Two Cases of Intratympanic Vascular 
Tumor, with a Pulsating Intact 
Drum Membrane. 
By ROBERT F. WEIR, M.D., 
Surgeon to the New York and Roosevelt Hospitals. 
(Reprinted from the American Journal of Otology, April, 1879.) TWO OASES 
OF 
Intratympanic Vascular Tumor, 
WITH A 
PULSATING INTACT DRUM-MEMBRANE. 
BY 
ROBERT F. WEIR, M.D., 
SURGEON TO THE NEW YORK AND ROOSEYELT HOSPITALS. 
NEW YORK: 
TROW’S PRINTING AND BOOKBINDING COMPANY, 
205-213 East 12th Street. 
1879. [From the American Journal of Otology, Yol. I., April, 1879.] 
TWO CASES OF INTRATYMPANIC VASCULAR TUMOR, 
WITH A PULSATING INTACT DRUM-MEMBRANE. 
By ROBERT F. WEIR, M.D., 
Surgeon to the New York and Roosevelt Hospitals. 
Pulsation at the bottom of the auditory canal has, since the time 
of Wilde, been regarded as pathognomonic of perforation of the 
drum-membrane. Though this statement has been repeated by 
various writers, and is undoubtedly in nearly every case correct, 
yet exceptions are occasionally to be met with. For instance, pul- 
sation is, as has been remarked by Hinton and Roosa, encountered 
in a thin drum-membrane, in a state of acute catarrhal inflamma- 
tion. This condition is, however, a rare one, for in an aural service 
of over eight years at the Hew York Eye and Ear Infirmary, I met 
with not more than four cases of this kind. But the following 
cases, with that reported by Dr. A. IT. Buck, in another part of this 
journal, will show that this symptom of pulsation may be due to a 
cause that I would have said was hitherto unknown but for an 
article published by Schwartze,1 in 1864, on the subject of “ Pul- 
sation in an uninjured Drum-membrane.” 
This author gives two cases of his own, and one communicated 
to him by Troltsch. In that of Troltsch there was pulsation in an 
intact drum-membrane without congestion ; the case is imperfect in 
its details, and was confessedly obscure. The second of Schwartze’s 
cases was probably due to acute catarrhal inflammation, as the pul- 
sation disappeared with the congestion. In his first case, however, 
in a patient with symptoms of advanced chronic catarrh of the 
middle ears, there was found on the left side—the drum-membrane 
of which was white and somewhat lustreless—and near the apex of 
the light spot, a pulsating-point, the size of a pin’s head, synchronous 
with the radial artery. These pulsations ceased when the Yalsal- 
1 Archiv f. Ohrenkeilkunde, Bd. 1, p. 140. 4 
vian experiment was resorted to, but returned in a short time. No 
injection whatever of the membrane was present. There was no 
tinnitus or pain in either ear, nor had the patient ever experienced 
any subjective sensations of sound. No treatment was apparently 
resorted to. Such was all the information that I was able to obtain, 
that threw any light upon the following case : 
Case I.—Mrs. J. A., aetat. 35, was sent to me in November, 1870, by Dr. J. 
T. Metcalfe, for deafness of the right ear, which had begun about a year pre- 
viously, had rapidly increased during the past few months, and was associated 
with a disagreeable, though regularly pulsating, noise; there had been no pain 
or discharge. At times slight attacks of vertigo had been experienced. 
On examination, H. D. right side = ; left, normal. After I had removed 
a slight layer of cerumen, a remarkable appearance presented itself. The whole 
drum-membrane was evenly and intensely reddened and strongly pushed 
forward in a bulging manner, except along the line of the malleus, which 
was situated apparently in a dejwession, and was marked at its free end by a 
white spot, in strong contrast to the other parts of the membrane. The whole 
membrane pulsated visibly and strongly, especially so superiorly, where there 
was a broad light spot. The pulsation was synchronous with that of the 
carotids, and was arrested by pressure on the artery of the corresponding side. 
No distinct vessels were to be seen on the membrane, only a general redness. 
By Siegle’s tympanoscope, the drum-membrane could be forced in but little, 
and the pressure only rendered the pulsation more broadly and decidedly 
marked, and particularly so near the inner side of the malleus. By the oto- 
scopic tube the heart sounds were distinctly heard, but not so on the sound 
side. No air could be felt to enter the tympanic cavity by Valsalva’s or 
Politzer’s method, nor by the catheter. No redness or abnormal change was 
noticed in the external auditory canal. 
Thinking at first that I had to do with an exaggerated case of bloody serum 
in the middle ear, paracentesis was resorted to at the middle of the posterior 
segment, giving exit to blood which rapidly filled up the canal and flowed to 
the amount of 3 i. in a few seconds, but was easily arrested by plugging the 
canal for a few moments with cotton. Attempts were made to inflate the 
tympanic cavity by the catheter, after bougieing the Eustachian tube up to its 
isthmus, but no air emerged from the puncture. On inspection no change in 
the appearance of the drum-membrane had resulted from the puncture, but 
three days later, when paracentesis was again resorted to, and after the cessa- 
tion of a moderate hemorrhage, the drum was found collapsed and somewhat 
wrinkled; the hearing also was found to have increased to -/$. This improve- 
ment in hearing and condition of the drum-membrane only continued until the 
next day, and the pulsation was then felt as decidedly as ever by the patient, though to the eye it was much more feeble. I had by this time come to the 
conclusion that I had to deal with a vascular tumor in the middle ear, or that 
I had, according to Schwartze, a hypertrophied condition of the mucous mem- 
brane associated with an accumulation of bloody serum in the cavity. Leaning, 
however, to the first view, a consultation with Dr. Simrock, an acknowledged 
aural authority, was suggested and carried out. Dr. Simrock thought that 
the difficulty was due either to fluid in the middle ear, or, as he thought that 
he succeeded in forcing air through the Eustachian tube, that it "was a collec- 
tion of fluid in the tissue of the drum-membrane itself. A third puncture was 
made posteriorly, carrying the needle in until it reached the promontory—no 
air could be forced out. Convinced of the correctness of my diagnosis, on 
December 5th, a fourth puncture was made with a large needle, and a probe 
dipped in pure nitric acid was inserted through the opening into the middle 
ear. But little pain was occasioned by this treatment. As a result of the 
several punctures, it was noticed not only that after each the hearing distance 
increased, but that the pulsation became less distinct. This subsidence became 
more and more permanent, but the cicatrices of the punctures, yielding under 
the pressure from within, protruded almost teat-like from the drum-membrane, 
and after this application of acid a mass projected through the opening there 
made and spreading out, and pulsating faintly, obscured nearly the whole 
membrane, and assumed a polypoid appearance in the course of a week. This 
mass was punctured and a probe dipped in liq. ferri persulph. introduced into 
its depths, blanching it at once. The subsequent history is in brief this: the 
mass sprouting from the opening in the drum-membrane was with difficulty 
destroyed by the use of nitric acid applied first every second or third day for a 
number of times, afterwards, at intervals of one or two weeks (as the patient 
lived out of the city) ; and subsequently, as the tissue became tougher, by the 
use of the acid nitrate of mercury, which was carried, by means of a thin film 
of cotton around the end of a fine wire, through the tympanic opening into the 
cavity itself. At times considerable pain was caused by the applications, but, 
as a rule, they were less distressing than would have been anticipated. Several 
attempts were made to extract pieces of the mass for microscopical examination, 
and the one or two small portions so obtained were reported, by Dr. A. II. Buck, 
to show nothing but scales of epidermis and ddbris so changed by caustics as 
to be unrecognizable. 
By this treatment, the tumor, in the course of four to five months, was ap- 
parently destroyed, and it was observed that in the later cauterizations, little 
or no hemorrhage occurred, and that when the punctures and applications— 
for they were sometimes conjoined—were carried into the tympanic cavity, the 
sensation was given that that space was more or less filled with a solid tissue. 
No air at any time was felt in middle ear. 
On July 1, 1871, three weeks after the cessation of treatment, it is noted 6 
tliat H. D. = -fa; bottom of canal closed by a smoothly depressed fleshy-look- 
ing membrane, still considerably though irregularly injected. No pulsation 
whatever to be seen or heard by the physician, and only very slightly perceived 
by the patient. 
Aug. 4.—Mrs. A. presented herself, on her way from Newport, stating that 
she only had occasional pulsation in the ear in the erect position, but always 
when in bed. On examination it was found that the membrane had changed 
from its former fleshy appearance to one more natural. Now the malleus could 
be defined; the membrane itself was still irregularly patchy, of a pink hue in 
spots, but with some translucency. By the use of Politzer’s inflation, for the 
first time air is heard to enter the middle ear by the otoscope. Ordered Val- 
salva’s experiment to be practised at home. 
Nov. 14.—Drum membrane is quite normal in the posterior part. Malleus 
clearly seen. Anteriorly, two months ago, was seen a red bulging spot, as if 
the tumor was returning there, but this to-day is not seen ; the drum-membrane 
at this point being now mottled with white bands running from malleus to the 
periphery. Tube slightly open by Valsalva’s method; by Politzer’s method 
air readily enters. H. D. =t/0—To use Politzer’s bag daily. 
Feb. 7, 1872.—H. D.=A- Only hears pulsation when in bed. Drum-mem- 
brane still mottled and sparsely injected. No evidence of return of tumor. 
Dec., 1878.—No recurrence of the tumor. Reports herself as hearing well. 
Ear giving her no trouble whatever. As patient was met in the street, exact 
information could not be obtained. 
In the second case there was apparently a vascular growth on 
the posterior wall of the tympanum, with an accumulation of serum 
overlaying it. 
Case II. —A. negro woman, rntat. 35, was seen by me Dec. 8,1870, with the 
history that for four years past she had had “beating noises” in the left side 
of her head, which were much increased by stooping, which position would 
also cause severe dizziness. Vertigo came on at times in the erect position. The 
hearing on the same side had also failed, and on her visit to me was while 
on the left side it was normal. She believed that her heart was affected, as she 
so distinctly and so persistently heard the sounds in her ear. There was, how- 
ever, no cardiac lesion. She was much depressed and anxious by reason of her 
ear trouble. On inspection it was perceived that the posterior surface of the 
drum-membrane, and more especially its inferior portion, was of a reddish hue, 
with some vessels running over it, and that it was not only bulged outwards, 
but that it visibly pulsated synchronously with the heart. Considerable in- 
jection of the malleus was also present. The Eustachian tube was pervious. 
By Siegle’s otoscope it was seen that a faint line half-way up the posterior seg- ment was movable. Paracentesis was, therefore, resorted to and blood rapidly 
filled the canal, but was readily checked by a mop of cotton left a few mo- 
ments against the drum. Politzer’s inflation being then used, air freely escaped 
through the opening in the drum-membrane. After which H. D. =-/0-. She was 
not seen again until June 1, 1871, when she returned with the statement that 
since the puncture she had been very much better, and her hearing had improved 
and kept in fair condition until a week previously, when the latter rapidly 
diminished. Now H. D. Left drum membrane translucent everywhere, 
except at postero-inferior portion, where a roundish red spot, the size of a 
small pea, was seen projecting forward, but not pulsating. By Siegle’s appa- 
ratus fluid line was again detected; it was rendered more clear after Politzer’s 
inflation had been successfully used. Projection outward apparently the same. 
July 15.—Paracentesis used for a second time, causing not only H. D. to rise 
to io, but also disappearance of the pulsating noise and redness. This absence 
of pulsation was only noticed a few days. 
Aug. 1.—Returned with symptoms of dizziness, deafness, and pulsation. 
Fluid seen in tympanic cavity. Redness and pulsation in drum-membrane ob- 
served as at first. Paracentesis, with needle carried in until it was arrested by 
bony resistance. 
Nov. 7.—Repeated paracentesis. Says that after every puncture the sound 
is lessened in intensity. 
Dec. 11.—Paracentesis twice in past week, and a probe wet with liq. ferri 
persulphat. also introduced. 
She was not seen subsequently until Feb. 18, 1873, when the tumor was 
seen projecting still on the posterior and inferior segment of the drum, pulsat- 
ing and of a red color. Dizziness complained of more than ever. H. D. =0. 
Up to March 24, paracentesis was performed three times, with the subsequent 
introduction of cotton wound round a cotton probe and dipped into acid 
nitrate of mercury. This kept the opening patent, and several applications 
through it of a solution of chromic acid (100 gr. to § i.) were made. Pulsa- 
tion scarcely seen, and heard much less distinctly by the patient. Dizziness has 
also ameliorated. 
April 25.—For the past three weeks she has been free from vertigo and pul- 
sating noises. After a rest of two weeks after last state, a new and long slit 
was made in the drum-membrane, and the chromic acid freely applied in the 
drum cavity by the cotton probe. Considerable swelling and discharge fol- 
lowed. This has nearly all subsided and she feels better in her head than she 
has felt in five or six years. She can now stoop down, and do her work with- 
out any unpleasant pulsation. 
June 25.—Has had the paracentesis and chromic acid used but twice since 
last note. She has steadily improved, having had no pulsation and no dizzi- 
ness until about ten days ago, when both were noticed after violent exertion. 8 
By the speculum the lower part of the drum was found to be quite normal, 
save a few cicatricial traces. At the upper part posteriorly and advancing a 
little forward on the roof of the external auditory canal is seen a reddish mass 
about two lines wide and about three long, not pulsating, but evidently an ex- 
tension of the angioma. She was then going into the country, and promised 
to return to me in the autumn if any further symptoms arose. She, however, 
did not do so. I have recently heard of her death in 1875, from phthisis. 
From her friends I learn that the noises in her ear slowly increased, and for 
several months prior to her death they caused her much annoyance and dis- 
tress.