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It being manifestly impracticable for a surgeon to have always at hand one of the bulky and expensive noise-producers operated by the electric current or by compressed air, and cases often presenting which require immediate diagnosis as to the presence or absence of unilateral deafness, the improvisation of a noise-producer becomes necessary.
This may be very satisfactorily accomplished by using a piece of ordinary rubber tubing, or better an otologic auscultation tube, or a stethoscope, one ear-piece being stopped up, if it is a double instrument. One end of the device should be inserted into the patient's ear, using care to prevent any occlusion of the lumen of the tube or ear. The other end should be held a few inches below and in front of the operator's mouth, and a fine column of air blown through the lips into and across the extremity of the apparatus thus adjusted. If
FOWLER EP. AN IMPROVISED NOISE-PRODUCER FOR DETERMINING UNILATERAL DEAFNESS. JAMA. 1912;LVIII(6):410. doi:10.1001/jama.1912.04260020094011
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