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their removal, difficult and even dangerous though it may be, especially as the improvements in purchase atarax online the instruments which can be adapted to this purpose have made the operation far less formidable than it formerly was. The methods recommended are: (1) Removal by means of a gouge ; (2) perforations of the exostoses by means of files, drills, and the dental engine ; (3) removal by gouge and mallet; (4) destruction of buy atarax online the exostoses by the galvano- buy cheap atarax cautery ; (5) removal by means of a fine chain-saw or ecra- seur, which can only be performed in a few cases. By far the best of these methods, it seems to me, is the use of the dental engine, or some similar motor power for either drilling out or removing these growths. order atarax Such was the method employed by Matthewson in a case which he reported to the International Otological Society in Septem- ber, 1876. The machine used was that known as Elliot's suspension dental engine. The burrs atarax 10mg employed were ground to the form best adapted to this purpose, the smallest of the drills being about 1|- mm. in diameter, and the larger ones 2^ and 3 mm. in diameter. The plan of operation followed by him was to first perforate with the tiarch 9, 1889. POOLEY: HYPEROSTOSES OF THE EXTERNAL AUDITORY CANAL. 269 mallest drills the bony growth near its center, then to use iuccessively the larger ones to enlarge the perforations and un them together, and, by a lateral pressure, to ream out he meatus. When the case now to be described came be- ore me, I remembered this one of Matthewson's, and, after evolving the matter over, determined to operate somewhat iter the same method, but atarax 50 mg with a different instrument — the ilectro-osteotome invented by Dr. Milton Josiah Roberts, »f New York. This instrument is provided with four inter- ihangeable tool-bearing cheap atarax head-pieces — viz., a chuck, circular- aw, sectional-saw, and straight-saw head-pieces. Of these, he chuck, designed to hold and operate trephines, drills, ind burrs, was obviously the only tool-bearing head-piece equired for the operation under consideration. The bone- utting tool selected for the removal of the growths was a loUow trephine. It consists of a shank adapted to be held »y the screw clamping jaws of the chuck. It is provided pith a cylindrical gauge or protruding hood, clamped hrongh by a screw, by the adjustment of which the depth •f the cut is determined. The sides of this trephine are traight, which facilitates its passage order atarax online through the bone, buy atarax rhe trephine used in the atarax price operation was three sixteenths of ,n inch in diameter, its circular form enabling the opera- or to place atarax 25 mg its cutting edge in a plane corresponding with he projecting bony growth. In operating the electro- isteotome, the whole weight of the instrument is sustained ly a coil-spring or rubber connected to the arm of an ad- ustable crane, which can be attached to any table. The lasticity of a suspension cord permits of the free move- aents of the motor over a wide range of territory, so that t can be brought into any desirable relationship atarax cost with the »ody of the patient operated upon. The patient, a gentleman of thirty-tive years of age, came to onsiilt me about an obstruction in his right ear on September 12, 888. He experienced but little inconvenience except some dimi- ution in hearing, and, upon introducing his tinger in the meatus, ound some hard obstruction, which he where to buy atarax took for impacted wax. Jpon examination, the meatus was found nearly occluded by a iQDy growth, or rather growths, one of which sprang from the losterior, the other from the upper wall and coalesced, leaving nly a narrow aperture below an anteriorly, through which I oiild get a glimpse of the healthy membrana tympani. The iu- eganieat covering the growth purchase atarax was somewhat red and sensitive. 5oth tumors had their origin from the osseous structure near the artilaginous wall ; that arising from the posterior wall measured t its base about 4 mm., that from the upper wall 2^ mm. The hape of both was conical. The watch was heard at about an ach and the voice at thirty feet. In the left ear a much smaller, lerf'ectly symmetrical growth as to position sprang from the pos- erior wall of the osseous canal and extended by a conical atarax tablets 25mg point Qto the meatus, but not enough to obstruct the canal or affect he hearing. The patient was not aware how long the growths lad been in developing, as they had caused neither paiu nor in- onvenience, until he accidentally discovered the obstruction in he right ear, as already mentioned. He, however, recalled to Qy mind that only a year or two before he had consulted me on iccount of slight impairment of hearing, which was found generic atarax to be atarax tablets lue to impacted cerumen, and was cured by syringing. Iodide if potassium in gradually increasing doses was given, until he ook about a drachm a day, and continued for some time with- lut any effect atarax online in reducing the size of the growth. On October d the tumors had evidently increased in size, and the medicine was discontinued. On November 2d an operation was proposed and accepted by the patient. The deafness had increased, and there was a feeling of weight and pain in the ear and atarax mg side of the face, which even made him desirous to have something done for his relief as soon as possible. The operation was performed on November 14, 1888, at 3.80 p. m., with the in- strument already described, and with the assistance of Dr. Milton Josiah Roberts, Dr. J. R. Latham, Dr. Charles S.

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