=Sources of illumination.= Although the light reflected from the sky on a bright cloudless day is excellent, it can seldom be made use of, and so for practical purposes the source of light is usually artificial. It is wiser always to use the same kind of light--for instance, electric--as in this way a more accurate comparison can be made of the various pathological conditions seen on examination. In the consulting room, the lamp recommended by Dr. Greville Macdonald, furnished either with a thirty-two candle-power frosted burner or with a Nernst light, is most suitable. As a portable lamp, it is useful to have an electric bull’s-eye lamp, run off from a dry-celled battery: it can be held in the position of the ordinary lamp, the light being reflected into the ear by means of the head mirror. The ordinary surgical head-lamp, although not well adapted for inspection of the deeper parts of the auditory canal, is eminently suited for obtaining good illumination during the performance of the mastoid operations; or in its stead a head-mirror with lamp attached may be used, as recommended by Clar (Fig. 171). =Aural specula.= Of the various aural specula employed, Gruber’s is very good (Fig. 172). A special speculum in which a portion has been removed from the narrow end is sometimes useful in order to facilitate operative procedures within the external meatus. =Forceps.= The best are angular spring forceps with bulbous points (Fig. 173). [Illustration: FIG. 172. GRUBER’S AURAL SPECULUM.] [Illustration: FIG. 173. ANGULAR SPRING FORCEPS.] =Position of the patient.= The patient should sit upright in a chair with the side to be examined turned towards the surgeon. To prevent movement, the head should be supported by an assistant or by a head-rest fixed to the back of the chair. The lamp is placed a little behind and to the left of the patient’s head, on a level with the head of the examiner. =Technique of examination.= To convert the external meatus into a straight canal, the auricle has to be pulled backwards and downwards in an infant, backwards in a child, and backwards and upwards in an adult. The speculum should be warmed and inserted gently into the meatus by the thumb and index-finger of the left hand, whilst the pinna is held between and pulled back by the second and third fingers (Fig. 174). This leaves the right hand free for manipulation. The largest possible speculum should be used, in order to give the maximum amount of room and illumination. It should only be introduced into the meatus as far as the adaptable cartilaginous portion permits--about half an inch in the adult--and not forced into the bony portion. The utmost gentleness is essential in order to obtain the confidence of the patient; this is absolutely necessary for the performance of the various small operations upon the auditory canal and tympanic cavity under local anæsthesia. [Illustration: FIG. 174. EXAMINATION OF THE EAR.]