If the polypus be very large and tough, the snare is made to cut clean through its pedicle as near to its attachment as possible, instead of employing traction. The snare is then withdrawn, the polypus being afterwards grasped and removed by means of forceps. In this latter case it may be necessary to use a stronger snare fitted with piano steel wire instead of the ordinary copper wire. On removal of the polypus there may be considerable hæmorrhage. After it has ceased the ear is syringed out and dried. The auditory canal is then inspected, and if it is found that the growth has not been removed completely, this can be done now by reapplication of the snare. After final cleansing of the meatus, a strip of gauze is inserted, and the ear protected with a pad of cotton-wool and a bandage. =After-treatment.= The dressing should be removed within twenty-four hours, and the ear cleansed by syringing. After mopping it dry drops of rectified spirits should be instilled. On removal of the first dressing, any polypoid tissue which remains may be cauterized under cocaine anæsthesia by the actual cautery, or by a bead of chromic or trichloracetic acid (see p. 348). [Illustration: FIG. 183. WILDE’S SNARE BEING PASSED ROUND AN AURAL POLYPUS. (_Semi-diagrammatic._)] Further treatment consists in keeping the ear clean and dry. For the first few days it should be syringed daily, dried, and spirit drops instilled. As the secretion becomes less the syringing should be diminished. If the perforation be large, instead of instilling drops, some finely powdered boric acid may be puffed in. =Other methods of removal.= These are not recommended, but merely mentioned for the sake of completeness. _By forceps._ The rough and ready method of extracting a polypus forcibly from the ear by means of forceps, although practised formerly, has now been discarded as being unsurgical and dangerous. _Ligation._ The operation consisted in passing a snare over the polypus and grasping it tightly as near to its base as possible. The snare was then twisted round its axis in order to tighten the loop further and so obliterate the blood-supply of the growth, the wire of the snare being afterwards cut through with pliers and the snare withdrawn. After a few days the polypus became gangrenous from want of blood-supply, and separated from its deep attachments. _Curetting._ This method, which should only be made use of in the case of small multiple polypi within the tympanic cavity, will be considered when discussing the treatment of granulations within the middle ear (see p. 398). =Dangers.= Hæmorrhage is seldom profuse, but if it is, it can always be arrested by packing the meatus with cocaine and adrenalin solution. [Illustration: FIG. 184. WILDE’S SNARE GRIPPING THE NECK OF POLYPUS. (_Semi-diagrammatic._)] [Illustration: FIG. 185. POLYPUS ARISING FROM THE ATTIC REGION. The snare is in position for the extraction of the polypus. (_Semi-diagrammatic._)]