Otitis Externa. Commonly Known as Swimmer Ear

Removal of Foreign Bodies from the Ear M Guersant in a recent number of the Bulletin General de Thtrapeutique makes the following remarks on this subject. If we except the concretions of cerumen that are principally met with in the aged and rarely amongst children it must be said that foreign bodies in the external auditory canal are more often observed in youth than at more advanced ages.

For our part we have seen a considerable number of them in hospital and private practice. The bodies thus met with are very diverse hardened cerumen pebbles stones extracted from rings or ear rings pearls peas shells beans fragments of glass tubes balls of paper seeds etc Insects have been mentioned but we have not on any occasion met with them.

All these foreign bodies when they remain in the auditory canal principally those which swell up may occasion severe accidents such as inflammation suppuration buzzing cerebral symptoms meningitis. Hence it is important to relieve as soon as possible children who have in their ears a pea or a seed which may swell up on becoming moist.

The surgeon ought before all to ascertain with accuracy that a foreign body exists because very dangerous attempts have often been made in cases where no such body has been present. If after the patient has been placed in a proper position and the light has been directed into the canal the foreign body is recognized the surgeon ought to act differently according to the case.

1) The foreign body may be a fluid such as water in swimmers or oil In these cases a single shake given to the head has sufficed to make the fluid run out.

2) Sometimes there is hardened cerumen. A simple ear pick previously dipped in oil will allow this concretion to be expelled It may be necessary first to soften the cerumen by several injections of lukewarm water or of oil or glycerine.

3) Peas beans seeds or balk of paper swell and soften. They may be caught and hooked out sometimes easily enough either with small forceps or with a small short hook.

4) Hard bodies as pebbles shells hard seeds can be removed in several manners. As was very anciently advised and as has been done by Meniere injections may be employed. We have says M Guersant very often used these means and for all sorts of foreign bodies It is necessary however to act in a certain manner with much perseverance and the relations ought to be shown how to practise these injections because it is often necessary to repeat them several days following before success is obtained.

In order to apply injections it is well to procure an Kguisier’s irrigator fitted with a straight tube and tilled with cold or better with luke warm water. The child should be wrapped in a cloth folded several times double so that the arms are thus kept wrapped up the cloth ought to surround the neck of the child in order to avoid wetting it. The head should also be held in a somewhat inclined position and a basin should be placed under to receive the water.

The surgeon should direct the pipe of the irrigator into the auditory canal propelling the jet of water very slowly at first so that it may pass between the foreign body and the walls of the canal strike on the membrane of the tympanum and in its return drive out the foreign body which will sometimes escape after the first injection It is important that the surgeon at the time of performing. 2 the irrigation should draw the lobe of the ear alternately upwards downwards forwards and backwards in order to modify the direction of the jet. The operation should be repeated several days following if no results follow the first injection and the relatives should be instructed how to make the injections M Guersant has seen cases in which

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