Vertigo, resulting from manipulations in the ear is always caused by a disturbance of the pressure-equilibrium of the labyrinthine fluid. Usually, this disturbance is in the form of pressure from without, consequent upon syringing into the middle ear, either through the tube of through a perforated drum. It may also be incidental to operations in the middle ear. In either case, the proper steps for its relief should never be forgotten.
Surgical Treatment of Deafness.-In this field, the American aurists have distanced those of other countries.
Extraction of the hammer is discouraged at Vienna, except for caries. Mobilization and circumcision of the stapes are the only surgical procedures having as their aim the restoration of hearing which are practiced there. In performing these, the opening in the drum-membrane is made either with the knife or galvano-cautery over the inco-stapedial articulation. A delicate paddle-shaped knife, cutting at the end of the blade, is pushed in below the foot-plate of the stapes into the oval window, and any existing adhesions are thus severed. It is a harmless but radical procedure, and should be undertaken in appropriate cases without hesitation.
Extraction of the stapes, however, as recently undertaken by Blake, of Boston, is a much more radical proceeding. The verdict as to its justification cannot yet be rendered. Two questions must first be answered,-first, is the improvement,if attained, permanent? second, are there dangers attending the operation which would overbalance the possible gain?.
The first question time alone can answer. Presumption, however, is in its favor. it is urged, that the space in the oval window, formerly occupied by the foot-plate of the stapes, is replaced after the operation by membrane which must, naturally respond to sound vibrations more freely than ankylosed bone. It is difficult to see how this membrane can be other than a permanent one, although, it may be subject to modifications, in course of time, which would impair its usefulness as a conductor of sound.
With reference to possible risks, the operations thus far undertaken have been unattended with any unpleasant consequences. Vertigo, sometimes protracted, is to be expected, although frequently altogether absent. The operation is unattended with pain when performed under the influence of Cocaine injected per tubam. Solution of Cocaine dropped into the external ear are comparatively impotent. If injected into the middle ear through the catheter, however, project local anaesthesia results.
The results of stapedectomy will be watched with great interest by the aurists of the world. Should its promises be fulfilled, it will be chronicled as one more triumph of American surgery.
