SKIN-GRAFTING IN CHRONIC SUPPURA- 
TION OF THE MIDDLE EAR 
BY 
EDWARD T. ELY 
Is'EW YORK 
[Reprinted from the Archives of Otology, December, 1880J SKIN-GRAFTING IN CHRONIC SUPPURATION 
OF THE MIDDLE EAR. 
EDWARD T. ELY, M. D., New York. 
DURING the past two years I have made some experi- 
ments with skin-grafting in the treatment of chronic 
suppuration of the middle ear, and I wish to publish a brief 
account of my experience thus far. I believe that this use 
of skin-grafting originated with me, my first trial of it hav- 
ing been made in June, 1878. Since then I have operated 
upon nine cases, repeating the operation several times in 
some of them. In six of these the drumhead had been 
almost entirely destroyed, there was little or no discharge, 
and the mucous membrane of the tympanic cavity pre- 
sented a more or less thickened and granular surface. Upon 
this surface were placed small pieces of skin taken from the 
forearm. In two cases, where a large part of the normal 
drumhead remained, the edges of the perforation were 
freshened by scraping, and a piece of skin laid over it. The 
dressing consisted of a borated cotton packing. The su- 
perficial layers of the cotton were removed within 24 hours, 
in order to inspect the deepest layer immediately over the 
grafts. This latter was not changed until it was found to 
be discolored by discharge. The packing was continued 
for several days, varying with circumstances. In one case 
the grafts were covered by a layer of goldbeater’s skin be- 
fore the cotton was applied. No advantage was seen from 
this. The instruments used were washed in carbolized 
water. The operation never caused pain or discomfort, but 
always excited a discharge. Sloughing of the grafts fol- 
Reprinted from the Archives of Otology, Vol. ix, No. 4, December, 1880. 344 
Edward T. Ely. 
lowed within a few days in most instances. The benefit 
which I have observed to follow this treatment will appear 
from the following brief abstracts of some of my notes; 
I. Female. JEt. 20. Chronic suppuration both middle ears for 
16 years. 
Nov. 21, 1879.—Three grafts placed in right ear. 
Nov. 25th.—Two of the grafts are adherent and living. 
Nov. 2gth.—Grafts doing well. 
Nov. 30th.—Discharge appeared, apparently caused by taking 
cold. 
Dec. T,d.—Some sloughing at edges of grafts. 
Dec. gth.—Discharge has ceased under use of balsam of Peru. 
A portion of one graft remains and is growing. 
The final result of treatment was the formation of a thin, ci- 
catricial membrane over most of the suppurating surface. Be- 
fore this result ensued, the grafting had been repeated several 
times and various medicinal applications had been made. The 
only point in the history upon which the writer would specially 
insist, is that two of the grafts certainly lived and grew. These 
pieces of skin were watched by Dr. D. B. St. John Roosa and 
by myself, and between Nov. 25th and Dec. 9th, we both saw 
new tissue shoot out from their edges. After this, the case did 
not progress so favorably, and much of what had been gained 
was lost again. All the subsequent grafts sloughed. It seemed 
to Dr. Roosa and myself that in this case and in one or two 
others, the operation had some effect in stimulating cicatrization, 
even though entire sloughing of the grafts appeared to occur. 
This beneficial effect is, of course, very doubtful, owing to the 
auxiliary treatment used. 
11. Male. FEt. 23. Chronic suppuration of left middle ear. 
Feb. 17, 1879.—One graft applied. 
March $d.—Part of the graft has lived and has been joined by 
offshoots from the edges of the surrounding tissue. The ex- 
posed surface has been reduced to about one-half of its former 
size. 
In this case the operation was certainly successful, although 
complete healing was never attained. The new tissue formed by 
grafting still remains. 
111. Female. JEt. 23. Chronic suppuration of left middle ear 
for 2 years. Skin-Grafting in the Middle Ear. 
345 
Between Oct. 18 and Nov. 2, 1880, six grafts were inserted. 
The operation caused considerable mucoid discharge, and the 
grafts seemed to be washed away. Two very damp and “ muggy ” 
days seemed to affect the case unfavorably. 
Nov. Bth.—No discharge. There are four whitish spots at 
the sites of four of the grafts and corresponding to them in 
shape. 
Dec. 2d.—No discharge since Nov. 6th. The appearances of 
the ear are improved. The cicatricial spots remain and are 
extending a little. 
The hearing was not altered in any of these cases. 
The results reported above are certainly not brilliant, 
and yet I am encouraged, by what I have seen, to continue 
these experiments and to predict that skin-grafting will 
prove a useful addition to our means of treating chronic 
suppuration of the middle ear. 
Two cases of myringoplasty have been recorded which 
were entirely successful. In these cases a piece of skin 
was laid over a perforation, the edges of which had been 
freshened. The operations were performed by Prof. Von 
Berthold, and an account of them may be found in the 
Monatsschrift fiir Ohrenheilkunde, November, 1878. To 
him belongs the credit of first calling the attention of the 
profession at large to this subject. His first operation 
seems to have been done August 1, 1878. An abstract of 
his paper, in English, may be found in the American Jour- 
nal of Otology, vol. i, p. 306.