This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1891 edition. Excerpt: . CHAPTER IV. THE OPERATION IN CHRONIC CATARRH OF THE MIDDLE EAR.

In this condition, which is also called dry, sclerotic, hyperplastic, proliferous, or adhesive inflammation (or catarrh) of the middle ear, the mucous membrane is at first swollen and thickened, afterward hardened and atrophic; the chain of bones (malleus, incus, and stapes--Figs, i and 2) becomes rigid, and finally more or less ankylosed, the Eustachian tube may be either more or less occluded or unduly patulous, and in many cases newly formed bands of fibrous tissue stretch across the drum-cavity, binding the tympanic structures together, and by the traction they exert upon these structures rendering them even more rigid than before. Owing to the changes in calibre in the Eustachian tube, and other causes, the elastic tension of the air in the tympanic cavity is altered. Partly because of this altered tension, partly because of the traction made by the shrinking bands of newly formed tissue, and the contracture of the sclerosing membranes of the drum, the chain of ossicles becomes rigid and no longer amenable to the action of sound-waves and may impinge strongly against the fluid of the labyrinth. The drumhead itself undergoes special changes, often becoming very thick and rigid, or, in some cases, unduly thinned and flaccid. In some of the earlier cases of middle-ear catarrh the drum is found greatly obstructed with thickened, granular-looking tissue. These changes, when once they have appeared, are generally progressive, growing steadily worse and worse. As they increase, the symptoms to which they give rise increase in like measure. These symptoms are mainly deafness and the presence of noises in the ear (tinnitus).

The former, beginning with a moderate hardness of.