REMARKABLE IMPROVEMENT IN HEARING 
BY REMOVAL OF THE STAPES, 
BY 
FREDERICK L. JACK, M.D., 
Assistant Aural Surgeon, Massachusetts Charitable Eye and 
Ear Infirmary; Aural Surgeon, Boston Children’s 
Friend Society, etc. 
Read refore the American Otological Society, 
July 20, 1892. The above instruments were made by Co dm. vs & Shurtlekk, Ibis ton. REMARKABLE IMPROVEMENT IN HEARING BY 
REMOVAL OF THE STAPES. 
Frederick L. Jack, M. D., Boston, Mass. 
In 1875, Dr. Kessel of Jena called the attention of the med- 
ical public to a case in which he had removed the drum 
membrane, malleus, and incus. Further attention to the same 
subject was again called in 1885 by Dr. Schwartze, who add- 
ed the result of his own experience in performing the opera- 
tion. July 20th, 1886, Dr. Sexton read a paper before this 
Society, describing what is practically the same operation as 
that performed by Dr.’s Kessel and Schwartze, although with 
a different object in view. This object was the cure of 
chronic otorrhoea. 
During my term of service for Dr. Blake last spring at the 
Massachusetts Charitable Eye and Ear Infirmary, I had oc- 
casion to perform this operation about twenty-five times with 
general success. About June 19th I undertook the operation 
on I. D., aged 12, whose ear had been discharging constantly 
since babyhood, the result of an attack of scarlet fever. 
Having removed portions of the membrana tympani, malleus, 
and incus, and curetted a few granulations from the attic, an 
examination with the probe showed the head of the stapes to 
be carious. Fearing the operation would not be successful if 
the stapes in such a condition were left in the ear, I deter- 
mined to remove it. By passing a slender knife around the 
head of the bone, it was loosened from its adhesions; after 
this a very small hook was introduced behind it, and it was 
extracted with little effort. However, in its removal, there 
was observed an amount of suction which led me to fear that 
a portion of the bony wall might have adhered to it. But 2 
REMARKABLE IMPROVEMENT IN HEARING 
this proved ungrounded. The removal of the stapes was un- 
dertaken in this case with the greater hope of success, as I 
had in mind an article recently published by a Frenchman,* 
in which it was stated that the stapes had been removed from 
animals, and that their hearing had been thereby improved. 
Careful tests made before the operation had shown that there 
was very little hearing in the ear, as will appear by the report 
of the case later. On the morning following the operation 
the patient informed me that she now heard sounds which 
she had never before noticed. This fact struck me so forci- 
bly that I was led to hope for good results from the removal 
of the stapes in other cases. 
Some weeks previous to performing the above operation, I 
had two cases of chronic non-suppurative inflammation of the 
middle ear, from which had resulted a marked degree of deaf- 
ness. From the ear in the worse condition I removed the 
entire drum membrane, malleus, and incus. The history of 
this case is as follows: B. S. Thirty-five years old. Had 
been hard of hearing for fifteen years, but has grown rapidly 
worse within the last two years. Loud voice heard at a few 
feet. Both drum heads were dull in color and slightly sunk- 
en. Operation, April 2nd, 1892. Left membrana tympani, 
malleus and incus removed. 
Operation followed in a few days by pain and slight 
mucous discharge. No improvement in hearing. Two months 
after the operation the ear remaining without treatment dur- 
ing the time, granulations were discovered on the promontory. 
These were partially removed, touched with a solution of cop- 
per and dermatol insufflated. At the present time the ear is 
healed, but the hearing remains the same as before the oper- 
ation. 
Case II. D. S. Fifty years old. Hearing much impaired 
for eight years by chronic non-suppurative inflammation of 
♦Boltey (Ricaeclo). Experiences d’avulsion de chez les animaux. An- 
nals des maladies de l’oreille No. i, Jan. 1891. RY REMOVAL OF THE STAPES. 
3 
the middle ears. The drum heads were thickened and re- 
tracted. May 18th, 1892. Operation on the right ear the 
same as in the preceding case. The hearing was improved 
for several days and then gradually returned to the same 
condition. Patient experienced considerable pain for two 
nights and was annoyed for four weeks by a purulent dis- 
charge from the ear, which up to the present time continues 
to form crusts. 
Notwithstanding the fact that these operations were per- 
formed with all care, and that there was in the second case 
an improvement in the hearing for a few days, both cases 
subsequently developed otorrhoea, and the second tinnitus. 
Furthermore, in the second case, the drum membrane had 
been entirely reproduced, with the exception of an extremely 
small opening in the centre. Led by these results, I resolved 
in future cases to see what would be the effect of removing 
but a small portion of the drum membrane and the stapes 
only, leaving the malleus and incus; since which time I have 
performed operations in this way, with uniformly good re- 
sults. Recently I suggested to the two patients above men- 
tioned the benefits to be derived from the removal of the 
stapes with the hope of thus securing what would be perhaps 
the very best basis of comparison of the two operations. Un- 
fortunately they declined to submit to further surgical treat- 
ment. 
Not only is the removal of the stapes much better in its 
results, as shown by the operations already performed, but 
on the ground of conservative surgery, it is also much to be 
preferred. It produces greater improvement in the hearing; 
and, according to my experience up to the present, there has 
been no inflammatory re-action whatever, or any other bad re- 
sults. So far as I have been able to discover, just such an 
operation as has been performed in these cases, has never 
been heretofore reported. Accordingly, the operation in de- 
tail may be here described, and is as follows: 4 
REMARKABLE IMPROVEMENT IN HEARING 
The first step is to make a cut shaped like an inverted V 
in the drum membrane, just over the incudo stapedial joint 
and allow the part so loosened to fall outwards. This gives 
a clear view of the long process of the incus and incudo sta- 
pedial articulation, and also affords an excellent opportunity 
to observe the pathological conditions in this, the most im- 
portant part of the ear for hearing. In fact, as one or two of 
the following cases illustrate, a condition is sometimes found 
which none of the ordinary tests for hearing could have re- 
vealed. It might be well then, in certain instances, for diag- 
nostic purposes, to make such an exploratory opening. But 
to return to the operation. It is important next to separate 
thoroughly the stapedius muscle from the head of the stapes. 
This is done by passing a very slender knife (Fig. i) behind 
the head of the bone and then carefully cutting the muscle 
at a short distance from the neck of the bone. Experience 
shows that this muscle must be completely severed, other- 
wise, when the stapes is loosened, the muscle will pull its 
head out of sight and cause great trouble in its subsequent 
removal. Having cut the muscle, the articulation with the 
long process of the incus is then severed by passing through 
the joint from behind forwards a very small triangular knife 
bent in the shape of an obtuse angle (Fig. 2). If the stapes 
is not yet perfectly loose it can be made so by passing a small 
pointed knife around the head (Fig. 4). A small hook (Fig. 
4, or sometimes forceps shown in Fig. 5) now introduced be- 
hind the head will, with gentle traction remove the stapes. 
However, in one case, the foot plate remained. The bone 
usually comes away with some suction. It has been found 
but seldom necessary to use cocaine to prevent bleeding in 
the small field of operation. Slowing of the pulse was no- 
ticed in two or three cases upon touching the stapes. This 
may have arisen because the patient was not thoroughly un- 
der ether. The patients usually remained quietly in bed two 
or three days, keeping the ear plugged with cotton undis- TiY REMOVAL OF THE STAPES. 
5 
turbed. A clot of blood was generally seen in the wound for 
a few days, but gradually disappeared. Experience has 
shown that in the cases where the ear has suppurated the 
operation is rendered much more difficult by the conditions 
thus produced, than in cases of so-called chronic catarrh. 
In performing these operations valuable assistance and sug- 
gestions have been received from Dr. W. Bryant, for which 
1 desire here to acknowledge my obligations. 
Case I. I. D. aet. 12 otitis media suppurativa chronica in the 
left ear for eight years. Hears only moderately loud voice. 
Ear continually discharging. The upper portion only of the 
drum membrane is left. 
Operation June 3rd, 1892. Remnant of the drum mem- 
brane with the malleus and incus removed. Small amount of 
granulations curetted from the attic. Head of stapes found 
carious. It was separated from adhesions and removed with 
the hook. Slowing of pulse was noticed upon moving the 
stapes. Soon after the operation, slight dizziness, probably 
due to the ether. No pain in the ear. Can now hear voices 
better than she can remember to have heard them before. 
Ear ceased discharging in two days. Nineteen days after 
the operation the middle ear was found perfectly dry. 
Ordinary voice heard at 21 ft. 
Eive weeks after the operation the ear was still found per- 
fectly dry and a moderately loud voice could be heard at 
25 ft. 
Case II. A boy twelve years of age in poor physical con- 
dition. Chronic suppurative inflammation in the right ear 
for several years. Only a small portion of the membrana 
tympani was left and the manubrium of the malleus had 
sloughed away. He could distinguish words spoken in an 
ordinary voice at ten feet. 
Operation June 6th, 1892. The remains of the membrane 
and the malleus were removed after some difficulty because 
of thick bands of tissue around the head of the bone. The 6 
REMARKABLE IMPROVEMENT IN HEARING 
incus was found after long searching firmly adherent to the 
anterior superior portion of the attic. It was freed from its 
attachment by means of a slender curved knife and removed 
by a bullet tipped hook. The head of the stapes was next 
loosened and the bone removed. Nothing peculiar was no- 
ticed about the pulse. The ear was syringed with a solution 
of corrosive sublimate (i to 3,000) and sealed with absorbent 
cotton. The operation lasted one hour and fifteen minutes. 
For the next twenty-four hours patient had considerable ver- 
tigo. Said, that on moving his head on the pillow objects in 
the ward went “round and round.” 
June 15th, nine days after the operation the hearing re- 
mained good and the ear was only slightly moist. 
July 8th. 1892. Hearing had improved since the opera- 
tion ; could then hear 
Whis. vo. 8 ft. 
Or. “ 18 ft. 
Ear slightly moist and had not been syringed for one 
month. 
Case III. A boy about twelve years old, with chronic 
suppurative inflammation in the left middle ear for nine 
months. A small perforation was discovered high up in the 
membrana flaccida but the membrana tensa was whole. 
Whis. vo. 18 in. 
Or. vo. 20 ft. 
H. a. s. At- 
T. F. R. C. verter 3 plus. 
Mastoid s “ 
Operation June 18th, 1892. The entire membrana was 
separated from the auditory ring. The tensa tympani was 
divided and the malleus brought forward by passing a blunt 
hook behind the neck. The incus was removed by means of 
a hook without difficulty. The head of the stapes was next 
loosened and removed by means of hook and forceps. It 
came away in three pieces, leaving in the window a small por- BY REMOVAL OF THE STAPES. 
7 
tion of the foot-plate. The attic was found crowded with 
granulations, a condition which was suspected before the op- 
eration. These were carefully removed with forceps and 
curette. Three weeks afterwards the ear was discharging 
slightly and the hearing was as follows: 
VVhis. vo. 8 ft. 
Or. vo. 20 ft. 
T. F. Bone s plus. 
Mastoid, s plus. 
H. a. s. 
Case IV. Female. Anaemic and worn out with pain 
from syphilitic iritis. The left middle ear showed the effects 
of an old suppurative process. Through a thin cicatrix the 
long process of the incus and the head of the stapes were 
seen. 
Loud vo. heard at 15 ft. 
H. a. s. 
Konigs rods 35,000, T. F. by bone in left ear. 
A triangular opening was made through the cicatrix. The 
tendon of the stapedius muscle was cut, then the incudo sta- 
pedial joint divided and the head of stapes freed from sychne- 
cial bands. The bone was now quite movable, but eluded all 
attempts to engage the hook behind the head. It was, how- 
ever, at last captured and removed entire. The trouble expe- 
rienced here was undoubtedly due to the action of the stape- 
dius muscle, which was not wholly divided. The bone being 
loosely held in the oval window, the action of the muscle natu- 
rally pulled the head out of sight. No change in the pulse 
was noticed. There was no bleeding. Nausea and vertigo 
were complained of for twenty-four hours. She was somewhat 
dizzy in walking for six days. Hearing much improved. 
H. M. 
Whis. vo 8 ft. 
Or. vo. 20 ft. 
Improvement in Konigirods of 5,000. 8 
REMARKABLE IMPROVEMENT IN HEARING 
Ear showed no signs of inflammation at the end of a week. 
Sixteen days after the operation the hearing remained good. 
Case V. Male, about forty years old. He gave a history 
of having had chronic suppurative inflammation of the right 
middle ear for twenty five years. He had been very hard of 
hearing in the ear ever since that time, and said he consid- 
ered the ear dead. Conplained of a disagreeable pressure on 
that side of the head. Examination of the ear showed exten- 
sive destruction of the membrana tympani. Malleus re- 
tracted and firmly adherent to the inner wall of the middle 
ear. The long process of the incus was not visible. Head 
of the stapes covered with a thick cicatrical membrane. 
Hearing very defective for 
H contact Whis. vo. not heard. 
Or. vo. i ft. 
K. rods 35,00. 
T. F. by aer 5”, bone, d plus. 
Operation June 20th, 1892. A triangular opening was 
made in the membrane over the stapes. A very slender knife 
was carried around the head and the tendon of the muscle 
divided. Owing to the prominence of the head it was 
grasped with small forceps and all but about one-half of the 
foot-plate was removed. This piece remained in the fenestra 
and was easily felt afterwards with the probe. Owing to this 
state of affairs it was a surprise on the morning after the op- 
eration to find a marked improvement in all but one of the 
tests of hearing previously tried. 
H. At. 
L. Whis. 2 ft. 
Or. vo. 9 ft. 
L. vo. 
K. rods 30,000, a loss of 5,000. 
Four days after returning home, his hearing remained the 
same and the pressure previously complained of in the head 
had disappeared. He volunteered the story that before the I5Y REMOVAL OF THE STARES. 
9 
operation his wife had complained very much of the squeak- 
ing made by a pair of new slippers. He failed to hear the 
noise at that time, but on his return home, he, also, found 
them too noisy. 
July 8th, 1892. Said he had thrown the new slippers away. 
Hearing remained good and practically the same as when last 
tested. The ear was perfectly healed. The membrana tym- 
pani had somewhat contracted from the fenestra ovalis and 
was adherent to the inner bony wall of the middle ear. The 
anterior segment of the membrane was somewhat more sunk- 
en than when seen shortly after the operation. This con- 
dition made no apparent difference in the power of hearing 
and did not tend to produce the pressure in the head com- 
plained of before the operation. 
Case VI. Female, twenty years of age. Deafness due to 
the effect of a chronic suppurative inflammation. No dis- 
charge from either ear for two years. Said she could not 
hear anything in the left ear. Everything had ulcerated 
away except the stapes, the head of which was made out 
through a somewhat thick cicatrix. Hearing in the left ear 
as follows : 
Whis. vo. not heard, 
Or. vo. 
L. vo. 1 foot. 
T. F. aer, not heard. 
\ 
Bone in the better hearing ear. 
II. a. s. tfV 
Operation June n, 1892. Head of stapes loosened and sta- 
pedius muscle divided. A hook readily brought away the bone. 
June 20, 1892, no pain or vertigo,—hearing greatly improved. 
Whis. vo. 1 foot. 
Or. vo. 15 ft. 
L. vo. 20 plus. 
T. F. ear 2”. 
Bone still heard in better hearing ear. 
H. a. s. A>. 10 
REMARKABLE IMPROVEMENT IN HEARING 
One month after the operation hearing remained as when 
last tested. Ear perfectly dry with no crusts. Said she 
could now carry on her work of stenography without trouble. 
Case VII. A boy, eighteen years of age. Patient was 
first seen on June 19th, for deafness in the right ear. Upon 
examination the right drum membrane was found partially 
destroyed and the remaining portion was calcified. Thick 
tissue over the fenestra ovalis. Ear had ceased discharging 
some years ago and the hearing had been gradually growing 
worse. 
Hearing H. A- 
K. rods 35,000. 
Or. vo. 9 ft. 
T. F. R. plus by bone. 
Operation June 20th, 1892. Head of stapes found with 
difficulty after cutting almost calcareous bands of tissue. 
The bone was found very firmly held in place. Crura were 
found so firmly fixed in the window that only portions could 
be removed. The head of the bone came away readily. The 
pulse was noticed to go slower upon moving the stapes. 
June 21, 1892. No pain complained of. Hearing much 
improved. Tests as follows : 
H. A. D. A- 
K. rods 40,000. 
Whis. vo. 4 foot. 
Or. vo. 30 ft. plus. 
Only slight redness observed at seat of operation. 
Case VIII. Girl, seventeen years of age. Deafness in 
the right ear due to the effects of a chronic suppurative in- 
flammation. A large perforation was found in the posterior 
half of the membrana tympani through which the head of the 
stapes was distinctly seen. Complained of a buzzing tinnitus. 
Hearing for Whis. vo. 4 ft. 
Or. vo. 20 ft. 
H. a. d. A- RY REMOVAL OF THE STAPES. 
K. rods 35,000 
Operation June 21, 1892. The head of the bone was thor- 
oughly separated from adhesions and easily removed by 
means of a small hook inserted behind the head. No bleed- 
ing. Pulse was perceptibly slower while moving the stapes. 
June 22, no symptoms. 
Hearing H. 
L. Whis. 15 ft. 
Or. vo. 25 ft. plus. 
K. rods 30,000. 
June 29th, hearing remained good and tinnitus nearly gone. 
No moisture in the ear. Improvement in hearing said to be 
noticed by members of her family and friends. 
Seventeen days after the operation, ear was perfectly 
healed. Less tinnitus. Hearing the same as when last 
tested, except for the watch. Here there was apparently a 
loss of ten inches. 
Case IX. Male, thirty-five years old. Deafness in the 
left ear since boyhood, the effects of a chronic suppurative 
inflammation, following an attack of scarlet fever. A large 
perforation was found in the posterior upper quadrant of the 
drum membrane. Head of stapes easily seen and removed 
in the manner previously described. Hearing before the op- 
eration for watch. 
H. *. 
Whis. vo. not heard. 
Or. vo. 2 ft. 
L. vo. 12 ft. 
On the next morning after the operation the patient com- 
plained of slight dizziness when sitting up in bed. Hearing 
for the voice improved. 
June 27th, no dizziness. Hearing better than immediately 
after the operation, no signs of inflammatory re-action in the 
ear. Can now hear 12 
REMARKABLE IMPROVEMENT IN HEARING 
Whis. vo. i ft. 
Or. vo. 25 ft. plus. 
T. F. by bone d plus. 
T. F. aer 35 sec. 
H. f*. 
K. rods 30,000. 
He was last seen nine days after the operation and was 
found to hear as well as when previously tested. 
Case X. J. M., nineteen years old. She has been 
troubled with chronic suppurative inflammation off and on 
for fifteen years and has had trouble about hearing for two 
years. The posterior segment of the membrana tympani had 
ulcerated away. The round window and the long process of 
the incus were easily seen. 
Hearing for H. 
Whis. vo. 2 ft. 
Or. vo. 6 ft. 
T. F. bone d plus. 
K. rods 30,000. 
Operation June 22nd, 1892. Stapedius muscle was first 
cut and then the incudo stapedial joint. Some trouble was 
experienced in removing the stapes from behind the long pro- 
cess of the incus. The incus was found so loose that in pass- 
ing a hook above the head to remove it, it fell from its posi- 
tion to the bottom of the middle ear behind the drum and 
could not be removed with any instrument at hand. It was 
finally removed by syringing. On the following day she 
complained of some dizziness. Hearing better, with excep- 
tion of watch which could not be heard on contact. 
Whis. vo. 3 ft. 
Or. vo. 9 ft. 
L. vo. 25 ft. plus. 
T. F. ver. s. plus T. d. plus. 
July 1st, slight dizziness; hearing the same, slight moisture 
in the ear. In two weeks the wound was found perfectly 
healed. Hearing remained good. BY REMOVAL OF THE STAPES. 
13 
Case XI. Female, thirty-five years of age. This case is 
one of the most interesting in the series. She gave a his- 
tory of sudden loss of hearing in the left ear, six months be- 
fore accompanied by tinnitus and vertigo. Membrana tym- 
pani somewhat thickened. The hearing of this ear was very 
carefully tested by Dr. Bryant and others, and found to be 
absolutely gone for all sounds, except a very loud shout 
through a conversation tube. Tuning-fork by bone heard 
only in the right ear. The operation for removal of the 
stapes was performed on the morning of June 23, 1892. In 
the evening, much to our surprise, she could hear the voice 
in the ear, but the hearing was not carefully tested until the 
next morning when it was found as follows: 
no c C lightly. 
• a. s. 
Voice. 
Whis. 7 ft. 
Or. 10 ft. 
L. 20 ft. 
Tuning-fork. 
Ver. & T. s plus, 
aer ” 15”. 
K. rods 45,000. 
The patient was tested by the same gentleman who saw 
her before the operation with the results practically agreeing. 
She was entirely free from dizziness and tinnitus. 
July 8th, fifteen days after the operation, the hearing re- 
mained good. Tuning-fork by bone now heard louder in the 
car which was operated upon. Has had no attacks of dizzi- 
ness and tinnitus. Wound perfectly healed. 
Case XII. F. D. Twenty years old. For some years 
her hearing, in spite of treatment for the nose as well as the 
ears, had been growing slowly worse. It was the result of 
chronic non-suppurative inflammation of both middle ears. 
The left was the worse,— ringing tinnitus at times in the left 
ear. No history of otorrhoea but a small cicatrix was ob- REMARKABLE IMPROVEMENT IN HEARING 
served directly over the head of the stapes on the left side. 
Her hearing in the right ear was fair, and in the left ear, as 
follows: 
Or. vo. about i ft. 
L. vo. 4 ft. 
H. a. s. 
T. F. aer. 15” through teeth in left car. 
K. rods. 30,000. 
Operation June 26th, 1892. Triangular cut through the 
cicatrix and head of stapes separated from all attachments 
and the bone removed in one piece from the fenestra ovalis. 
No change in the pulse rate was noticed. 
June 28th, complained of slight pain in ear. Seat of oper- 
ation covered with a dry clot of blood. Was somewhat dizzy 
on moving the head quickly. Temperature night before one 
degree higher than normal. Said she had noticed a great 
improvement in hearing. It was found to be as follows: 
Low Whis. 1 ft. 
Or. vo. 10 ft. 
L. vo. 18 ft. plus. 
T. F. by bone heard louder in right ear, just the reverse 
was found before the operation. 
H. Heard only on contact. 
K. rods 30,000. 
July 1st, still a little dizzy. Hearing the same. Ear a 
little tender to touch and secreting slightly a thin bloody 
fluid. 
Ten days after the operation the hearing for the voice was 
found much better than when last tested. Could now hear 
Whis. vo. 12 ft. 
Or. vo. 30 ft. 
Other tests about the same. No vertigo or tinnitus. July 
10th, two weeks after the operation. Dry clot of blood cov- 
ering seat of wound. A little tinnitus at times. Said that 
hearing had greatly improved since the operation. On re- MY REMOVAL OF THE STAPES. 
15 
turning home could hear sounds of teams on the road much 
better than she could remember to have ever heard before. 
Friends and relatives all noticed great change in her hearing. 
H. «%. 
T. F. aer. 50” bone s, plus. 
VVhis. vo. 18 ft. 
Case XIII. A. C. Sixteen years old. Increasing deaf- 
ness for two years. Worse in the left. Diagnosis otitis 
media insidiosa. 
H. a. s. *c0 lightly. 
T. F. aer. r. plus. 
Vertex and T. s plus. 
K. rods 35,000. 
Or. vo. 2 ft. 
Whis. vo. 4 ”. 
L. vo. 10 ft. 
Left drum-head quite transparent. Long process of incus 
made out with difficulty. 
Operation June 27th, 1892. Triangular opening made 
through the drum, long process of incus found firmly adhe- 
rent to the inner wall. On being released by introducing a 
bent knife behind the process, it sprang outwards and back- 
wards, probably by the action of the stapedius muscle, which, 
as we shall'see, was a powerful one. The operation might 
have stopped here and been followed by marked improvement 
in hearing. The stapedius muscle was next separated, as was 
supposed, and the articulation with the incus divided. A 
small hook brought the stapes from the oval window, when 
the stapedius muscle immediately pulled it out of sight. 
This accident occasioned no end of trouble and portions of 
the bone were left in the ear as less likely to cause subse- 
quent trouble than further manipulations. A little dizziness 
was experienced after the operation, but only for a few hours. 
A slight exudation was noticed for a few days. The hear- 
ing was greatly improved. 16 
REMARKABLE IMPROVEMENT IN HEARING 
Whis. vo 7 ft. 
Or. vo. 12 ft. 
L. vo. 20 ft. 
T. F. by bone in the left ear. 
H. a. s. 
K. rods. 45,000. 
July 5th. Eight days after the operation the hearing was 
as follows: 
Whis. vo. 5 ft. 
Or. vo. 15 ft. 
T. F. Bone s plus. 
H. 
K. rods 50.000. 
Case XIV. A lady, forty-five years old. She had been 
very deaf for twenty years, the result of otitis media insidio- 
sa. The membrana tympani looked fairly well, though some- 
what dull in color. 
H earing a. d. 
Whis. vo. not heard. 
Or. vo. 6 inches. 
L. vo. 5 ft. 
Or. vo. only 5 ft. through large ear trumpet. 
T. F. by bone and aer. in the right. 
Watch not heard in close contact. 
K. rods 20,000. 
Operation June 28th, 1892. Small triangular opening 
made in the drum membrane. Stapedius muscle was first 
divided and then the incudo stapedial joint. A few adhe- 
sions were also separated from the head of the bone. The 
stapes was removed in the usual way. Examination showed 
the absence of foot-plate. No attempt was made, however, 
to remove it, for a case already reported was in mind, where 
with a portion of the foot-plate remaining, marked improve- 
ment in hearing resulted. Patient was up and dressed on the 
next morning, having experienced no dizziness or pain. I5Y REMOVAL OF THE STARES. 
17 
Hearing considerably improved. 
Whis. vo. i ft. 
Or. vo. 7 ft. 
L. VO. 20 ft. 
T. F. vertex s plus. Teeth d plus. 
K. rods 40,000. 
H. s'V contact. 
Says she can hear voices much clearer than before. No 
sign of inflammation in the ear. Nine days after the opera- 
tion the hearing was found the same as when last tested, ex- 
cept for tuning-fork and rods T. F. by bone was now heard 
alike in both ears. K. rods only 30,000. Ear perfectly dry. 
Case XV. Female. Effects of a suppurative inflamma- 
tion. In this case the stapes was not found. What was sup- 
posed to be the long process of the incus proved to be the 
displaced handle of the malleus. The end was somewhat 
bifurcated. The bone was freed from its attachments and re- 
moved, after which careful search with the probe failed to 
discover any trace of the incus or stapes. Slight dizziness 
was complained of for twenty-four hours. 
Nine days after the operation, by careful tests the hearing 
was found improved 6 in. for the watch, and a few feet for the 
ordinary voice. This slight improvement was probably due 
to the loosening of the tissues about the round window. 
Slight discharge from the ear but less than three days before. 
Case XVI. Miss K. M.; age forty-seven. She had been 
gradually growing more and more deaf for five years, the re- 
sult of a progressive non-suppurative inflammation of both 
middle ears. Both drum membranes were somewhat thin 
and lacked lustre. The incudo stapedial joint seen in both 
ears. In the right ear she heard 
L. vo. only at 3 ft. / 
Watch not heard at all. 
T. F. aer. about 3” bone D. plus. 
K. rods 30,000. 18 
REMARKABLE IMPROVEMENT IN HEARING 
The usual operation was performed on June 30th, 1892. 
After removing the stapes the incus seemed to drop down 
from the attic and being very loose was removed. On the 
next day hearing for voice had wonderfully improved. 
Whis. vo. 6 ft. 
Or. vo. 19 ft. 
L. vo. 30 ft. 
T. F. by bone heard equally well in both ears. 
By aer. in the right 10”. 
A. D. contact. 
K. rods 35,000. 
No inflammatory re-action in the ear. Said she was made 
dizzy by lying on the right side. In a week the hearing for 
the voice seemed to have improved still more. 
While recognizing the possibility of error in all human cal- 
culations, the results obtained in the cases whose history has 
been presented to you, are of such a nature as to lead me to 
be very hopeful of the future possibilities of this operation. 
Any fear of danger connected with the operation is obviated 
by the fact that even in two of the above mentioned cases, 
where there was considerable suppuration at the time of per- 
forming the operation, there were absolutely no bad results; 
on the contrary, one of them healed entirely within four or 
five days, and the other was greatly improved. In three cases 
the patients complained of vertigo after the operation, which, 
however, entirely disappeared within four or five days. In 
general, the cases showed little tendency toward inflammatory 
re-action, and were, after a few days, entirely dry. 
The effect of the operation on the hearing, as tested by the 
watch, in some was not marked in either way, indicating in 
some cases a slight gain, in others, a slight loss. 
The test by Konig’s rods met with a similar result. 
In one of the above cases, a curious fact was brought to 
light. During the bone test with the tuning-fork before the 
operation, the patient entirely failed to hear it in the worse BY REMOVAL OF THE STAPES. 
19 
ear; but on a repetition of the test after the operation, she 
heard it better in the ear operated upon than in the other one. 
Many of these cases were tested both before and after the 
operation by others than myself, with nearly the same results. 
There still remains to be mentioned the one result of this 
operation which gives it its importance and has led me to re- 
port these cases to this Society, and that is the very marked 
improvement in hearing the human voice, which is thereby 
accomplished. If persons who have heretofore heard only 
with difficulty can be made to hear with ease, by treatment 
unattended with danger, the operation as above described, 
which has accomplished this result, is certainly worth consid- 
eration. As to the reason why this effect is produced by the 
operation, I have no theory to offer, other than the simple 
supposition that it is by the removal of a mechanical obstruc- 
tion to the sound-waves. TABULAR VIEW. 
(Tests of hearing before and after the operation.) 
BEFORE. 
CASE I. 
AFTER. 
Moderately loud voice 1 foot. 
Moderately loud voice 25 feet. 
CASE II. 
Ordinary voice 10 feet. 
Whispered voice 8 feet. 
Ordinary “ 18 feet. 
Whispered voice 18 inches. 
Ordinary “ 20 feet. 
Watch a. s. 
Tuning-fork, vertex s plus. 
Mastoid s plus. 
CASE III. 
Whispered voice 8 feet. 
Ordinary “ 20 feet. 
Watch a. s. 
Tuning-fork, vertex s plus. 
Mastoid s plus. 
CASE IV. 
Loud voice 15 feet. 
Watch a. s. 
Tuning-fork by bone in left ear. 
rods 35,000. 
Whispered 8 feet. 
Ordinary “ 20 feet. 
Watch a. s. 
Tuning-fork by bone left. 
Konig& rods. ’. 40,000 
CASE V. 
Whispered voice not heard. 
Ordinary “ 1 foot. 
Watch a. d. s*,0" 
Tuning-fork by air 5 seconds. 
By bone d. plus. 
Konigs rods 35,000. 
Whispered voice 2 feet. 
Ordinary “ 9 feet. 
Loud “ 20 feet. 
Watch a. d. 
Konigs rods 30,000. 22 
REMARKABLE IMPROVEMENT IN HEARING 
CASE VI. 
Whispered voice not heard. 
Ordinary “ “ 
Loud “ 1 foot. 
Watch a. s. &con,act 
Tuning-fork by air not heard. 
By bone in the better hearing ear. 
Whispered voice 1 foot. 
Ordinary “ 15 feet. 
Loud “ 20 feet plus. 
Watch a. s. 
Tuning-fork, air 2 seconds. 
By bone still in better hearing ear. 
Ordinary voice 9 feet. 
Watch a. d. 
Tuning-fork by bone, right ear. 
Konigs rods 35,000. 
CASE VII. 
Whispered voice 4 feet. 
Ordinary “ 30 feet plus. 
Watch a. d. 
Konigs rods 40,000. 
Whispered voice 4 feet. 
Ordinary “ 20 feet. 
Watch a. d. 
Konigs rods 35,000. 
CASE VIII. 
Whispered voice 15 feet. 
Ordinary “ 25 feet plus. 
Watch a. d. 
Konigs rods 30,000. 
CASE IX. 
Whispered voice not heard. 
Ordinary “ 2 feet. 
Loud “ 12 feet. 
Watch. * a> s. bV 
Whispered voice 1 foot. 
Ordinary “ 25 feet plus. 
Watch . a. s. H*01 
Tuning-fork, air 35 seconds. 
By bone d. plus. 
Konigs rods .30,000. 
CASE X. 
Whispered voice 2 feet. 
Ordinary “ 6 feet. 
Watch a. s. 
Tuning-fork, bone d. plus. 
Konigs rods 30,000. 
Whispered voice 3 feet. 
Ordinary “ 9 feet. 
Loud “ 25 feet plus. 
Watch a. s. ,act 
Tuning-fork s. plus. BY REMOVAL OF THE STAPES. 
23 
CASE XI. 
Hearing absolutely gone for all 
sounds, except for very loud voice 
through a conversation tube. 
Whispered voice 7 feet. 
Ordinary “ 10 feet. 
Loud “ 20 feet. 
Watch a. s. sC,Tlightly 
Tuning-fork, air 15 seconds. 
By bone s. plus. 
Konigs rods 45,000. 
CASE XIT. 
Ordinary voice 1 foot. 
Loud “ 4 feet. 
Watch a. s. 
Tuning-fork, air 15 seconds. 
By bone in left ear. 
Konigs rods 30,000. 
Loud whisper 10 feet. 
Ordinary voice 30 feet. 
Watch !°£tact 
Tuning-fork, air 50 seconds. 
By bone in left ear. 
Konigs rods 30,000. 
CASE XIII. 
Whispered voice 2 feet. 
Ordinary “ 4 feet. 
Ixmd '• . .. 10 feet. 
Watch a. s. *V‘*h“7 
Tuning-fork by bone s. plus. 
Konigs rods 35,000. 
Whispered voice 5 feet. 
Ordinary “ 15 feet. _ 
Loud “ 20 feet. 
Watch a. s. 
Tuning-fork, bone s. plus. 
Konigs rods 50,000. 
Whispered .voice not heard. 
Ordinary “ 6 inches. 
Loud “ 5 feet. 
Ordinary voice only 5 feet through 
ear-trumpet. 
Watch a. d. B°0conUct 
Tuning-fork by bone and air in the 
right. 
Konigs rods 20,000. 
CASE XIV. 
Whispered voice 1 foot. 
Ordinary “ 7 feet. 
Loud “ 20 feet. 
Watch a. d. C°ntoc‘ 
Tuning-fork, vertex . .s. teeth d. plus. 
Konigs rods ■ 40,000. 
CASE XV. 
Stapes not found. 
Slight improvement in hearing. 24 
REMARKABLE IMPROVEMENT IN HEARING. 
CASE XVI. 
Loud voice 3 feet. 
Watch a. d. )TTcontact 
Tuning-fork, air 3 seconds. 
By bone d. plus. 
Konigs rods 30,000. 
Whispered voice 6 feet. 
Ordinary “ 19 feet. 
Loud “ 30 feet. 
Watch a. d. ff°5COntaCt 
Tuning-fork, air 10 seconds. 
By bone alike in both. 
Konigs rods 35,000. Since the printing of this report the right ear of Case 
XII has been operated on. It seems to me that the results 
in this case show conclusively the great value of the proce- 
dure. The patient returned to the Infirmary in September, 
of her own accord and asked for the operation on the 
right ear. This was done on September 27th, 1892. 
Results as follows:— 
BEFORE. 
Whispered voice 6 inches. 
Moderate voice 10 feet. 
Watch ec5. 
AFTER. 
Whispered voice 6 feet 
Moderate voice 30 feet 
Watch 
The peculiar value of this case as evidence lies in the 
fact that there is no stapes in either ear. In each instance 
immediate great improvement followed the removal. Fur- 
ther, the conditions in the two ears were different, the left 
having had a suppurative inflammation and the right a 
chronic catarrh. 
Many of the cases mentioned in the paper have been seen 
recently. The hearing power in all is as good as when re- 
ported and in some a still further improvement has been 
noticed; e. g.—hearing in the left ear of the case above, 
three months after previous record :— 
Whispered voice 20 feet. 
Watch BV