[Illustration: FIG. 175. AURAL FORCEPS HOLDING COTTON-WOOL.] =Method of cleansing the ear.= Except when the auditory canal is completely blocked by inspissated pus, cerumen, or epithelial débris, it is sufficient to mop out the ear with small pledgets of cotton-wool. To prevent injury to the walls of the meatus and to the tympanic membrane, the pledget is held between the blades of the forceps in such a fashion that it partially projects beyond its points (Fig. 175). The forceps is passed through the lumen of the speculum along the auditory canal and then quickly withdrawn. This is repeated with fresh pledgets until the meatus is cleansed. If there is much purulent discharge, only a brief moment may be given (after the withdrawal of the forceps) in which to inspect the deeper parts. Such a view, however, should always be obtained in order to form an accurate diagnosis. If this method fails to cleanse the ear, syringing becomes necessary. =Technique of syringing.= The patient should be sitting down, as syringing may cause giddiness. The fluid should be aseptic, and at a temperature of 100° F. The patient’s head is inclined to the affected side, and the auricle is pulled upwards or backwards. The syringe is inserted a short distance within the meatus, and applied to the upper posterior wall so that the stream of lotion flows along the roof of the canal to the drum, and returns along the floor, thus washing out the contents. The best syringe is one with a metal plunger, as it can be easily sterilized. After syringing, the auditory canal should be dried and again inspected. If the inspissated pus or epithelial débris cannot be removed by simple syringing, an ear-bath of warm hydrogen peroxide (10 vols. %) should be given, and the ear again syringed after ten minutes. [Illustration: FIG. 176. MILLIGAN’S INTRATYMPANIC SYRINGE.] =Syringing out of the attic.= In certain cases of chronic attic suppuration, it is advisable to syringe out the attic. For this a special syringe is necessary. It consists of a fine canula whose point is turned up almost at right angles to its shaft (known as Hartmann’s canula), to which is fitted a piece of india-rubber tubing and a ball syringe. Milligan’s modification of this instrument is now generally used, as it permits of the canula being held in the hand, and instead of having a ball syringe, is connected by rubber tubing to a small irrigator (Fig. 176). The patient sits upright in a chair in the ordinary position for examination of the ear; a speculum is inserted into the meatus, and held in position with the left hand; the canula, together with the ball syringe (if Hartmann’s is used), is held in the right hand. Under good illumination the canula is passed inwards along the auditory canal, and its point inserted through the perforation. By gently pressing on the syringe, the fluid is forced into the attic, which is thus washed out.