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Graph Theoretic Concepts in Computer Science 42nd International Workshop WG 2016 Istanbul Turkey June 22 24 2016 Revised Selected Papers 1st Edition Pinar Heggernes (Eds.)
Springer Studies in Media and Political Communication
Series Editors
Stylianos Papathanassopoulos
Department of Communication and Media Studies, National and Kapodistrian University of Athens, Athens, Greece
Susana Salgado Instituto de Ciencias Sociais, Universidade de Lisboa, Lisboa, Portugal
This book series offers an outlet for cutting-edge research on all areas at the nexus of politics, the media, and political communication. Springer Studies in Media and Political Communication (SSMPC) welcomes theoretically sound and empirically robust monographs, edited volumes and handbooks from various disciplines and approaches on topics such as the role and function of communication in the realm of politics including campaigns and elections, media, and political institutions; the relations between political actors, citizens, and the media; as well as research investigating the in luence of media coverage on political behavior or attitudes, party communication strategies, political campaigns, agenda-setting, and political journalism. All books in this series are peer-reviewed.
Editors
Susana Salgado and Stylianos Papathanassopoulos
Streamlining Political Communication Concepts
Updates, Changes, Normalcies
Editors
Susana Salgado
Institute of Social Sciences, University of Lisbon, Lisbon, Portugal
Stylianos Papathanassopoulos
Department of Communication and Media Studies, National and Kapodistrian University of Athens, Athens, Greece
ISSN 2731-4081 e-ISSN 2731-409X
Springer Studies in Media and Political Communication
ISBN 978-3-031-45334-2 e-ISBN 978-3-031-45335-9 https://doi.org/10.1007/978-3-031-45335-9
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci ic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
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Contents
The Old Meets the New: “Old” Political Communication Concepts in a “‘New” Social Media Era
Susana Salgado, Afonso Biscaia and Stylianos Papathanassopoulos
Features of the Digital Era: Deinstitutionalization and Reinstitutionalization
Paolo Mancini
Ever More Dynamic, Complex, and Transnational: Comparing Political Communication Under the Conditions of Digital Environments and Disrupted Democracy
Barbara Pfetsch, Vivien Benert and David Schieferdecker
A Brief History of the Disinformation Age: Information Wars and the Decline of Institutional Authority
W. Lance Bennett and Steven Livingston
Media Populism Revisited
Benjamin Kramer
Political Corruption Scandals in the (Social) Media Environment
Rosa Berganza, Marta Martın-Llaguno and Azahara Ortiz-Gonzalez
Digital Election Campaigns: Does Professionalization Still Matter?
Lars Nord
Political (Election) Advertising
Christina Holtz-Bacha
Strategic Political Public Relations in the “Age of Populism”
Concepts, Springer Studies in Media and Political Communication
https://doi org/10 1007/978-3-031-45335-9 1
The Old Meets the New: “Old” Political Communication Concepts in a “‘New” Social Media Era
Susana Salgado1 , Afonso Biscaia1 and Stylianos Papathanassopoulos2
(1)
(2)
Universidade de Lisboa, Instituto de Ciencias Sociais, Lisbon, Portugal
Department of Communication and Media Studies of the National and Kapodistrian University of Athens, Athens, Greece
Susana Salgado
Email: susana.salgado@ics.ulisboa.pt
Abstract
In this introductory chapter, we explain the rationale of the edited book and delve into the changes that social media have been provoking in political communication and political communication research. The book brings together contributions of renowned scholars who look into some of the most pivotal political communication concepts and re lect on whether and how the new media environments and social media have affected these concepts. Potential changes in theoretical perspectives and methodological approaches are considered, as well as re lections on how to encompass such new realities (e.g., growing disruptive communication and incivility, disinformation, trans-national networks) in political communication research in an environment of further erosion of trust in institutional authorities.
Keywords Political Communication Research – Social Media –Concepts – Methods
New Political Communication Environments
The latest changes in media environments, particularly those caused by the emergence and widespread use of social media in politics, have been revealing new critical challenges not only to democratic politics, but also to political communication research. More than ever, it is important to understand the dynamics of information lows and the processes of contagion and exponential ampli ication caused by social media, but this complex task seems to be increasingly dif icult.
There is still no consensus about the (positive and negative) effects of social media platforms, but today few would deny their impact on political communication. There has been anxiety any time society deals with the emergence of new media (e.g., printing press, radio, television) and there are certainly problems that precede social media, and therefore research focused on the question whether social media platforms are an ampli ier of pre-existing problems or a major independent driver is much needed. Nonetheless, and either as ampli ier or driver, there are speci ic features of social media that have been raising more and more public concern, such as the so-called tools of virality (e.g., the Facebook like and share buttons and the retweet function on Twitter), the possibility to quickly and broadly disseminate fake news and all kinds of potentially harmful content, or their use to directly and narrowly target intended recipients with speci ic objectives (e.g., election campaigns, disinformation campaigns, etc.), which affect political communication at different levels: how actors communicate, whom they target, and what is said (see, e.g., Frankel & Hillygus, 2014).
More sources of information producing and disseminating content represents (at least in theory) the possibility of more diversity overall, but it also means more low-quality, un iltered content circulating. Alternative views can easily circumvent traditional information gatekeepers, who have thus been increasingly weakened. Political discussions are usually less civil online than of line and systemic trolling inhibits several individuals and groups from participating in
online discussions. Radical and extreme views proliferate online much due to the social media platforms’ business model that promotes this type of content over any other, and often have signi icant contagions of line, as it has happened in several cases worldwide. Social media platforms’ logic and affordances have thus been pointed out as cause not only of further radicalization and polarization, but also of the uncontrolled proliferation of misinformation and disinformation, because any content can now be disseminated without any ilters and there are new, quick, easy ways of fabricating, exaggerating, or simply promoting stories.
The challenges in studying, understanding, and measuring these new environments, interactions, and contents, as well as their effects have increased immensely. As the context and the users’ pro ile are different from platform to platform, it is likely that different platforms do induce different types of effects. Previous political communication research does point in this direction: the process by which individuals obtain information about politics through the media has always been complex and multifaceted; the effects can vary by medium and the mix of sources that individuals use, as well as by the motivations, prior beliefs, and characteristics of the individuals (Eveland & Garrett, 2014).
Simultaneously, the opacity of social media platforms has been increasing, as most of them—particularly Facebook, but not only—have created (unsurmountable in some cases) obstacles in the access to their data, including for research purposes. The tools that allow for the crossplatform and cross-national virality of messages have made these environments very dif icult to fully apprehend both in terms of data collection and analysis. Moreover, the pace of change and the fragmentation of these new environments add to the dif iculties. Scienti ic research is methodical, intensive, and therefore slow, but the social media platforms experience dramatic changes in rather short periods of time and thus potentially some of their effects could also change faster than research can actually document and understand. Just this discrepancy makes it dif icult to study the changes occurring in and because of social media, as well as the impact of their effects on individuals, politics, and society in general. Moreover, it is likely that when speci ic empirical research is inally ready, it is already dated and thus no longer re lects reality or the most important effects in that
moment. This means that research may not be able to timely document potential harmful effects on time in order to allow for effective preventive action or adequate response and mitigation measures.
On the one hand, research is dealing with unprecedented amounts of data, but on the other hand, the tools available for big data analysis do not capture many key nuances of the content and of the actors involved in the production and dissemination of content (e.g., radicalization and polarization caused by algorithms and the platforms’ monetization logic or by real individuals and groups (organized or not) who were already interested in extremist positions and deliberately look for and spread radical and extreme contents).
Research also needs to ind the right tools to capture and assess the dynamics of current hybrid contexts, as social media platforms in luence and are in luenced by other media, including legacy media from different countries. We already know from research that different contexts and different issues do impact differently on the degree and type of effects (see, e.g., Salgado, 2019). Furthermore, effects are expectedly different in different individuals, as background, motivations, ideology, etc., vary and these will very likely moderate the impact of speci ic contents or situations.
Finally, conceptualization is another key element to consider in these challenges facing political communication research. It is not uncommon to ind contrasting results in research approaches on the same topic, which thus tend to lead to inconclusive indings, dragging debates out, and sometimes even polarizing academic discussions. And this is often caused by different conceptualizations or different operationalizations of the concepts.
Considering these challenges, the purpose of the book is to contribute to the ield with a discussion and updated re lections on how key political communication concepts are (or not) being adapted to the new media and political environments and particularly to the empirical study of the impact of social media on democratic politics. Current challenges have been increasing the need of updated, empirical research; however, for such research to be meaningful, it needs to be grounded on solid conceptualizations and operationalizations. This discussion is all the more important if we think that in order to measure recent changes in political communication and their effects,
the tools employed have to be closely adjusted to reality. Furthermore, both comparative and longitudinal research approaches need to be considered in this equation and for those speci ically clarity and accuracy in conceptualization and operationalization is paramount. Particularly noting that one of the reasons why researchers often reach opposing conclusions in studies on the same issue is because they conceptualize the issue differently and/or operationalize it differently in empirical research designs. More speci ically, the contributions included in this edited book look into whether changes in political communication environments mean fresh perspectives and changes in this regard. These contributions will be brie ly described at the end of this introductory chapter. Next, we look into more detail to some of the changes that were introduced in political communication research in recent years.
Changes in Political Communication Research
As a ield of study, political communication covers “all stages in the process by which issues emerge in the public sphere to be debated, negotiated around and, on occasion, resolved” (McNair, 2011: 227). In other words, political communication is interested in how ideas about how society is and should be organized, and how resources distributed among its members are circulated and brought to peoples’ attention, be it through the efforts of political actors, journalistic mediation, or common citizens who engage in political discussions. These communicative phenomena are intrinsic to modern societies and representative democracies where most citizens do not participate directly in political decision-making processes but are still expected to be able to make informed decisions which include choosing their representatives through elections. Nevertheless, one does not expect that attendant practices remain the same through profound societal changes, or that researchers resort to the same theoretical frameworks and methodologies to study them. Indeed, while some common threads have remained, the past recent decades have heralded very signi icant changes to political communication, both as a practice and a scholarly pursuit. Especially relevant are those concerning the development of hybrid media systems and the introduction and eventual pervasiveness
of digital communication and social media, referred to in the previous section.
The new paradigm impacts all the stages through which political ideas are produced, disseminated, and debated and is characterized by the collision and mutual in luence of legacy media and new media logics (Chadwick, 2017) and the decrease in the former’s gatekeeping power as information lows from social media and digital networks gain visibility and political in luence (Bennett & Pfetsch, 2018; Mancini, 2023). Consequently, it presents new challenges and opportunities, not only to media outlets but also to political actors who are increasingly forced to adapt and professionalize their operations to contend with new demands (Gibson & Rommele, 2009; Enli, 2017; Nord, 2023), and to citizens who are now afforded an unprecedentedly large and diverse amount of information and spaces to make their opinions known, but are also exposed to more content, disinformation, and sophisticated disinformation campaigns designed to undermine trust in institutions (Wardle & Derakhshan, 2017; Bennett & Livingston, 2023), even if their effectiveness is not a given (Boulianne & Humprecht, 2023).
This sweeping technopolitical evolution is re lected in how scholars have chosen to address digital political communication. As an example, at the turn of the century, Gibson and Ward pioneered a systematic, comparative, empirical approach to party and candidate websites focused on their affordances (2000a, 2000b), i.e., the functions they ful illed and how they were delivered, drawing from content analysis techniques and organized around the concept of information and communication low (2000a: 306). Gibson and Ward’s framework proved in luential and was widely applied (e.g., Gibson et al., 2003; Gulati & Williams, 2007; Vaccari, 2013), but it was not devised to take in the way parties and political actors communicate and campaign on social media, which would not become relevant until the mid- to lateaughts. Before the Internet, political communication empirical research employed mainly manual content analysis, discourse analysis, surveys, experiments, elite interviews, or, even though less commonly, also ethnographic methods. And the amount of data analyzed tended to be small when compared to the period post-Internet. Moreover, as Bennett and Iyengar (2008) had already noted, in previous years theoretical
advances have not kept pace with both social and technological changes.
Even more than websites which are heavily dependent on the resources employed by parties and candidates, social media levels the political communication playing ield in the sense that platforms provide roughly the same affordances to every user: ordinary voters, political actors, and media outlets could, at least in theory, attain similar levels of visibility and, potentially, engagement. Thus, political communication researchers sought to employ new methods and techniques that allow them to analyze an increasing volume of data, namely, by turning to digital means themselves. Especially during the last decade, scholars have adopted API (Application Programming Interface) data collection techniques, enabling them to get large amounts of textual and audiovisual data from social media platforms like Twitter, YouTube, Reddit, or TikTok, which can then be analyzed from a variety of frameworks, including those based on manifest content and style of political actors (e.g., Lewis, 2018; Ernst et al., 2019); or general trends in political communication on social media, such as polarization (e.g., Gaudette et al., 2020; Saveski et al., 2022), for instance. Additionally, studies focusing on how information lows between social media users, the networks they form among themselves, and how they can be strategically used have also lourished (e.g., MacDonald et al., 2019; MacDonald et al., 2022; Froio & Ganesh, 2019).
Besides using digital means to collect data produced and published in social media platforms, scholars have also employed them to analyze that data. The so-called big data techniques, i.e., those using very large amounts of data and analyzing it, computationally, have been used to study a varied range of issues, such as disparate as affect in visual political communication (Hokka & Nelimarkka, 2020); how candidates and other political actors use digital communication and e-mail to in luence potential voters and fundraise (Mathur et al., 2023); or how data voids may in luence politics of exclusion (Norocel & Lewandowski, 2023).
Language models, despite their relative recency, have also been growingly deployed in political communication research, although current literature still vehemently recommends its combination with other methods (Paullada et al., 2021; Jungherr, 2023). For example,
Peeters et al. (2022) use language models to recognize different types of Facebook posts from political actors, and combine that with the use of an emotion lexicon and manual coding to analyze how politicians and citizens interact on that platform; Salgado et al. (2023) combine manual and automated text analysis with statistical methods to identify uncivil language and markers of populism; Gupta et al. (2020) developed a BERT (Bidirectional Encoder Representations from Transformers) language model speci ically geared toward the analysis of political content.
These new, powerful, tools allow researchers to more irmly grasp the evolving complexity of political communication phenomena, and account for developments such as the transnationalization of political discourse (e.g., Froio & Ganesh, 2019; Heft et al., 2021; Pfetsch et al., 2023), while retaining traditional interests such as exploring the role of political advertising (Holtz-Bacha, 2023), or the visibility and impact of political scandals (Berganza et al., 2023).
Nevertheless, despite the vitality of political communication as a discipline and the important part it plays in understanding current political and social dynamics, it faces a constant need to adapt and evolve in tandem with its subject matter, which can sometimes be challenging. For instance, while social media giants like Twitter and Reddit used to provide researchers easy and inexpensive access to the large amounts of data created on their sites via their APIs, new platform policies have severely restricted access or made it unaffordable for most researchers, especially those located in lowerincome contexts, thus increasing inequality of access to vital research tools, upending research practices (Trezza, 2023). However, this is not the irst time social media platforms decided to roll back data access, impacting researchers; in fact, Freelon (2018) coined the expression “post API-age” after Facebook’s closure of its Pages API, which previously allowed access to a large amount of data, in 2018, underlining the “tenuousness of our access to digital data” (2018: 5).
Despite these obstacles, political communication researchers kept on investigating social media platforms, especially focusing on Twitter which had for a long time been popular with politicians and journalists (Parmlee & Bichard, 2013). Now that Twitter, which recently and under Elon Musk leadership changed its name to X, looks set to lose that kind
of in luence and new platforms have been emerging, including the new Meta launch, Threads, and competitors including, but not restricted to, Mastodon, Bluesky, Spoutible, Post.news, Hive, and Spill, we may be headed toward a further fragmentation of social media environments, analogous with that of legacy media which contributed to the rise of hybrid media systems.
Thematic Overview of this Volume
This volume looks at how the new digital environments have impacted some of the most pivotal concepts in political communication research. It thus approaches several central concepts in contemporary political communication research from diverse, enriching perspectives pointing to future avenues for research focused on how political actors and citizens reach and in luence each other in today’s ever-changing media systems, where the traditional legacy outlets’ gatekeeping role has been diminishing amid hybridization. We thus need to further understand how old concepts can be applied to new communication environments and practices, their potential to analyze such contexts and how these contexts reframe the traditional conceptualizations. Our choice of concepts included in this edited book was not meant to be fully comprehensive; even though several other concepts could have been included, our choice was intended to capture some of the most relevant concepts considering current political communication practices and challenges. These concepts and the authors’ approaches are brie ly explained next.
Pfetsch, Benert, and Schieferdecker’s chapter emphasizes how political communication research can lesh out the context wherein particular communication dynamics and processes unfold by employing comparative research designs. The method is especially suited to approach political communication in liberal democracies, since political actors and organizations are mostly free to choose their communication strategy according to their preferences and resources, while being constrained by macro-level factors, such as the speci ic features of national media and political systems. However, researchers should also face up to the profound and ongoing changes in the aforementioned systems in globalized societies, where “public spheres
are now characterized by a dissonant polyvocality, a cacophony of heterogeneous and dispersed actors who speak synchronously and asynchronously on volatile issues in disconnected, disruptive, contradicting, erratic, and agonistic ways” (p.). The growing complexity and fragmentation of national media systems are compounded by increasing interconnectedness giving rise to translocal issue and relational networks—networked public spheres—which challenge scholars to shed the idea of neatly ordered and self-contained political communication systems and instead conceptualize communication ecosystems organized around communities and issues (Anderson, 2016), but also to endeavor to make their research take in more diverse settings, actors, and context factors, the complexity of their interaction, and the platforms where such interaction develops, which in turn impacts on the levels and units of analysis. Overcoming these challenges will enable political communication research to peer more deeply into phenomena currently af licting Western democracies, such as populism or disinformation.
Bennett and Livingston’s chapter focuses on the history of disinformation. The authors de ine it as “intentional falsehoods or distortions often spread as news to advance political goals” (p.), rejecting that the rise of social media, polarization, and or/foreign interference can squarely be blamed for the spread and buy-in of disinformation. Instead, these are conceptualized as symptoms of a dysfunctional public sphere, where authoritative institutions’ legitimacy is questioned due to their capture by moneyed private interests and compliant political elites. The chapter traces the evolution of the strategic spread of false information from the emergence of propaganda with Edward L. Bernays, to its rechristening as “public relations,” and its use by neoliberal and libertarian ideologues to push through unpopular agendas such as the privatization and deregulation of all sorts of activities, including the media. In recent decades, this was compounded by TINA rhetoric and the rise of “third way” politics, detaching politics from usual left-right cleavages and reducing the representational role of parties, particularly in economic issues, leading parties to resort to spin. This leads to unintended consequences, such as growing support for right wing populist political movements, who feed on voters’ growing discontent with the aforementioned status quo.
Therefore, solutions to this “disinformation order” can only stem from “repairing the basic functioning of democratic institutions themselves” (p.), according to the authors.
Shaughnessy and Kiousis look deeper into contemporary spin and public relations efforts in politics. They conceptualize political public relations as “centered around maintaining relationships and reputations with media organizations and practitioners, the public, and relevant stakeholders” (p.), and thus conclude its practitioners share a goal with populist politicians, especially when they engage in advocative messaging referring to allegedly homogeneous in-groups. The authors explain how recent technological innovations, particularly social media, allow populist politicians to remove barriers and communicate directly to the public, emphasizing the lower costs of engagement and communication as the public now has a “direct line” to politicians not yet seen throughout history (p.).
Mancini’s chapter focuses on how the “digital revolution” changed social relations in the public arena, and the consequences of those changes, through the prism of deinstitutionalization and reinstitutionalization. Centering the analysis in the ield of communication, the former is related to the downgrading of the media’s gatekeeping role in contexts where even single individuals can spread news and be part of conversations developing in the public sphere, but also to the fragmentation, volatility, and globalization of media markets, which preclude national government intervention, and result in polarization, hate speech, and incivility. Deinstitutionalization coexists with reinstitutionalization, namely, through the growing importance of large corporations, such as GAMA (Google, Apple, Meta, Amazon) in the media landscape, as well as with the enduring relevance of legacy media, namely, in recirculating content produced within deinstitutionalized frameworks.
Kramer’s chapter revisits the in luential conceptualization of media populism and re lects on some of its proposed expansions. It highlights how the original framework derived from observing how certain tabloid news outlets framed their relation to readers, presenting as representatives of the people and opposed to the elites, rather than how populist actors were portrayed in news coverage—although the two can sometimes coincide, both contributing to fuel the audience’s
anti-elite sentiment, for instance. Therefore, there is no direct way to transfer this conceptualization of media populism to social media, since platforms do not usually overtly voice political positions, but these can be used to further disseminate speci ic views and news framings. Recent developments in the social media landscape, such as the acquisition of Twitter by Elon Musk, an outspoken billionaire who is frequently aligned with radical right-wing populist positions, could introduce further changes in the platform’s positioning, but thus far there has been no indication that Musk intends to present himself as a representative of the people.
Nord’s chapter proposes a fresh look at the relevance and drivers of professionalization, a salient feature in campaigns since the twentieth century, in digital election campaigns. Professional-electoral parties employ experts and consultants to manage their communications according to structural conditions, strategic considerations, and partyspeci ic factors. Communicating through social media or their own websites allows parties to reach larger audiences but also entails the need to professionalize further to campaign effectively. Professionalization implies the risks of downgrading internal democracy and lattening differences between competitors, but also allows parties to communicate more effectively, in novel ways, to larger audiences than before.
Holtz-Bacha’s chapter looks more speci ically into the content and effects of political advertising, and how its formats and effects were impacted by digital platforms in the United States and in Europe. The introduction of new channels to broadcast political content means advertisers can de ine a wider range of campaign goals (from mobilization and fundraising to straightforward persuasion) and more precisely target messaging, and tailor it to the sensibilities of different groups. Holtz-Bacha also highlights the dif iculty in making generalizations regarding the effectiveness of political advertising, both due to being approached by research from different angles and methodologies and to the fact that political environments change drastically over time and space. Thus, political advertising is de initely important for campaigners, but its effects on voters “vary with the nature of the ads, the communication channels, and the recipients” (p.).
Finally, Berganza, Martın-Llaguno, and Ortiz-Gonzalez’s chapter focus on how the perception of political corruption scandals has changed in the mass media and social media environments, and how that relates with how political communication scholars should approach the topic, namely, by looking into how the issue is framed by the media, and into media systems themselves, including their hybrid characteristics, i.e., how mainstream media and social media logics interact in constructing public perceptions about matters related to scandals.
Media environments have been changing and politicians have been adapting to these changes. This small sample of concepts shows that with them also political communication research has been changing. While in the recent past political communication research dealt with printed newspapers, radio, television, nowadays it also includes the Internet and social media, as well as arti icial intelligence, etc. The advancements in technology have raised new questions and perspectives in the conceptualizations and operationalizations in political communication research and these developments have been adding new ields and directions to political communication research, which also deserve our re lection.
References
Anderson, C. W. (2016). News ecosystems. In T. Witschge, C. W. Anderson, & A. Hermida (Eds.), The sage handbook of digital journalism. Sage.
Bennett, W. L., & Iyengar, S. (2008). A new era of minimal effects? The changing foundations of political communication. Journal of Communication, 58(4), 707–731. https://doi.org/10.1111/j.1460-2466.2008.00410.x
[Crossref]
Bennett, W. L., & Livingston, S. (2023). A brief history of the disinformation age: Information wars and the decline of institutional authority. In Streamlining political communication concepts: Updates, changes, normalcies. Springer.
Bennett, W. L., & Pfetsch, B. (2018). Rethinking political communication in a time of disrupted public spheres. Journal of Communication, 68(2018), 243–253. https://doi. org/10.1093/joc/jqx017
[Crossref]
Berganza, R., Martın-Llaguno, M., & Ortiz-Gonzalez, A. (2023). Political corruption scandals in the (Social) Media environment. In Streamlining political communication concepts: Updates, changes, normalcies. Springer.
Boulianne, S., & Humprecht, E. (2023). Perceived exposure to misinformation and Trust in Institutions in four countries before and during a pandemic. International Journal of Communication, 17, 2024–2047.
Chadwick, A. (2017). The hybrid media system–politics and power. Oxford University Press
[Crossref]
Enli, G (2017) Twitter as arena for the authentic outsider: Exploring the social media campaigns of trump and Clinton in the 2016 US presidential election European Journal of Communication, 32(1), 50–61 https://doi org/10 1177/ 0267323116682802
[Crossref]
Ernst, N , Blassnig, S , Engesser, S , Buchel, F, & Esser, F (2019) Populists prefer social media over talk shows: An analysis of populist messages and stylistic elements across six countries. Social media +. Society, 5(1), 205630511882335. https://doi.org/ 10.1177/2056305118823358
[Crossref]
Eveland, W. P., & Garrett, R. K. (2014). Communication modalities and political knowledge. In K. Kenski & K. H. Jamieson (Eds.), The Oxford handbook of political communication (pp. 517–530). Oxford University Press.
Frankel, L. L., & Hillygus, D. S. (2014). Niche communication in political campaigns. In K. Kenski & K. H. Jamieson (Eds.), The Oxford handbook of political communication (pp. 179–194). Oxford University Press.
Freelon, D. (2018). Computational research in the post-API age. Political Communication, 35(4), 665–668. https://doi.org/10.1080/10584609.2018.1477506 [Crossref]
Froio, C., & Ganesh, B. (2019). The Transnationalisation of far right discourse on twitter: Issues and actors that cross Borders in Western European democracies. European Societies, 21(4), 513–539. https://doi.org/10.1080/14616696.2018.1494295 [Crossref]
Gaudette, T., Scrivens, R., Davies, G., & Frank, R. (2020). Upvoting extremism: Collective identity formation and the extreme right on Reddit. New Media & Society,
Gibson, R. K., Nixon, P., & Ward, S. J. (Eds.). (2003). Political parties and the internet: Net gain? Routledge
Gibson, R. K., & Rommele, A. (2009). Measuring the professionalization of political campaigning. Party Politics, 15(3), 265–293.
[Crossref]
Gibson, R K , & Ward, S J (2000a) A proposed methodology for studying the function and effectiveness of party and candidate web sites Social Science Computer Review, 18(3), 301–319
[Crossref]
Gibson, R K , & Ward, S J (2000b) New media, same impact? British party activity in cyberspace. In R. Gibson & S. Ward (Eds.), Reinvigorating government? British politics and the internet (pp. 107–128). Ashgate.
Gulati, G , & Williams, C (2007) Closing the gap, raising the Bar: Candidate web site communication in the 2006 campaign for congress. Social Science Computer Review, 25(4), 443–465.
[Crossref]
Gupta, S., Bloden, S. E., Kachhadia, J., Korsunska, A., & Stromer-Galley, J. (2020)
PoliBERT: Classi iying political social media messages with BERT. Paper presented at the Social, Cultural and Behavioral Modeling (SBP-BRIMS 2020) Conference. Available at https://news.illuminating.ischool.syr.edu/2020/11/24/polibertclassifying-political-social-media-messages-with-bert/
Heft, A., Knupfer, C., Reinhardt, S., & Mayerhoffer, E. (2021). Toward a transnational information ecology on the right? Hyperlink networking among right-wing digital news sites in Europe and the United States. The International Journal of Press/Politics, 26(2), 484–504. https://doi.org/10.1177/1940161220963670 [Crossref]
Hokka, J., & Nelimarkka, M. (2020). Affective economy of national-populist images: Investigating national and transnational online networks through visual big data. New Media & Society, 22(5), 770–792. https://doi.org/10.1177/1461444819868686 [Crossref]
Holtz-Bacha, C. (2023). Political (Election) advertising. In Streamlining political communication concepts: Updates, changes, normalcies. Springer.
Jungherr, A. (2023). Using ChatGPT and other large language model (LLM) applications for academic paper assignments. SocArXiv, 2023. https://doi.org/10. 31235/osf.io/d84q6. Available at https://osf.io/preprints/socarxiv/d84q6/
Lewis, R. (2018). Alternative in luence: Broadcasting the reactionary right on YouTube. Data & Society Research Institute.
MacDonald, S., Grinnell, D., Kinzel, A., & Lorenzo-Dus, N. (2019). Daesh, twitter and the social media ecosystem. The RUSI Journal, 164(4), 60–72. https://doi.org/10. 1080/03071847 2019 1644775
[Crossref]
MacDonald, S , Yilmaz, K , Herath, C , Berger, J M; Lakhani, S , Nouri, L , Conway, M (2022) The European far-right online: An exploratory twitter Outlink analysis of German and French online ecosystems (research report may 2022) RESOLVE network. https://doi.org/10.37805/remve2022.3. Available at: https://resolvenet. org/research/european-far-right-online-exploratory-twitter-outlink-analysisgerman-french-far-right
Mancini, P. (2023). Features of the digital era: Deinstitutionalization and reinstitutionalization. In Streamlining political communication concepts: Updates, changes, normalcies. Springer.
Mathur, A., Wang, A., Schwemmer, C., Hamin, M., Stewart, B. M., & Narayanan, A. (2023). Manipulative tactics are the norm in political emails: Evidence from 300k emails from the 2020 US election cycle. Big Data & Society, 10(1), 205395172211453. https://doi.org/10.1177/20539517221145371
[Crossref]
McNair, B. (2011). An introduction to political communication. Routledge. [Crossref]
Nord, L. (2023). Digital election campaigns: Does professionalization still matter? In Streamlining political communication concepts: Updates, changes, normalcies. Springer.
Norocel, O. C., & Lewandowski, D. (2023). Google, data voids, and the dynamics of the politics of exclusion. Big Data & Society, 10(1), 205395172211490. https://doi.org/10. 1177/20539517221149099
[Crossref]
Parmlee, J. H., & Bichard, S. L. (2013). Politics and the twitter revolution: How tweets in luence the relationship between political leaders and the public. Lexington Books.
Paullada, A., Raji, I. D., Bender, E. M., Denton, E., & Hanna, A. (2021). Data and its (dis)contents: A survey of dataset development and use in machine learning research. Patterns, 2(11), 100336. https://doi.org/10.1016/j.patter.2021.100336 [Crossref]
Peeters, J., Opgenhaffen, M., Kreutz, T., & Van Aelst, P. (2022). Understanding the online relationship between politicians and citizens. A study on the user engagement of politicians’ Facebook posts in election and routine periods Journal of Information Technology & Politics, 20(1), 44–59 https://doi org/10 1080/19331681 2022 2029791 [Crossref]
Pfetsch, B , Benert, V, & Schieferdecker, D (2023) Ever more dynamic, complex, and transnationa: Comparing political communication under the conditions of digital environments and disrupted democracy. In Streamlining political communication concepts: Updates, changes, normalcies. Springer.
Salgado, S. (2019). Never say never … or the value of context in political communication research. Political Communication, 36(4), 671–675. https://doi.org/ 10.1080/10584609.2019.1670902
[Crossref]
Salgado, S., Zuniga, H. G., da Silva, P. A., Biscaia, A., Coimbra, M. E., Martins, B., & Francisco, A. (2023). Assessing the prevalence and predictors of incivility in online news comments across six countries. Journalism Practice, 1. https://doi.org/10.1080/ 17512786.2023.2246431
Saveski, M., Beeferman, D., McClure, D., & Roy, D. (2022) Engaging politically diverse audiences on social media. Proceedings of the Sixteenth International AAAI Conference on Web and Social Media (ICWSM, 2022).
Trezza, D. (2023). To scrape or not to scrape, this is dilemma. The post-API scenario and implications on digital research. Frontiers in Sociology, 8, 1145038. https://doi. org/10.3389/fsoc.2023.1145038
[Crossref]
Vaccari, C. (2013). Digital politics in Western democracies. Johns Hopkins University Press.
[Crossref]
Wardle, C., Derakhshan, H. (2017) Information Disorder: Toward an interdisciplinary framework for research and policymaking (DGI (2017)09; Council of Europe Report). Council of Europe report. Available at: https://rm.coe.int/information-disordertoward-an-interdisciplinary-framework-for-researc/168076277c
Concepts, Springer Studies in Media and Political Communication
https://doi org/10 1007/978-3-031-45335-9 2
Features of the Digital Era: Deinstitutionalization and Reinstitutionalization
Paolo Mancini1
(1)
Dipartimento di Scienze Politiche, Universita di Perugia, Perugia, Italy
Paolo Mancini
Email: paolo.mancini@unipg.it
Abstract
The process of deinstitutionalization is one of the major consequences of digital revolution. Deinstitutionalization refers to the transfer of social functions from established institutions to single, dispersed citizens that is taking place both in the ield of communication and in the ield of politics. As to the ield of communication, blogs, twits, posts replace the work of previous, formal institutions, while in the ield of politics, single citizens are able to take an active role in the political life replacing the traditional role of mass parties. In this chapter the author discusses the consequences of this transfer that is dramatically affecting today democracy. In the meanwhile, new institutions, mainly of private nature, develop assuming some of the functions that were played by the old, weaker institutions.
A previous version of this chapter has been published in International Journal of Communication, 14 (2020), p. 5761–5774.
A Different Point of View
In their introduction to the special issue of The International Journal of Press Politics devoted to “Digital Threats to Democracy,” Miller and Vaccari (2020) offers an exhaustive reading of the contrasting views that have accompanied, and are still accompanying the digital revolution. These views can be summarized with the pair “technoptimism” and “technopessimism” (Curran et al., 2016): on one side, there are all those scholars, intellectuals, journalists, etc. who see the Internet as a liberating force that will enable citizens to share news and culture and to increase their control over power holders. In their view, the Internet offers many opportunities for cultural and social participation enrichment (technoptimists). On the other side, there are all those who, mainly in the most recent period, underline all the risks and threats that are connected to the development of digital technology (technopessimists).
Starting with the seminal work by Manuel Castells (2009) and many other seminal works on the topic (Rheingold, 2000), at its very beginning, the Internet was seen in a very positive way as it could empower citizens with more information and more opportunities for civic participation. In the view of these pioneering observers, digital age would bring more opportunities for information and knowledge, would circulate more news, would increase the possibilities for a larger and more powerful civil participation. Citizens would be able to take an active part in the life of the community as never before.
Progressively, this initial view of the digital revolution has been replaced by a more pessimistic view. This gradual shift from optimism to pessimism as to the nature and the consequences of the digital revolution is convincingly discussed in one of the most recent books dealing with this question “The Digital Republic” (Susskind, 2022). Some essays and some real life events too (the Cambridge Analytica and the Capitol Hill attack, among the others) have pushed toward this direction. The book by Evgenj Morozov (2012) made clear, a few years ago, how the Internet could become a powerful instrument of
manipulation challenging a vivid democracy; this book opened the way to many other criticisms of similar nature. More recently, the volume by Shoshana Zuboff (2019) has initiated a new wave of criticisms dealing with the economic nature and consequences of the digital revolution. As it is well known, the book of Zuboff speculated about the beginning of a new form of capitalism based on digital data.
In this chapter, I want to foster a quite different view: the main question is not to be in favor of either a positive or negative evaluation of digital revolution. This seems to me a quite unproductive exercise; rather we need to understand the major modi ications in the ield of social interactions that the digital revolution implies and then to discuss the possible consequences. I want to argue about some of the consequences that are inherently implied to digital revolution and that are often underestimated. In particular, I will point my attention to the modi ications that digital revolution is bringing to public arena and particularly to the frameworks of interactions that allow citizens to take an active part in it. Since the beginning of the digital era, many other authors have confronted this theme starting with pioneering work by Stephen Coleman and Jay Blumler to inish with the already quoted book by Jamie Susskind (2022). If I am allowed to use the following adjectives, I want to offer here a more “radical” and “extreme” point of view looking at the way in which Internet is changing the nature itself of public institutions and the distribution of power and functions.
I am also well aware of the fact that many other changes pertain to the area of political economy of the institutions and the States and that these changes may be interpreted following different criteria (Schlesinger, 2020).
A New Framework of Social Interactions
Different words have been used to indicate the new framework of social interactions that digital revolution implies: in particular, many scholars have proposed the word “disintermediation” to indicate the more direct and immediate system of interactions that today allow citizens to interact with each other and with organized institutions without the intervention of intermediaries of different nature and mostly without
the intervention of established media outlets (Chadwick, 2007; boyd & Ellison, 2007).
In this chapter, such as I have done in other essays (Mancini, 2020), I propose to refer to the process of deinstitutionalization as a major consequence of digital revolution. The process of deinstitutionalization affects the realm of public institutions and that of private institutions as well. As already said, deinstitutionalization is seen as major feature of digital communication in a large part of the existing literature, even if this exact word is not used. In a way, the idea of deinstitutionalization was already highlighted in the 1996 already quoted, pioneering book by Manuel Castells, The Rise of the Network Society. Manuel Castells used the idea of “network society” to indicate the dramatic transformations of traditional societies following the arrival and development of digital revolution: I believe that his idea has often been interpreted such as a catchword and its implications have been underestimated. This is what I want to challenge with this chapter. Since Castell’s book, most of the following literature, in large part in line with what I de ined the technooptimistic view, pointed out how digital communication was pushing forward a process of citizens’ empowerment stealing power and functions from already established institutions. Up to a few years ago, this was the dominant view of the changes brought about by digital revolution.
The book by Bennett and Segerberg, The Logic of Connective Action, is another precursor of the idea of deinstitutionalization. In their 2013 book, they noticed a similar process of “personalization” of the actions in the public sphere that was made possible by digital revolution giving single persons the possibility to participate to public life and to interact each other without the support of any possible organization.
The process of deinstitutionalization is also connected to the idea of “platform society” introduced by van Dijk, Poell, and de Wall (2018): discussing this idea, the authors write that “individual citizens or consumers organize themselves through online networks, so they are less dependent on legacy institutions and companies such as publishers, news organizations, hospitals, unions, brokers and so on. The Internet based utopian marketplace would allow individuals to offer products or services “directly” without having to rely on “of line” intermediaries, whether state or corporate” (van Dijck et al., 2018, p. 1).
While the book by van Dijk, Poell, and de Wall focuses mainly, but not only, on services, business, and economic facilities, my idea of deinstitutionalization is here applied to the ield of politics and news media. Related to these ields, deinstitutionalization thus means that today we observe the possibility for single citizens to spread information and news, to intervene actively in the public sphere with their comments, judgments, and even actions. Consequently, established institutions, both of public and private nature, transfer to single citizens a large number of functions that they were used to play. This transformation that I want to discuss in this chapter takes place both in the ield of news media and in the ield of politics.
Deinstitutionalization in the Field of News Media
In the ield of news media, we observe the dramatic development of opportunities of communication independently of formal organizations (if not those of the providers and platforms as we shall discuss later). Online platforms enable single and dispersed citizens to produce and circulate news, comments, and evaluations and then to take part in the public life without being part of any organization and without relying on established socialization structures.
I am referring to the activity of social media, blogs, citizen journalism, and so on. Tweets and posts on Facebook are of the same nature. All these communication activities are not seated within stable organizations; single, dispersed citizens communicate and operate without being submitted to established hierarchy, rules, and proceedings. Hierarchical control is quite completely missing. Professional education for many of these sources of information does not exist. This is deinstitutionalization.
Even if the just mentioned communication activities are produced by some sort of organizations (social groups, etc.), these are much less formal organizations if compared with the ones that existed until now. In most cases, these sources of communication are not restricted within ixed national borders and therefore they do not have to comply with speci ic legislations and cultural or ethical frameworks. In this way, single citizens can take an active part in the life of the public arena and may become important sources of news and opinion. They can interact
with each other without being inserted within ixed proceedings. There is no doubt that this enrichment on the side of the citizens may be enlisted among the positive consequences of the digital revolution reinforcing the optimistic view on digitalization.
In one of his last books, John Lloyd, mixing together his experience as a professional journalist and his scienti ic expertise, writes as to the new tendencies in journalism: “There is a new vision of journalism, call it the auteur school, in which the business shifts from being organized by institutions to being organized around single journalists with discrete following” (2018, p. 326).
By deinstitutionalization in the ield of news media, I mean exactly this shift from organized, hierarchically rigid institutions, such as the legacy media organizations were and still are, toward single individuals, more or less experienced in journalism, who produce and circulate news able to motivate and affect public debate. Digital communication offers many opportunities for such a shift: bloggers (either more or less experienced) and citizen journalists spread news that are then taken by legacy media and become major topics of public discussion. Twitter, Facebook, and now also Instagram and Tik Tok and other social media are other sources that are used by single citizens most often outside of any sort of institution: with either their short messages or long posts, with their photos and short videos they mobilize other citizens and, very often, set the main important topics of public discussion. The life of these sources of information depends on many different, speci ic, and temporary events and situations and this increases the volatility of the entire new media world, as many other scholars have already pointed out (Davis, 2019).
Deinstitutionalization affects in the same way both private and public institutions: all the institutions that depend in different forms from the government or the State are affected by a progressive weakening of their functions. Very often the messages circulated by State or Government institutions (see the emergency situations, etc.) arrive only after those produced by private and personal sources. In the same way, the private ones (see news organizations, news room organizations, etc.) transfer to single persons their communication activities. In most cases this is not a voluntary transfer, rather it is imposed by technological innovation.
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that the general surgeon should be peculiarly equipped for this task. But the ordinary office operations should be left to those who make a specialty of these diseases.
When the cavity of the tympanum is involved in a suppurative condition, with caries of the surrounding bone and extension into the spongy tissue of the adjoining mastoid, this abscess cavity should be cleaned out. Therefore the more radical operations of the aurist, by which the membrana tympani is destroyed, the ossicles of the ear removed, etc., are but applications of broad surgical principles to a limited region of the body, but made justifiable by their results. Moreover, in a more chronic type of cases, where the tympanum is filled by redundant granulation tissue and by polypoid formations, which are producing more or less circumscribed caries or necrotic processes in the bone, by which bony partitions between the cranial cavity and the ear proper are gradually thinned or lost, and by which encroachment on the intracranial sinuses with all its dangers is incurred, they are still to be subjected to the same general radical methods of treatment, no matter whether it be carried out by a specialist or a general operator.
THE ACCESSORY CRANIOFACIAL SINUSES.
While these cranial cavities are connected with the respiratory tract there are, nevertheless, good topographical and physiological reasons for considering their lesions in this place. There is free venous communication between each of them and the cranial cavity, and free lymphatic communication as well from at least three of them. Infection, therefore, may and often does travel from the smaller to the greater cavity, and thrombophlebitis, brain abscess, or purulent meningitis may be the ultimate result of apparently trifling infection of one of the sinuses.
They are four in number—the frontal, the ethmoidal, the sphenoidal, and the maxillary, or antrum of Highmore. They are all connected with the nasal cavity, and all lined with the same Schneiderian membrane, which affords a continuous pathway of infection. At least two of them are cellular in character, much resembling the mastoid cells. Their means of communication with the nasal cavity are small, and often
obstructed by catarrhal swelling and inspissated discharge. If thus plugged their retained contents may undergo decomposition and intensify the trouble. It has been shown that the effect of inward currents of air through the nostrils is to suck out from these sinuses more or less of their secretion. In this way perhaps may be accounted for the strings of tenacious mucopus which slowly make their way out of especially the anterior sinus openings. Some surgeons believe that if one sinus is affected all the others on that side of the head are more or less involved; while this may be true in many cases, and is easily explained on anatomical grounds, it is not strictly true of all instances, least of all in cases of chronic empyema of the antrum, which often long remains simple and uncomplicated.
Surgical lesions within the accessory sinuses result from infective processes, proceed often to suppuration, often, too, with caries of the surrounding spongy bone as well. These conditions may result from the ordinary acute catarrhs, or follow the more specific fevers, like influenza and the exanthems, and frequently follow diphtheria. Traumatic causes may also conspire to produce the same effect. In the maxillary sinus disease is often due to extension upward from carious teeth. In syphilitic and tuberculous patients these affections will partake to a greater or less degree of the specific nature of these diseases.
Symptoms differ according to location and are often obscure enough to make diagnosis difficult. Perhaps the most prominent symptom is pain, either deep-seated, vague, or disquieting, located in the neighborhood of the diseased sinus; or intense and neuralgic in character, radiating from the source of the trouble. Its severity is proportionate to the acuteness of the case. When the frontal and maxillary sinuses are involved there occur external swelling and tenderness. If the sinus openings be patulous there will be more or less purulent discharge into the nasal cavity, that which comes down from the upper sinuses appearing beneath the middle turbinate body. Transillumination by means of a small electric light, passed into the nostril, will demonstrate an opacity in the region of the affected sinus which does not appear on the healthy side. The condition is frequently associated with nasal polypi, small or large; while granulations in time spring up within these cavities and may even escape therefrom as these become filled. The general clinical picture is one of nasal
obstruction, with more or less constant discharge, sometimes mucopurulent, sometimes offensive, which perhaps may be favored by certain positions of the head, this being especially true of the maxillary antrum. Along with these features go a degree of headache, of local pain, and even of mild or severe febrile disturbances, proportionate to the severity of the lesions which produce them.
When the anterior ethmoid cells are involved pain is usually referred to the temples rather than the forehead, though both may suffer alike.
Treatment should be based upon the fact that we have affected and infected cavities whose interiors are diseased, and whose outlets are blocked. The more free and thorough the drainage and the cleansing which can be given, the more prompt the results. In all well-marked cases, then, radical treatment is indicated. The ordinary treatment by sprays, inhalations, etc., is useless, as the source of the trouble is not reached.
Special treatment for each sinus will now be considered.
Frontal Sinus.—Most of the symptoms of affection of the frontal sinus are objective, and there is frequently external swelling, with tenderness and edema. For its relief intranasal methods will often suffice. In almost all cases we may expect to find hypertrophic conditions within the nose. When empyema exists there is often a deviated septum. It is impossible to avoid the conclusion that there is a strong relation between hypertrophic lesions and sinus retention. The difficulty may arise from many causes, most of which lead to sneezing, coughing, and hacking, by which the mucous membrane of the nasopharynx is both thickened, loosened, and predisposed to polypoid changes. The irregularities thus produced harbor more germs than usual and their effect is, in a measure, proportionate to their numbers. For the examination of the upper part of the nasal cavity Killian’s speculum is of great help.
The frontal sinus differs very much in shape and size, not only in different individuals but on opposite sides of the same individual. It may be rudimentary upon one side and large upon the other. It is usually more capacious in those individuals who have prominent foreheads and resonant voices. Here, as elsewhere, it will usually be found that the most radical operation is the best, although one endeavors naturally to preserve cosmetic features of the nose, so far as he can, without sacrificing the patient’s interests. The
nasopharyngeal duct is so often connected with the ethmoidal cells, as well as the frontal, that the former may be easily affected when the frontal sinus is diseased.
In case of sinus disease, especially when the frontal sinus is involved, it is better to encourage patients to snuff materials back into the throat rather than to forcibly blow the nose or expectorate them, as the latter would tend to force into the sinus that which it would be better to have aspirated out of it.
The frontal sinuses may be attacked from within the nose or externally. It is perhaps the least open to mild and conservative treatment, as it is the most difficult of access by non-operative methods. The anterior ethmoid cells are usually connected with it and infection rarely spares one part to involve the other alone. Therefore if it be necessary to operate on the frontal sinus the anterior and upper cells should be exposed at the same time. Thus operations which have for their object continuous drainage have usually as an objection the necessity for wearing the drainage tube for months. After opening the sinus from without the nasal duct may be enlarged to any size and desired degree, and a tube inserted which shall afford ample drainage downward. This may be covered with a flap and allowed to remain for a number of weeks. Nevertheless it is a foreign body which has to be subsequently removed from the nose. Killian’s method is doubtless the best for most cases, as the most anterior of the ethmoid cells, and those which extend over the orbits, cannot be easily reached through the nose, and if disease involve the posterior ethmoid cells its extension to the sphenoid may be expected. The operation includes an incision from the temporal end of the shaved eyebrow, along its curve to the side of the nose, and down to the middle of the nasal processes. The periosteum is divided along a line a little higher, and again in the centre of the frontal process, the intent being to so remove it that a bony bridge may be left after removal of the anterior lower wall of the sinus. The first periosteal incision should correspond to the upper border of this bridge, either above or below it. The sinus is opened at first with a chisel, afterward with bone forceps or surgical engine. It is then completely scraped out, leaving the supra-orbital ridge for a bridge. Its floor is resected along with the frontal process of the superior maxilla. Through this opening the anterior and middle ethmoid cells may be reached and cleaned out to the middle turbinate.
The ethmoid cells may then be attacked, the sphenoidal cells inspected, and also attacked if necessary The opening into the nose should be made free, and a flap should be formed from the nasal mucoperiosteum, so that there may remain a permanent opening of sufficient size. This method may be modified to suit various needs. After doing all the work necessary the external wound is closed, with a tube for drainage, while the formation of the bridge above alluded to prevents much of the sinking in of the anterior wall of the sinus, which would otherwise occur. If the little pulley over the superior oblique muscle has been interfered with in the operation or loosened from its attachment there will be at least temporary and perhaps permanent diplopia. This should be carefully avoided. There is also danger of injury to the contents of the orbit. For some time after the operation there will be some drooping of the upper lid. Nevertheless the results are usually satisfactory. After the operation the patient should be permitted to lie upon the healthy side and be forbidden to blow his nose; he should rather attempt to aspirate the fluid from the wound. If necessary both sinuses can be attacked at the same time and after the same fashion, the septum being removed.
Here as with the other sinuses the test of the efficacy of the treatment will be furnished by relief of the headache, pressure, and pain. Should carious or necrotic bone be exposed, or should there be indications of malignancy, much more radical surgery would be indicated.
The Ethmoidal and Sphenoidal Cells.—For the exposure of these, especially the latter, it is necessary to make room for work. This would be true even in normal cases, and is still more so when the parts are hypertrophied and the passage-way is obstructed. It is necessary at least to remove all deviated portions of the nasal septum, and to clear away not only all hypertrophies of the turbinates, but to remove more or less of these bones. With a free passage-way it is possible to expose the opening of the sphenoidal cells, whose anterior wall may then be broken down, after which granulations may be removed with an appropriate small spoon, or the purulent contents cleaned out with swabs.
In dealing with the ethmoidal cells by intranasal methods it is necessary to break down the slight compartments between them, one after another, because of the fact that they all constitute foci of
disease. An opening at least 2 Cm. in length will usually be required, and can be comfortably made, under suitable illumination, if all obstructions have been removed; after this a probe is gently passed upward and alongside of the nasal septum until it rests against the ethmoid, then passed backward until it meets the posterior wall, which will be in the immediate neighborhood of the sphenoidal opening, through which, by gentle manipulation, it may be passed. At this point the presence of polyps or a greatly thickened mucosa may be detected by palpation with the finger within the nasopharynx, while should pus be removed by the end of the probe it would indicate empyema of this cavity
In all these accessory nasal sinus examinations and operations the greatest aid will be afforded by cocaine solution, which has the double advantage of not merely abolishing sensation, but of contracting and rendering anemic the mucous membranes, and thus to a certain extent shrinking them. When necessary for this latter purpose, or for the control of hemorrhage, adrenalin may be added to the cocaine. For all these purposes a spray of a mild solution may be first used, for its general benumbing effect, after which it would be advisable to use a strong solution, even saturated, very sparingly, applying it by the aid of illumination just to the area where the effect is desired, and not allowing it to come in contact with other parts of the nasal cavity; this is done to avoid unpleasant symptoms from cocaine absorption. Another benefit obtained from the use of cocaine is in thus abolishing sensation to an extent which does away with reflex vasomotor symptoms, shock, etc. Therefore even when a general anesthetic is used it will be well to use at least a small amount of it for this latter purpose.
The question of instruments and of methods will depend much on the equipment of the operator and his expertness in the necessary technique.
The Maxillary Antrum of Highmore.—This is the largest of the accessory sinuses, the most easily approached, and the one whose disturbance is most quickly and easily appreciated. It may be infected by continuity, along the Schneiderian membrane which lines it, or by extension upward of disease from carious teeth, as well as after a variety of injuries involving its integrity. So long as its opening into the nose be not plugged it will, when involved in catarrhal or suppurative
inflammation, discharge into the latter a characteristic fluid, which is especially likely to escape when the head is held downward and to the opposite side. Any statement of this fact, coupled with evidences of local inflammation, should enable an easy recognition of antral disease. In more chronic cases it becomes blocked by thickening of its membrane, the production of granulations or of polypi, which sometimes completely fill it. When thus plugged and filled there is a tendency to protrusion of its anterior outer wall and floor, while the overlying cheek may become somewhat edematous, the parts at the same time being tender. The pain from a diseased antrum will often induce the patient to go to the dentist for extraction of a molar tooth, which, however, affords little relief.
The relief for chronic antral disease is surgical, as in the case of the other sinuses. Opening the antrum through a tooth socket would seem judicious only when a diseased tooth is the cause of the lesion. It is useful only for such otherwise uncomplicated cases. The argument usually used in its favor is that it affords better drainage. This, however, is not the case, since the position assumed by the head for the greater part of the time does not locate such an opening in the most dependent part of the cavity Moreover, the discharge is not always fluid, nor does it flow freely; on the contrary it is often thick, and so adherent to the wall or roof of the cavity that it takes a strong irrigating stream or swab to dislodge it. If the antrum is to be opened through the mouth it would seem more surgical to open it widely, cleanse it, and then either drain it or close it again. Other things being equal, the best method is that which permits of both examination and subsequent treatment. Jansen’s method is frequently most serviceable. It includes careful cleansing of the teeth, with disinfection of the mouth, and walling off the area to be exposed by gauze strips in order to prevent hemorrhage into the throat. An incision is made through the anterior mucoperiosteum, beneath the floor of the antrum, from the first incisor to the first molar. Its edges are then separated and the entire front wall of the antrum removed. Through such an opening its interior can be carefully inspected and cleansed. Should it seem desirable to go farther the inner wall may be removed by forceps, and through this opening the ethmoid cells can be seen and curetted up to the insertion of the middle turbinate. Then the sphenoid surface can be inspected and the lower portion of the sphenoid cells
resected. Finally a good-sized counteropening is made inward, onto the floor of the nose, the antrum is loosely packed, the ends of the gauze extending into the nose, and the mucoperiosteal wound closed, in order to secure primary union. All bone edges should be made smooth and non-irritating; the sphenoidal cells should not be packed, but left open for subsequent treatment.
In the presence of bone disease, malignant growth, etc., it may not be possible to shut off the mouth again from the antral cavity In such cases the packing may be made more snug and the granulation process will have to be substituted for sutures.
Special flaps or plastic methods should be devised for special cases, as, for instance, the formation of a mucoperiosteal flap from the outer side of the antral wall and its union posteriorly within the cavity of the antrum with another made from the antral floor By turning the latter in the necessary direction a line of suture may be made through the mouth. Any such cavity, long diseased, will call for a radical method of attack and opening, which latter can be maintained to permit of subsequent treatment, as an early closure would sometimes be undesirable. Antral cavities thus left more or less open should be treated with cleansing sprays or applications, and with such stimulating applications as silver nitrate in various strengths of solution, or similar antiseptic stimulants.
THE CRANIAL NERVES.
While most of the affections of the nerves are considered to be nonoperative, and to belong rather to the internist than to the surgeon, there are, nevertheless, some nerve lesions which are only to be relieved by surgical intervention. These may be divided into: (1) Wounds and injuries. (2) Morbid conditions, such as (a) neuralgia, and (b) muscle spasm.
WOUNDS OF THE NERVES.
Wounds of nerves have been considered in the chapter on Wounds, and the possibility of nerve regeneration and repair therein discussed. In every division of a nerve trunk of importance or size the nerve ends
should be trimmed and reunited by a suture, passed either through the sheaths or through the nerve itself. The ends should be brought together securely and the tension should not be too great. If this be promptly done the best of results may be expected. This is equally true of cranial and peripheral nerves. Clinical experience has long since established the necessity of this procedure after all such injuries, and nerve suture, or neurorrhaphy, is now a standard operation. Later there was added to this measure the analogous one of nerve grafting, and it has been found that nerves can be juggled with just as can tendons, as described in the section on Tendon Suture. Indeed the methods of nerve suture and nerve grafting are strikingly similar to those employed with tendons, where can be made either end-to-end junction, lateral implantation, or a more properly termed grafting, a trimmed end of one nerve being inserted into another In the arm, when the ulnar nerve has been caught in callus and completely destroyed, both the upper and lower portions may be grafted into one of the adjoining nerves, e. g., the median; this procedure seems to reëstablish communication and serve the double purpose, in a manner corresponding to duplex or quadruplex telegraphy over one wire. Nerves which have been divided and entangled in scars may be disengaged, their ends trimmed off and approximated, success being proportionate to the length of time during which nerve degeneration may have been taking place.
Another operation is practised on nerves, solely for the relief of painful or disturbing symptoms, i. e., neurectomy. In cases of intractable and hopeless neuralgia, where other measures fail, sensory or complex nerve trunks are divided, a portion of the continuity being resected. This operation is practised more often upon the trifacial nerve than upon all others. It is generally successful, but in those cases where pain is due to some central lesion it is often palliative rather than curative. In the case of the trifacial nerve the operator endeavors to be as radical as possible in its practice, and to remove the Gasserian ganglion rather than portions of any of its branches.
The neuralgia for which these operations are performed may be due either to central or constitutional causes, as well as to local irritations, compressions, or degenerations. The term neuralgia itself is so vague and covers such widely differing changes that nothing which can be
said in this place would clear up the problems of its pathology; consequently attention will be directed here solely to its surgical relief in connection with the various nerve trunks which are usually attacked. One other operation is practised upon nerves for the relief of pain and spasmodic affections—namely, nerve stretching, or nerve elongation. This is practised more often upon the sciatic than upon any other nerve, but has been done for the relief of choreic spasm of the arm and shoulder, by exposing and stretching the various cords of the brachial plexus, for the relief of spasmodic torticollis, and in various other places. Nussbaum was the first to note that obstinate intercostal neuralgia was relieved by accidental stretching of an intercostal nerve, and introduced the procedure.
F 398
Various incisions for reaching different branches of the trifacial nerve: a, supra-orbital; b, external nasal; c, Bruns’ incision; d, inf. dent. at mental foramen; e, internal nasal; f, infra-orbital; g, Carnochan’s incision. (Marion.)
Operations upon nerves, then, include suture, grafting, stretching, division, and resection After any operation upon a nerve trunk the parts pertaining to it should be placed in a position of rest; and, furthermore, such position as will prevent stretching and favor relaxation of the sutured trunk should be maintained. The writer is credited with the first primary suture of the sciatic nerve, which was done immediately after its accidental division, during the course of an extensive operation. Recovery was prompt and complete. The limb
was immobilized in the extended position and physiological rest thus maintained.
Nerves can be stretched, it has been found, to one-twentieth of their length. Nerve trunks have much more strength than has been generally appreciated. The sciatic trunk of a full-grown individual will bear a stress of more than eighty pounds, while even six pounds’ pull are necessary to tear the supra-orbital nerve. The benefit which follows nerve elongation is ascribed to the improvement in its nutrition produced by the damage done to its substance, and the consequently enhanced blood supply, as well as to the severing of adhesions between the sheath and its surroundings and between the nerve bundles within the sheath.
The operation of nerve stretching consists simply in exposing the nerve at a site of election, detaching it from its surroundings, and then hooking either the finger or some smaller instrument beneath it and pulling firmly, yet gently, in both directions; in the case of the sciatic, for instance, the entire limb should be lifted from the table, and even this does not entail upon the nerve trunk anywhere near a breaking force.
The cranial nerves are sought, found, and treated as follows, in their respective cases:
The supra-orbital nerve is attacked at its exit from the supra-orbital notch, which can usually be felt, or foramen, when such exists, either by a straight incision made directly over it, where it can be felt, or by a curved incision through the region of the eyebrow, which should have been shaved for the purpose, the resulting scar being hidden by the hair as it grows again.
The infra-orbital nerve is similarly treated at the infra-orbital foramen, where it lies under the levator labii superioris. It may be exposed by either a curved incision, parallel to the orbital margin, or by a vertical incision, which will leave a more disfiguring scar.
The second branch of the fifth nerve may be attacked from the front by Chavasse’s modification of Carnochan’s original method, consisting of a T-shaped incision from one corner of the eye to the other, the vertical branch extending from its middle well down to the mouth. After the infra-orbital nerve is identified it is secured with a piece of silk. The anterior wall of the antrum is then removed, the cavity opened, and a small trephine applied to its posterior wall. The
nerve, being exposed in its canal or groove, is divided anteriorly, pulled down into the cavity by means of a ligature previously applied to it, and now made to serve as a guide into the sphenomaxillary fossa. Here it may be followed directly into its connection with Meckel’s ganglion, which may also be extirpated. The nerve trunk is forcibly pulled out of the foramen rotundum, through which it escapes from the Gasserian ganglion.
Horsley does not open the antrum but lifts the orbital contents, including the periosteum, follows the nerve along the canal by means of sharp-pointed bone forceps, and thus follows it up to the foramen rotundum, where it is evulsed as above. (See Fig. 399.)
Luecke years ago devised a method of lateral approach, attacking the ganglion and the nerve from the temporal region. An incision is made from the external angle of the orbit straight downward in the direction of the molar teeth, where it is met by another extending from the middle root of the zygoma, downward and forward. Through these incisions the zygoma is exposed and divided. Thus an osteoplastic flap is formed which is laid up over the temporal region, the divided piece of bone being raised with the overlying skin and not detached. This exposes the temporal and zygomatic fossæ. The temporal muscle is then drawn backward with a hook, the fatty tissue which fills these fossæ cleaned out, and the nerve sought for in the sphenomaxillary fossa, where both it and Meckel’s ganglion may be extirpated. The flap is then turned down and fastened in place (Fig. 400).
F 399
Branches of the inferior maxillary nerve which most concern the surgeon: a, auriculo-temporal; b, inf. dental; c, buccal. (Marion )
F 400
Exposure of Meckel’s and the Gasserian ganglia by temporary resection of the zygoma; Luecke’s method. (Marion.)
The inferior dental, or third division of the fifth nerve, may be reached in several ways: Its terminal portion where it escapes at the mental foramen; its upper portion by an incision two inches along the lower border of the jaw and above the angle, the masseter muscle being separated from the jaw, and the ascending ramus opened with a ³⁄₄-inch trephine at a point 1¹⁄₄ inches above the angle, its upper edge ¹⁄₄ inch below the sigmoid notch. The nerve is here exposed before it enters the canal. The lingual nerve may also be found resting upon the internal pterygoid muscle. A ligature tied around each nerve, for traction purposes, permits easy tracing of their trunks to the foramen ovale, where, after vigorous stretching, they are divided. They should then be traced downward and at least one inch of their trunks removed.
The Gasserian Ganglion.
—When all three branches of the trifiacial nerve are involved in painful tic, or when operation has already been practised upon one or more of them and the tic has recurred, it becomes necessary to attack the Gasserian ganglion itself.[45] This may be approached by either one of two methods. Both are difficult and serious, having a mortality of from 15 to 20 per cent. As Cushing has pointed out, however, its mortality rate is scarcely as great as the death rate by suicide in neuralgic cases of this kind. The attack from below was first carefully worked out by Rose and then by Andrews, and is begun in much the same way as the operation for the removal of Meckel’s ganglion by resection of the zygoma, described above. A flap is laid up, larger and wider, including the zygoma, with the most complete possible exposure of the zygomatic fossa. The coronoid process is drilled in two places, divided between the openings, which are to be used for subsequent suture, and the temporal muscle pushed upward and forward, out of the way, with the upper fragment. The foramen ovale is then identified by following into it the inferior maxillary nerve, the base of the skull being cleaned away in that neighborhood, and a small trephine opening made between it and the foramen rotundum, connecting these two openings by a much larger one. Through this opening the ganglion is exposed and destroyed piecemeal or extracted as completely as possible. The operation is exceedingly difficult, and hemorrhage, especially from the middle meningeal artery at the foramen spinosum, maybe so troublesome as to make it impracticable unless the carotid be tied. I have preferred in doing this operation to make preliminary ligation of the common carotid, which facilitates the balance of the procedure. The exposure by this method, however, is not as satisfactory as by that next to be described.
[45] Osmic Acid and Other Treatment of Trigeminal Neuralgia. While it hardly pertains to operative surgery, it may be worth while to say that it seems to me that no case of trifacial neuralgia should be subjected to radical operation until at least two or three remedies have been given a fair trial. One of these is castor oil its use being based upon the theory that such neuralgia is of toxic origin and that a prolonged evacuant treatment should benefit it. This would mean the administration of two or three good-sized doses of castor oil every day for a period of two to three weeks. It is not such a drastic remedy, thus given, as would appear, for after the oil has once thoroughly produced its laxative effect it ceases to distress, but serves as a very effective eliminant The second remedy is gelsemium, the best preparation being the
tincture of the green root It seems to exercise a selective affinity for the trifacial nerve. It should be given in large doses, pushed to the physiological limit, i e , until the patient begins to see everything in yellow colors Its effect on the heart must also be guarded. Fifteen drops of the green tincture given every two hours, and for a few days, will usually suffice to thoroughly test its efficacy
Osmic acid is used only for intraneural injection, its efficiency now being under trial. Ten to twelve drops of a 2 per cent., freshly prepared aqueous solution are directly injected into the nerve trunk after its exposure Murphy has been its particular advocate, and has reported relief of pain in a number of cases thus treated. It seems to depend for its effect upon two factors the destruction of nerve filaments and their substitution by connective tissue All the nerve branches that can be exposed should be injected; the palatine and lingual through the mouth; the intra-orbital and supra-orbital by incisions upon the face; orbicular-branches, as well, should be injected, if possible. Most of those who have used it advise also to inject a few drops into the foramina of exit, around the trunks, which are thus infiltrated with the solution. The procedure is painful and usually requires a general anesthetic, but it seems to be free from danger. While the treatment has been successful in some cases it has been equally disappointing in others, and the method will scarcely supplant the more radical method of ganglion exsection
Hartley and Krause, about the same time and independently, devised a method of attacking the ganglion, after raising an osteoplastic flap from the side of the skull, which affords a better exposure and a more satisfactory method. Within reason the larger the osteoplastic flap the easier the balance of the operation. Whether it be square or horseshoe in shape, whether it be made by chisel, by Gigli saw, or by surgical engine, matters little. In fact experience has shown that the conservation of the bone is not a matter of serious import, and there is no good reason why there should be any hesitancy to remove the bone should the formation of such an osteal flap present too many difficulties. After the dura is completely exposed it is to be separated from the base of the skull until the foramen spinosum and middle meningeal artery are reached. It is better to do this quickly and with the finger than slowly with instruments. After this separation the brain with its dural covering is lifted by a spatula or retractor, so as to afford a good view of the region of the ganglion. It will be necessary to double ligate the middle meningeal artery unless preference has been given to make a preliminary temporary or permanent ligation of the carotid. Should this
artery have been injured in raising the flap it should be secured before going any farther, either by plugging the opening or canal with gauze or with antiseptic wax (Fig. 401).
The upper surface of the ganglion is adherent to the dura, and these adhesions should be separated. The second and third branches should be identified and divided near their exit. The first branch is in too close relation with the cavernous sinus to justify much interference. The ganglion itself is then seized, after complete isolation, with forceps and evulsed, with as much of its longer and shorter roots as possible. Hemorrhage is checked by adrenalin or by pressure with gauze, as may be required. If gauze be used for the purpose it may also be utilized for drainage. The brain is restored to position and the flap sutured in its proper place.
Before doing either of these operations I should prefer to place the patient within the Crile pneumatic suit and then tilt the body to an angle of at least 45 degrees, thus prompting emptying of the cranial and cervical veins by gravity, while at the same time blood pressure is maintained by the pneumatic pressure (see p. 180).
Abbe has endeavored to lessen the shock of the operation by not formally tearing out the ganglion, but by taking out a section of the nerve trunks between it and their foramen of exit, and then interposing a piece of thin, sterile, rubber tissue, inserting it in such a way that it shall effectually prevent regeneration of nerve trunks across the interval, this rubber being intended to remain and become encapsulated. This method of Abbe seems to have made operative attack upon the Gasserian ganglion less formidable and less dangerous. It remains to be seen whether it is permanently as effective as more complete extirpation.
The Lingual Nerve.
—In some cases of cancer of the tongue there is such intense pain that not only has the lingual artery been tied but the lingual nerve been stretched or exsected. It can ordinarily be reached where it lies on the floor of the mouth beneath the mucous membrane, at the fold between it and the tongue, where it can be felt if the tongue be forcibly stretched. Through a small incision a blunt hook may be passed and the nerve thus secured. Close to the first lower molar the nerve lies in the tongue near the surface, where it can also be found.
The Seventh or Facial Nerve.
—This nerve has sometimes to be stretched for spasmodic affections. When the desire is simply to reach its trunk it may be sought through an incision behind the ear, by which the posterior border of the parotid is exposed, the sternocleidal insertion identified, the nerve lying in the interval between these two landmarks. A more easy method of reaching it would probably be by an incision in front of the ear just before its main branch divides as it enters the parotid gland. If necessary this may be followed backward until the main trunk is reached.
Relations of the facial and spinal accessory nerves: a, carotid; b, int. jug ; c, facial nerve; d, transv proc atlas; e, spinal acces.; f, stern. mast. muscle (Marion )
Neuro-anastomosis for Facial Palsy.
—In view of the hopelessness of facial paralysis, when resulting from destructive injuries to the nerve trunk, the introduction of anastomotic methods has marked a very distinct advance. Ballance, in 1895, was the first to apply neuro-anastomotic methods to the facial nerve. He attached the facial to the spinal accessory. His own experience, as well as that of half-a-dozen later operators, proved that nerve regeneration is possible, but that in this particular instance voluntary movements of the face were often accompanied by distressing and unsightly associated movements of the shoulder, and vice versa Hence, Taylor and others suggested the use of the hypoglossal instead of the spinal accessory, the former being a purely motor nerve running near the facial, intimately associated with it in function, and arising by nuclei, which are equally closely associated in the cranial centres. The operation is indicated in all cases of paralysis caused by lesion of the nucleus within the brain, or the nerve trunk at the base of the brain, or along its course. It is justifiable in Bell’s palsy, when there is complete reaction of degeneration in the facial nerve after several months of treatment (Fig. 402).
The steps of the operation are practically as follows: Incision is made along the anterior margin of the mastoid and the sternomastoid muscle, and the parotid gland is retracted forward and the posterior belly of the digastric is exposed. It should then be pulled downward and backward and divided if necessary. The styloid process is identified, and the facial nerve which emerges from the stylomastoid foramen near its base is then sought and isolated. It should be separated as high as possible and divided close to its exit, so that one-half inch of its free trunk may be secured before it enters the gland. Two fine silk sutures are then passed, one on either side, through the peripheral end of its sheath and tied, the ends remaining long, to be subsequently used. This nerve end should be trimmed to a wedge shape. Next the transverse process of the atlas is identified and the deep cervical fascia divided. This will expose the internal jugular, which should be separated and held out of the way. There will now be seen the spinal accessory nerve, which runs obliquely downward and outward, sometimes in front of and sometimes behind the jugular (Fig. 403). When the vein is held forward and the fascia
well retracted both the hypoglossal (Fig. 404) and the pneumogastric nerves are seen, with the internal carotid to their inner sides. The former may be identified either by the electric current, which will cause contractions in the muscles supplied by it, or it may be followed down to where it turns forward around the occipital artery and gives off the descendens noni. Here it should be separated until its trunk is sufficiently free, so that the facial stump can be inserted into it without tension. The nerve being elevated by a hook a slit is made in it, about ³⁄₄ inch long. Into this the wedge-shaped end of the facial trunk is introduced, and held there by utilizing the sutures which have already been passed through its sheath. When the nerve is thus firmly held in the cleft, with its end turned toward the direction of nerve supply, a little cargile membrane may be wrapped around the junction and the wound closed.[46]
[46] Taylor and Clark, New York Medical Record, February 27, 1904, p. 321
Nerve regeneration has been known to follow this procedure in a number of cases, and it has given encouraging results. Considerable time, however, is required, and the patients should be warned that results are not to be quickly expected.
Exposure required for anastomosis of facial and spinal accessory nerves: a, facial nerve; b, sp acces ; c, int. jug.; d, digastric muscle; e, atlas, trans proc (Marion )
Exposure required for anastomosis of facial and hypoglossal nerves: a, facial nerve; b, sternomastoid; c, digastric; d, parotid; e, hypoglossal (Marion )
