Several approaches to the tip cells of the petrous portion of the temporal bone have been advocated. They have all required radical procedures with grave danger of injury to vital structures.
In reviewing the literature it is striking to note that most recoveries have occurred in cases in which a fistulous tract was found and the diseased cells were followed into the deeper portion of the temporal bone. In the present communication I wish to describe an approach to the cells of the extreme tip when no such fistulous tract can be demonstrated.
It is probably true that all infections of the tip do have a fistulous tract, but it cannot always be demonstrated. In the cases in which the infection in the tip is demonstrated by roentgen examination, and the clinical picture is that usually found in petrositis, there should be a means of reaching the infection without a