In the case of a round substance like a pea, especially if it is tightly impacted within the meatus, its removal is sometimes facilitated by first slicing it into pieces by means of a small bistoury. As a rule, the foreign body is impacted at the junction of the cartilaginous and bony portion of the auditory canal; sometimes, however, it is more deeply situated within the osseous meatus, usually the result of previous attempts to extract it. [Illustration: FIG. 180. IMRAY’S SCOOP FOR EXTRACTING A FOREIGN BODY.] In the former case, the instrument is passed along the upper posterior wall of the canal between it and the foreign body, the point of the hook being kept upwards or downwards so as not to project into the auditory canal. The instrument is first passed well beyond the foreign body, and then the shaft is twisted round so that the hook projects into the auditory canal. With a quick movement it is drawn outwards a short distance so that the point of the hook pierces the impacted substance. Gentle traction is now used and in the majority of cases the foreign body can be extracted. If this fails, a slightly curved fenestrated scoop (Fig. 180) or curette should be passed, if possible, between the foreign body and the anterior wall of the auditory canal. The hook already fixed into the foreign body prevents it from being driven further within the meatus, whilst the scoop, if it can be got beyond the foreign body, can usually lever it out. If the foreign body has been pushed in beyond the isthmus and lies deeply within the osseous canal, it is better to pass the hook along the anterior inferior wall of the meatus, because owing to the inclination of the tympanic membrane its anterior inferior margin is much more deeply placed than its upper posterior part. (ii) _In the case of a hard substance_, such as a piece of stone, coal, or a bead, blunt hooks may be used instead of sharp ones. They should be passed into the meatus _beyond_ the foreign body in the manner already described. (iii) _In other cases_, depending on its shape and position, the foreign body is better removed by means of a snare, the loop of which is manipulated round it and then drawn tight in the same manner as in the extraction of a polypus. The chief points to observe in these manipulations are (_a_) not to push the foreign body farther in and (_b_) not to injure the walls of the meatus or the tympanic membrane.