Operations on the Drum-Head 
for Impaired Hearing; with 
Fourteen Cases. 
BY 
SETH S. BISHOP, M.D., 
OF CHICAGO. 
ATTENDING SURGEON TO THE ILLINOIS CHARITABLE EYE AND EAR 
INFIRMARY, AND TO THE SOUTH SIDE FREE DISPENSARY. 
Read in the Section on Ophthalmology, Otology and Laryngology, at the 
Thirty-Seventh Annual Meeting of the American Medical Association. 
Reprinted from the Journal of the American Medical 
Association, August 38, 1886. 
CHICAGO: 
Printed at the Office of the American Medical Association 
1886. OPERATIONS ON THE DRUM-HEAD FOR IMPAIRED 
HEARING; WITH FOURTEEN CASES. 
I will not occupy the time of the Section with a 
historical account of this operation, although it is re- 
plete with interest. Those facts only will be pre- 
sented which are necessary to an intelligent study of 
this group of cases. The subjects for operation were 
not selected with a view to the promising nature of 
their cases. This method would have been more 
brilliant but less scientific. 
If I have erred at all it has been in the opposite di- 
rection.- For the purpose of making a crucial test 
of the efficacy of this procedure, I have made if the 
last resort in those cases which afforded no hope for 
relief from any other treatment. Perhaps the pro- 
priety of operating on these patients that seemed to 
promise* no results might be questioned, were it not 
for the facts that in nearly all of them there was an 
unexpected improvement, and that no unfortunate 
consequences followed the operation. The cases I 
-have chosen to operate on were far more hopeless 
than those with chronic suppurative inflammation. 
The consideration that the former respond so little 
to our efforts, while the latter are so amenable to 
treatment with inflations, cleansing, peroxide of hy- 
drogen, boracic acid, bichloride of mercury, etc., with 
the result of not only arresting the disease, but of 
improving the hearing, has led me to seriously con- 
template the advisability of establishing the suppura- 
tive process in proliferous inflammation of the middle 
ear. In but three cases in my piactice has this con- 
dition followed the procedure under discussion, and 4 
I have operated more than one hundred times. It 
happened while I was preparing this paper. A tem- 
porary purulent discharge occurred immediately after 
the operations. It had the effect of keeping open the 
apertures, and no evil consequences followed. 
In choosing the location for the incisions I have 
usually given preference to the section of membrane 
anterior to the handle of the malleus, in order to 
avoid the possibility of wounding the carotid artery, 
should the bony wall of the carotid canal be deficient, 
or of penetrating the labyrinth through the fenestra 
ovalis. 
Cocaine in a four per cent, solution was employed 
as a local anaesthetic in very sensitive individuals. 
It allows sufficient deliberation on the part of the 
operator, for patients experience no actual pain, al- 
though they feel the knife. 
Chronic non-suppurative inflammation of the mid- 
dle ear existed in all of the following cases. 
Case i.—Male, 43 years old, on Board of Trade. 
Said he had not been able to hear with the right ear 
for many years. He consulted me relative to a sud- 
den attack of sub-acute inflammation of the left mid- 
dle ear and Eustachian tube. The right drum-head 
was thickened, opaque, and retracted. The handle 
of the malleus was fore-shortened and the processus 
brevis prominent. There was no hearing for the 
watch even by bone conduction, but the tuning-fork 
could be heard by aerial conduction close to the 
auricle. I advised him to submit to an operation; 
but as he had no hope of receiving any benefit for 
his worse ear, and requested me to direct my efforts 
toward the better ear only, to save what hearing he 
had, I contented myself at first with the ordinary 
treatment addressed to both ears. The left ear im- 
proved rapidly, while the right remained unaffected. 
Before discharging him I instilled a warm four per 
cent, solution of cocaine into his right ear, and at the 
expiration of twelve minutes made a free opening in 5 
the anterior half of the membrana tympani, with Pol- 
itzer’s paracentesis knife. He was not conscious 
that any cutting was done, and gave no evidence of 
any unpleasant sensation, except by the remark that 
‘ The funnel seemed to press against the ear.” The 
immediate result was that he heard my watch on 
contact with the auricle, and the tuning-fork five 
inches distant. He said it was the first time in many 
years that he had heard a watch with that ear. April 
29th he could still hear the watch with that ear. 
Case 2.—Deaf mute, German farmer boy, 19 years 
old, came under treatment in September, 1885, dur- 
ing my service at the Illinois Charitable Eye and Ear 
Infirmary. There was no sign of any perception of 
sound either by aerial or bone conduction with either 
ear. I placed him on a course of treatment ad- 
dressed to both the middle and internal ears. For 
the former I employed catheterism at first, and the 
Politzer method later, as the Eustachian tubes be- 
came more pervious. For the purpose of imparting 
tone to the auditory nerves, I employed central gal- 
vanization daily. After four months of persistence 
in these methods, the only apparent improvement 
was his ability to hear the tuning-fork as it vibrated 
in contact with the mastoid process of the right side. 
I repeatedly tested his hearing in the presence of 
• others, but he was unable to hear loud clapping of 
hands immediately behind the auricles. 
January 28th I opened both drum-heads, leaving 
elliptic perforations which remained open two or 
three days. My record book shows the immediate 
result to have been as follows: Patient hears the 
loud voice through the conversation tube, but does 
not understand words. He makes an effort to reply, 
but the result is only unintelligible gibberish. In 
speaking to him through the tube, care is taken to 
prevent him from watching the lips, for he has ac- 
quired some proficiency in lip-reading. He repeats 
the vowel sounds with more or less accuracy, and if 6 
given an opportunity to watch the relative positions 
and movements of the lips, tongue and teeth, he re- 
produces the sounds with surprising fidelity. 
February ist, the aperture having closed, I opened 
the right membrane. Patient hears ordinary conver- 
sational tone through the tube, repeating words. 
February 8th, made long openings in both mem- 
branes. I have taken pains to exercise the auditory 
apparatus by using the vowel sounds and the powers 
of the consonants separately. He says he hears 
better with both ears, and seems to appreciate va- 
rious sounds with greater nicety than before. 
February i ith, 17th, and 27th, opened both drum- 
heads. Patient says he hears my watch on pressure 
with right ear, and imitates the ticking. He hears 
the fork close to the right meatus. At the last oper- 
ation I made two incisions in such a manner as to 
leave triangular openings. I waited nearly a month 
before operating again, continuing the inflations and 
galvanization. The perforation on the left side had 
then closed, but on the right it remained open. 
March 25th, made long aperture in both drum- 
heads. Hears watch on contact, and fork one inch, 
with right ear. 
March 30th, operated on both drum-heads, making 
two incisions in each, so as to embrace large trian- 
gular portions of the membrane. He is now able to 
construct and utter sentences of considerable length 
quite intelligibly. 
Encouraged by the improvement in the preceding 
case, I adopted the same course of treatment in the 
the following one. It is in striking contrast with the 
first, and illustrates the impossibility of predicting 
results. 
Case 3.—Farmer, 25 years old. December nth, 
1885, said he had been losing his hearing for "anum- 
ber of years.” There were evidences of disease of 
the labyrinth, bu: no syphilitic history could be elicit- 
ed. Neither the watch nor fork was heard by bone 7 
conduction with either ear, but he could hear the 
fork one inch from the right meatus. There had 
never been any tinnitus aurium. His treatment was 
exactly the same as in Case 2. Central galvaniza- 
tion and inflations failing to accomplish anything for 
him up to January 27, 1886,1 opened the right drum 
head, with no result. 
February 3d, operated on the left one, with no im- 
provement. 
February 12th and 17th, and March 4th, operated 
on both drum-heads. When I discharged him he 
said there was no perceptible change of any kind in 
his condition. 
Case 4.—Brought for consultation by Dr. Bennett, 
from Richmond, Illinois, on February 5, 1886. The 
patient was a young woman 19 years old, and had 
suffered for “several years.” The tympanic mem- 
branes were thickened, opaque and retracted. She 
could not hear the watch, and could hear the fork 
only when in contact with the mastoid process. 
Symptoms were present which pointed strongly to 
labyrinthine disease. No satisfactory results had at- 
tended the ordinary treatment. I made free open- 
ings in the drum-heads with the immediate result that 
she heard the fork at a distance of ten inches from 
either ear. The patient returned home with her phy- 
sician, who promised to keep a record of her case 
and report the results to me. 
March 23d I received a letter from Dr. Bennett in 
which he stated, after referring to my operation, that 
“Since then I have punctured one drum-head twice 
and the other once. She seemed better after each 
puncture, but now has reached a stationary period 
where she does not improve. I am inflating the 
middle ear with the catheter once a week, and apply- 
ing the galvanic current. What would you further 
advise?” etc. 
Case 5.—Cooper, 36 years old. Has had great 
tinnitus in both ears for two years. The drum-heads 8 
were opaque, thickened and retracted. Hearing for 
the watch was on pressure for the right, nil for the 
left. Fork was heard one-fourth inch from the right 
ear, and on contact with the left mastoid process. 
After the operation he could hear the watch two and 
one half inches, and the fork ten inches with the right 
ear, the the watch seven inches with the left. The 
tinnitus ceased in the right ear and diminished by 
seventy-five per cent, in the left. 
Case 6.—Woman, jet. 42. Has suffered greatly 
from noises in both ears. Heard watch on contact 
with the right ear, and on pressure with the left. 
February 18th, opened both drum heads. Watch 
was heard two inches from the right ear. Hearing 
remained the same as before in the left, although she 
thought it was better. The tinnitus, which was in- 
creasing before, now intermits, and is less annoying. 
February 20th, hears watch two and one-half inches 
from right ear. Hearing unchanged in left ear. Tin- 
nitus diminished in both. 
February 27th, hearing distance for watch on right 
side, a little more than five inches. No change in 
left ear. Tinnitus less in both. The improvement 
in the hearing distance for the right ear was more 
than 500 per cent. 
Case 7.—Woman, 50 years old. Proliferous in- 
flammation of long duration. Hearing for watch on 
right side, nil, on left side, pressure; for fork on right 
side, one-half inch.' » 
March 28th, opened both drum-heads; immediate 
result, nil. 
March 29th, both apertures remain open. Hears 
fork four inches from right ear, and watch on con- 
tact with left. The improvement in the right ear 
was 800 per cent. 
Case 8.—A woman about 40 years old came from 
the country for consultation. She attributed her 
trouble to the use of quinine. Said she had taken it 
during a year for intermittent fever, which she had 9 
about fifteen years ago. Ever since then her ears 
have rung constantly. She had typhoid fever nine 
years ago. The group of symptoms were character- 
istic of proliferous inflammation. Hearing for watch 
was on contact for the right ear, one-eighth inch for 
the left. I opened both membranes, whereupon she 
heard the watch one-eighth inch from the right, and 
one-half inch from the left. The tinnitus had di- 
minished. 
Case g.—Iron worker, 45 years old. Hearing of 
the right ear for watch, nil; for fork, at rim of auri- 
cle. Hears watch in left ear on pressure, and fork, 
one inch. Operated on right ear, with the imme- 
diate result that he heard the fork one-half inch dis- 
tant. Two days later the hearing had improved so 
much that he heard the fork two inches from the 
auricle, and the snapping of the nails six inches. 
Case 10.—Horseman, 50 years old, whom I had 
treated several months in the South Side Free Dis- 
pensary, by catheterism and Politzer’s method, with- 
out any perceptible permanent improvement. The 
drum-heads were greatly thickened, and 
opaque. The manubrium was much foreshortened, 
and there were cretaceous deposits in both mem- 
branes. As in many such cases, there was a chronic 
naso-pharyngeal catarrh which was quite intractable. 
There was absolutely no hearing for the fork or watch. 
The disease had evidently invaded the labyrinth. 
Although there appeared to be no reason to expect 
any improvement, since I had never witnessed any 
ill consequences following the operation, I opened 
both drum-heads. It was like cutting through leather, 
so thick and hard and tough were the membranes. 
The chalky deposit imparted a grating sensation to 
the fingers that held the knife. He strongly insisted 
that the operation not only improved his hearing, but 
relieved the uncomfortable sensations in his head. 
No later history was obtainable. 
Case ii.—Laborer, 51 years old. Had tinnitus of 10 
long duration. There was inspissated cerumen in 
the left meatus when he presented himself at my clinic 
at the Infirmary in July, 1885. Hearing for the watch 
then was one-fourth inch for the right ear, and press- 
ure for the left. After eight months of the usual 
treatment the hearing distance had increased by four 
times the original distance in the right ear, and from 
bone to aerial conduction, at one half inch distance, 
in the left. But there it remained without further 
progress until March 29, 1886, when I opened both 
drum-heads with triangular apertures. Immediately 
the hearing distance was increased in the proportion, 
in the right ear, of two to seven, and in the left ear 
it was doubled. 
Case 12.—Man, 27 years old. Had a fall when 
four years old and alighted on the left parietal emi- 
nence. Says he has been deaf in the left ear ever 
since. Has had noises in both ears for eight years. 
Inspection revealed proliferous inflammation in both 
middle ears, and I strongly suspect that there had 
been a fracture of the temporal bone, extending 
through the left tympanic cavity. There was no 
hearing for the watch, and the fork could be heard 
only when vibrating loudly on either mastoid process. 
I made large openings in the drum-heads, whereupon 
he could hear the fork by aerial conduction one and 
one-half inch from the right ear, and one inch from 
the left. The tinnitus remained undiminished. 
Case 13.—Old soldier, 54 years of age. His afflic- 
tion dates from the battle of Pittsburgh Landing, 
where he was precipitated by the explosion of a shell. 
Thus his disease is over twenty years old. There 
was no hearing for the fork. The inflammation was 
of a proliferous type, and the auditory nerves were 
diseased, beyond a reasonable doubt. There were 
noises in both ears. As there was no improvement 
from the usual treatment, I opened both drum-heads, 
merely to see what the result would be. It seemed 
to have no effect on the right ear, except to diminish 11 
the tinnitus, but he was able to hear the fork close 
to the tragus on the left 'side. Four days later the 
tinnitus had ceased, and the hearing remained the 
same for the fork. He repeatedly assured me that 
he could hear better, and said his “ head felt clearer 
and better” for the operation. He said he could 
hear some with the left ear. I doubt it. I saw the 
patient several times subsequently, and to my sur- 
prise, when I last saw him, he retained the improve- 
ment he had made. 
Case 14.—Swedish workman, 35 years old. Had 
tinnitus one and one-half year in the right ear, and 
two and one-half in the left. No hearing for watch. 
Fork heard one-half inch from right, and one-eighth 
inch from left ear. 
March 29th.—I made large openings in the mem- 
branes, after which he could hear the watch on con- 
tact with the right ear, but not with the left. Hearing 
for the fork was increased just fourfold for both ears. 
The tinnitus was diminished. 
March 30th.—The hearing was five times better in 
the right ear, and eight times better in the left, than 
it was just after the operation, and the tinnitus was 
further decreased. 
April 22.—Hears watch one inch with the right ear, 
and on contact with the left. Tinnitus is diminished 
by one-half in the right ear, but remains the same in 
the left. I operated on both ears again, whereupon 
the hearing was less acute, and the tinnitus was di- 
minished. 
April 29th.—Hearing for the watch was one-half 
inch for the right ear, and contact for the left. There 
was slight tinnitus in both ears. 
The watch employed for testing the hearing can 
be heard sixty inches by the normal ear, and the 
tuning-fork is of ordinary size, pitched at a above 
middle c. 
In recapitulating it will be observed that only two 
out of these fourteen cases were under 25 years of 12 
age. One of these was a deaf mute and the other pre 
sented symptoms of labyrinthine disease. All except 
two of the remaining twelve were 35 or older. Four 
were 40 or more, and four were 50 or over. The aver- 
age age was above 38 years. It should not be forgot- 
ten that the conditions for which these operations were 
performed were among those generally regarded as 
the most hopelessly incurable that ever confronted 
an aurist. Notwithstanding this, thirteen out of the 
fourteen cases were more or less benefited, and some 
were improved by not less than 500 and 800 per 
cent. How permanent this improvement may prove 
to be remains for the future to. determine, I give the 
facts as far as they are in my possession. 
The history of these cases has been brought down 
to as recent a date as the nature of circumstances 
would permit. I have examined and operated on 
some of them within the last week. I have had as 
yet no reason to regret the operation, and in some 
cases of this group, as well as in others which there 
is not time to report at this meeting, the improve- 
ment has been greater than I was prepared to expect. 
I shall follow up the history of all cases as far as 
possible and record remote results. My object in 
operating was to cause cicatrices in retracted drum 
heads, for the purpose of restoring their normal ten- 
sion through contraction of the cicatricial tissue. 
But when the loss of hearing seemed to be due largely 
to the interposition of a thick, dense, unyielding 
drum head between the source of sound waves and 
the perceptive apparatus, I attempted to maintain a 
permanent aperture. 
In conclusion I must say that the happy results 
obtained in the majority of cases in which I have 
operated, and the fact that no ill consequences have 
followed the operation, have convinced me that the 
procedure is advisable in the class of cases I have 13 
selected. It improves hearing, and sometimes re- 
lieves distressing noises and other subjective symp- 
toms when nothing else will. 
7x9 W. Adams St., Chicago.