1. In the minor operations the patient may be operated on whilst in the sitting posture, whether a local anæsthetic or a general one of gas and oxygen is employed. The relative positions of the patient and the surgeon are then the same as for the ordinary routine examination of the ear. Special care, however, should be taken that the patient’s head is supported by the anæsthetist or assistant in order to prevent involuntary movements. 2. If the patient is operated on in the recumbent position, the head may rest comfortably on an ordinary pillow, but if chiselling is going to take place, the best support is a loosely filled sand-bag. The head should be turned towards the opposite side so that the affected ear is uppermost, and the surgeon stands at the side to be operated on. The lamp, the source of reflected light, should be held about six inches above the patient’s shoulder on the opposite side. CHAPTER II OPERATIONS UPON THE EXTERNAL AUDITORY CANAL OPERATIONS FOR FURUNCULOSIS The operative treatment consists in incising the furuncles and, if necessary, curetting out their contents. =Indications.= (1) If, in spite of palliative treatment for two days, the pain be so intense as to prevent sleep, and be accompanied by pyrexia. (2) If there be accompanying œdema of the auricle and surrounding parts. (3) If the furuncles occur during the course of a middle-ear suppuration, and occlusion of the external meatus prevents free drainage of the purulent secretion. When possible, it is always preferable to operate under a general anæsthetic, such as gas and oxygen. If, however, the patient objects to a general anæsthetic, it should be explained that, in spite of the application of anodynes, the operation, although of momentary duration, will be excessively painful. =Operation.= After the ear has been thoroughly cleansed, a large aural speculum is inserted within the meatus and the auditory canal dried with pledgets of cotton-wool. The instrument usually used for this operation is a small and narrow sharp-pointed knife known as Hartmann’s furunculotome (Fig. 178, C). Equally suitable, however, is a fine bistoury; or, if necessary, a small tenotome or the ordinary paracentesis knife. The surgeon holds the speculum in position within the meatus with the left hand, and with the right inserts the knife through the lumen of the speculum along the meatus until its point passes the innermost limit of the furuncle. It is then quickly withdrawn, at the same time _incising the furuncle_ freely down to its base. Another method is to _transfix the furuncle_ by passing the knife through its base and making it cut outwards through the skin. In a similar manner any other furuncles that may be present are incised or transfixed.