Paracentesis Tympani

PARACENTESIS TYMPANI or, better, myringotomy, means the incision of the tympanic membrane. It was first advocated and used by a Parisian charlatan named Eli, who flourished in the latter part of the eighteenth century. It had its first legitimate employment at the hands of Himley and Cooper during the beginning of the nineteenth century. The indications for the operation at this time were legion, and included practically all forms of deafness. It is now restricted to cases of suppura-tive otitis media, and occasionally catarrhal otitis media when accompanied by an exudate in the middle ear which does not absorb. The indications may be enumerated as follows:-1. Acute purulent otitis media with bulging of the whole tympanic membrane. 2. Acute purulent otitis media involving the attic region as shown by bulging of Shrapnel's membrane and the upper posterior segment of the tense membrane. 3. Suppurative otitis media with resolution delayed by insufficient drainage produced by a small and inadequate perforation. 4. Subacute catarrhal otitis media characterised by inflamed and infiltrated membrane and the presence of fluid in the middle ear. 5. Acute exacerbation of a chronic suppurative otitis media with physical signs of pus retention anywhere in the middle ear. The chief indication is the bulging drum of acute suppurative otitis media, the bulging being due to the pressure of serum, sero-pus, or pus against the least resistant wall of the middle ear. Owing to the attachment of the handle of the malleus to the drum at its centre, the periphery bulges more than the centre, so, in a case where the whole drum is involved, all the anatomical landmarks are obscured and the membrane looks like a red convolvulus. If the exudate has collected slowly and has been present for some days, the redness gives place to a yellowish pink colour; this is, I think, partly due to the colour of the pus and partly to ischaemia of the drum vessels produced by pressure. The middle ear is divided into several pouches by the ligaments of the ossicles and folds of mucous membrane, so that the bulging may be localised to one part of the drum. The objects of the operation are, first, to provide adequate drainage and so prevent extension to the mastoid air cells; second, to preserve hearing by procuring quick resolution of the inflammation and so reducing intra-tympanic adhesions to the minimum. The incision in the drum …