RUPTURE OF BOTH MEMBRANE TYMPANI FROM A 
FALL ON THE HEAD. ESCAPE OF BLOOD FOL- 
LOWED BY A WATERY DISCHARGE. FRACTURE 
OF THE TYMPANIC PORTION OF B6TH TEMPO- 
RAL BONES. \ 
J. MORRISON RAY, M.D., 
SURGEON TO THE EYE AND EAR DEPARTMENT OF STS. MARY AND ELIZABETH, AND LOUISVILLE 
CITY HOSPITAL ! FORMERLY HOUSE SURGEON MANHATTAN EYE AND EAR HOSPITAL. 
May 28, 1885. I was requested by Dr. Ap. Morgan Vance to 
see John Ridge, age fifty-four. The following history was given. 
Five days previous to my visit the patient had fallen through an 
elevator hatchway a distance of twelve feet, alighting on his head 
and hands. There was only temporary unconsciousness or a 
stunning, but it was not followed by vomiting. When examined 
by the surgeon, he was found to have sustained a compound frac- 
ture of both bones of the right forearm, with bruises on the chest, 
an injury to the lower jaw, and profuse bleeding from both ears. 
The fracture was treated in the proper manner. In two days 
gangrene of the extremity occurred and amputation of the arm 
at the upper third was done. 
On the day before my visit the bleeding from the ears, which 
had amounted to several drams daily, had given place to a pale 
straw-colored fluid. This filled the meatus and trickled down, 
saturating the bed-clothing. The ticking of the watch could not 
be heard, but the sound of the tuning-fork was perceptible. 
When the fork was placed in contact with the mastoid, its vibra- 
tions seemed more intense and were heard twice as long as when 
it was held in the air in front of the auricle. Voice in stress 
slightly above ordinary conversation was heard. Tinnitus was 
intense. There was some difficulty in speech, in consequence of 
the injury to the jaw, which was found on examination to have a 
Reprinted from the Archives of Otology, Vol. xv., Nos. 2 and 3, 1886 193 
Rupture of both Membrance Tympani. 
splintered fracture, one tooth being driven through the bone and 
coming out behind the symphysis. 
With absorbent cotton the external canal was carefully cleansed 
and on inspection a linear rupture in each membrana tympani was 
found. On one side this was situated vertically in front of the mal- 
leus handle. On the other it extended obliquely from above in front 
downwards and backwards below the umbo. Through these rup- 
tures the pale yellowish pulsating fluid oozed freely, and in such 
quantities as to quickly obstruct the view. This flow continued 
for ten days, several ounces being lost. Gradually it diminished 
in quantity and became purulent in character, then ceased. No 
cleansing of the ears by the syringe was attempted, nor was infla- 
tion practised, as the patient was not expected to live. When the 
parts had become healed the middle ear was inflated for a few 
days by Politzer’s air-bag and Valsalva’s method. Three months 
after the injury the patient was well. The hearing-distance for the 
watch and voice was perfect. On examination of the membranse 
tympani a small white line marked the seat of the rupture. 
Writers on the subject of fractures of the temporal bone 
do not agree as to the symptoms necessary to establish 
a diagnosis. Simple ruptures of the membranae tympani 
are of comparatively common occurrence. Injuries as ex- 
tensive as those sustained in this case are generally fatal 
from the damage done to the cranial contents. If death 
does not occur the hearing is usually totally and perma- 
nently destroyed. 
Buck1 says “ when a fall or blow upon the head is fol- 
lowed by bleeding from the ears, no matter how trivial, we 
may diagnose a fracture of the temporal bone in the neigh- 
borhood of Shrapnell’s membrane, and probably in the line of 
the Glaserian fissure.” The works of Holmes and Erichsen 
on general surgery maintain that bleeding from the ears 
by itself cannot be considered a sign of much importance. 
Wilde remarks “ that hemorrhage is strong presumptive 
evidence that fracture has occurred. . . . Subsequently 
in cases of fracture a clear pale straw-colored fluid flows out 
of the ear in immense quantities so as to saturate the bed on 
which the patient lies.” 
1 “ Diagnosis and Treatment of Ear Disease,” p. 290 J. Morrison Ray. 
194 
The symptoms in the case here reported are highly sig- 
nificant of fracture of both temporal bones through the mid- 
dle ear; possibly a disjunction of the squamo-parietal suture. 
Inspection gave no evidence of the situation of the lesion 
beyond excluding a fracture of the bony canal. The 
amount of injury done the lower jaw might have led to 
this belief. The injury to the membranae tympani was 
similar on the two sides. The pulsations were well 
marked, being plainly visible in the column of fluid filling 
the canal. The ultimate complete restoration of the hear- 
ing power gives further evidence of fracture only of the 
bony roof of the middle-ear cavity close to the mem- 
branae tympani.