to operate. Difficulties in the Second Stage. In regard to this stage, there is sometimes difficulty in turning the beak of the catheter. This may be due to the catheter having slipped into the middle meatus or to the space between the posterior edge of the nasal septum and the mouth of the tube being unusually small, or the free space of the naso- pharynx may be diminished by swelling of the mucous membrane or by post-nasal growths. We can overcome these difficulties by keeping the point of the catheter on the floor of the inferior meatus or by using a catheter having a short and slightly curved beak. Spas- modic contractions of the pharyngeal muscles may hinder the turning of the catheter; these pass off when the patient breathes deeply a few times through the nose. The contact of the catheter with the mucous membrane of the nose or pharynx sometimes excites coughing, sneezing, or retching, but it is sufficient simply to let go the catheter until these pass off. There is occasionally slight bleeding, but rarely more than a stain of blood on the beak of the catheter is seen. Third Stage of Catheterization. This consists in inflating air, by means of an air-bag, through the catheter into the middle ear. During inflation the catheter is retained in situ most conveniently by being held between the thumb and index finger of the left hand, while the hand is steadied by resting the other three fingers on the forehead and bridge of the nose (Fig. 18). The air-bag (Fig. 19) is a pear-shaped india-rubber balloon, of a size capable of containing eight or ten ounces of fluid, furnished with a tubular mouth-piece, somewhat conical in shape, so as to fit accurately into the outer opening of the catheter. While the catheter is being introduced, the air-bag may be conveniently held in the left arm-pit of the surgeon. The mouth-piece is placed in the outer opening of the catheter (Fig. 18), and the bag is then firmly compressed laterally between the four fingers and thumb, so as to force the air into the catheter. Before relaxing the hand, the mouth-piece of the bag should be withdrawn from the catheter, and then the bag allowed to fill with air. Three or four compressions of the bag are generally sufficient. If the patient swallows during compression of the bag, the air usually passes in more](https://iiif.wellcomecollection.org/image/b24932577_0059.jp2/full/800%2C/0/default.jpg)
