6. =Examination of the Ear.= The dura is removed from over the
temporal bone and the _tegmen tympani_ cut off with chisel and hammer
as indicated in Fig. 32, _1_, _2_, _3_, _4_, _5_, thus exposing
the tympanic cavity as shown in Fig. 33. When the tegmen tympani
is very hard and compact the hammer and chisel are used to remove
that portion of the tegmen lying laterally to the eminence formed by
the upper semicircular canals. As the ear-ossicles lie immediately
beneath the roof of the tympanic cavity care should be taken not to
injure them with the chisel, and this can be best accomplished by
beginning to chisel so far posteriorly that the tegmen of the mastoid
antrum is first cut away, and from this opening the cut is extended
carefully until the tegmen tympani is removed. When the tegmen of
the tympanic cavity is very thin and porcelain-like, as is often the
case, it may be most quickly and expediently removed by means of
the pointed bone-forceps. A complete view of the tympanic cavity is
obtained by removing the coverings of the mastoid antrum posteriorly
and the bony canal anteriorly after first drawing out the musc.
tensor tymp. from the canal. The mastoid process may be opened with
the saw or with chisel and hammer. The labyrinth may be exposed by
cutting anteriorly with the chisel held horizontally in such a way
as to spring off the upper half of the bony labyrinth, exposing the
vestibule and cochlea. The superior and posterior semicircular canals
come off, and from their open spaces the membranous semicircular
canals can be lifted out with the forceps and then examined in water.
The external auditory canal may be opened and the outer surface of
the ear-drum examined by carrying the anterior flap of the scalp
downward and forward until the entrance into the bony canal is
reached. The external ear is then cut off close to the bone, using
slight pressure so as to avoid tearing out the lining of the canal
or injuring the tympanum. The anterior bony wall of the canal, and
a part of the lower, are then carefully chiseled away until the
membrane is exposed. Any bony projections on the thicker upper or
lower wall of the canal may be trimmed off to give an unobstructed
view. When pathologic changes are present upon any part of the wall
of the canal the latter should be opened from the other side so as to
expose the condition fully.
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