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hammer even when Online Zyprexa the hearing is still good, as it is more important to try to bring about a cessation of the suppuration which is often most dangerous to life, with the hope that the hearing Olanzapine 5mg may remain as before or may even be improved. Stacke's results were, on the whole, very en- couraging, as he not only brought about a cessation of the discharge but also an improvement in Buy Zyprexa the hearing, so that he advised excision of the hammer in all cases in which there was an impairment in hearing due to fixation of the hammer and in cases in which there was an adhesion of the hammer and Febnmiy 17. 1000.1 BALLIN: OSSICULECTOMY. 337 tympanic nieiiibrane with the promontory, as is ob- served after suppurations and neglected middle ear catarrhs. We therefore notice that Stacke was really the first to perfonn ossiculectomy more for the purpose of bringing about an arrest of the chronic ottorhoea, tlian to improve the hearing. Shortly after these publications we find others advocating this opera- tion such surgeons as Luc, Ludewig, Burnett. The last of these recorded a case in 1889 (9) of chronic otitis media punilenta with perforation of Shrap- nell's membrane and caries of the head of Risperidone Olanzapine the ham- mer, in which he removed the membrane and ham- mer, and not only jjut an end to the suppuration but also noticed a marked improvement in the hear- ing; this was almost nil before the operation and increased to 2 to 3 feet for whispered, and 12 feet for ordinary speech. Burnett went even further and claimed to have stopped the suppuration in nearly every case in which he performed ossiculectomy. This the writer thinks Zyprexa 10 rather extreme, as there are many cases met with in which the suppuration does not cease after the removal of the hammer Zyprexa Buy and Olanzapine Tablets incus, as Zyprexa Purchase one cannot tell in advance how far the necrotic condition extends. A cessation of the discharge occurs generally only in those cases in which the disease is limited to the ossicles themselves. In the following year, namely, in 1890, Ludewig (10) published a very excellent paper in which he was the first to show that the great majority of chronic. suppurations of the middle ear were due to a necrotic condition of the incus, and pointed out that, although this bone could not, as a rule, be seen or probed, it was, nevertheless, often the seat of caries and most often the cause of the disorder. Inasmuch as this organ no longer functionated when diseased, and Zyprexa Online as no disturbance in the hearing was brought about by its extraction, Ludewig recoiiimended that in all cases of suppuration the hammer should be removed. Purchase Zyprexa In his report Olanzapine 10 Mg of 32 cases he found : the incus carious with hammer intact eleven times, 34 per cent. ; the incus carious with hammer also, sixteen times, 50 per cent. Hence it will be seen that the incus was carious twenty- seven times (or 84 per Olanzapine Price cent.) in 32 cases, in two cases it was nomial, once with, and once without, a diseased condition of the malleus. In two cases it Olanzapine 5 Mg was missing (?) and in- one case extraction was stopped because twitchings of the facial nerve were observed, Olanzapine Tablet yet paralysis ensued after the operation. This report of Ludewig is very interesting as it shows the great frequency of caries of the incus and Zyprexa 10mg makes it very apparent that in all chronic sup- purations of the middle ear we must not fail to re- move both ossicles if we wish to get a favorable result. As to the Cheap Zyprexa hearing, Ludewig found an improve- ment in sixteen cases, a change for the worse in three cases, no change at all in nine cases, and gives no record in four cases ; so that it will be seen that nearly Zyprexa 5 50 per cent, of his cases were improved which is indeed very gratifying. In the next year he again published a series of Olanzapine Risperidone cases in which os- siculectomy Zyprexa Mg was perfomed. making his total num- ber 75. and, in all, caries of the incus was found 64 times or about 85 per cent. Stacke (11) now went a step further in cases of chronic suppuration using more radical measures; he advised removal of the hammer and incus but also advocated the chisseling away of the external wall of the attic. In order to gain a better view of the field of operation he was the first to detach the auricle and in this way to gain an entrance to the middle ear. His cases were usually followed by success and he thus established the so called Stacke operation which was the nucleus to the more ex-

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