In the case of small and soft polypi, the polypus is removed by traction--formerly called =avulsion=--after the snare has been tightened round its pedicle; with a large, tough, fibrous polypus considerable force may be required to tear through its pedicle. This procedure in the case of polypi arising from the region of the tegmen tympani has been known to give rise to fatal meningitis. In such cases the pedicle of the polypus should be cleanly cut through by the snare--so-called =excision=. As aural polypi are always associated with suppuration, it is especially necessary that the ear should be thoroughly cleansed before operation. A local anæsthetic (see p. 310) is sufficient in the case of smaller polypi, but if the polypus be large and tough, it is wiser to give a general anæsthetic, such as gas and oxygen. Or a 3% solution of cocaine may be injected into the growth, which, according to Frey of Vienna, renders removal absolutely painless; this, however, has not always been my experience. The size of the polypus and the origin of its pedicle should be determined before operating, if necessary by using a probe (Fig. 181); also it must be diagnosed from a bulging congested tympanic membrane, or from the inner surface of the tympanic cavity, which may be exposed to view owing to complete destruction of the membrane having already occurred. [Illustration: FIG. 181. AURAL PROBE.] [Illustration: FIG. 182. WILDE’S AURAL SNARE. The snare is held in the usual position for extraction of a polypus.] A Wilde’s snare is generally used. It is a fine angular snare fitted with soft copper wire. The loop of the snare should be bent downwards and forwards and should be of such a size as to just surround the growth. The snare is held between the thumb and the first and second finger of the right hand (Fig. 182). Under good illumination, and using the speculum and reflected light if necessary, the shaft of the snare is passed along the upper portion of the auditory canal until the edge of the polypus is reached. The loop is made to encircle the polypus (Fig. 183), the snare is gradually pushed inwards with a gentle sinuous movement until it reaches the point of attachment of the growth. The loop is then tightened until it firmly grasps the neck of the polypus (Fig. 184). The friable tissue is torn through by gentle traction and the polypus is withdrawn in the snare. Care must be taken not to injure the tympanic membrane through which the polypus may be projecting; it is for this reason that the loop is bent at an angle to the shaft of the snare so that it may lie parallel to the tympanic membrane whilst in the act of grasping the polypus. If the polypus be very small its pedicle may be clearly defined before operation, and the snare passed round it directly (Fig. 185).