[Reprinted from 
The Philadelphia Polyclinic, 
Vol. VI, March 6, 1897, No. io.] 
TRAUMATIC PERFORATION OF THE MEMBRANA TYMPANI. 
BY LEWIS S. SOMERS, M.D., Philadelphia, Pa 
The following case is reported on account 
of the unique method resorted to by the pa- 
tient to relieve his impaired hearing and also 
to show nature's mode of healing a trau- 
matic perforation of the membrana tympani. 
W. D., male, age 53 years, a phlegmatic 
German, was seen November 10, 1896, com- 
plaining of pain in the right ear and 
diminished hearing. On questioning it was 
ascertained that his hearing had been pro- 
gressively diminishing for a number of years 
and on the advice of a friend he had taken 
a splinter of bone with a sharp point and 
pushed it into his right ear. This procedure 
was followed by intense pain and total deaf- 
ness on that side; the pain was described as 
sharp and constant in character, preventing 
sleep for several nights, then gradually grow- 
ing less severe, although continuing for a 
period of four weeks. 
Aural examination showed both tympanic 
membranes to be much retracted and thick- 
ened and on the right side a central perfora- 
tion existed immediately below and posterior 
to the umbo, being therefore in the posterior 
inferior quadrant of the drum. The perfora- 
tion was clean cut, about one millimeter in 
diameter and irregularly oval in shape. 
Through it could be seen the mucous mem- 
brane of the middle ear and for a short space 
around its edge was a border of clotted blood. 
There was a moderate amount of congestion 
of Shrapnell's membrane and another area of 
congestion over the short process of the mal- 
leus. This latter area of congestion had been 
brought about by the pressure exerted by the 
splinter of bone forcing the tympanic mem- 
brane inwards and increasing the pressure on 
the chain of ossicles, jamming them together, 
thereby forcing the short process of the malle- 
us against the drum head and retaining it in 
that position. By the use of the Siegle oto- 
scope the membrane was drawn outwards 
from the middle ear and the ossicular chain 
relieved from its increased pressure. This 
was followed by an immediate increase in the 
hearing distance and relief from the pain, 
which, though moderate,was still present. A 
plug of cotton was placed over the external 
auditory canal; the nares and pharynx 
were cleansed with an alkaline antiseptic 
solution and within a week cure was com- 
plete, a small firm cicatrix alone remaining. 
After ascertaining by visual inspection the 
extent of the injuries in these cases, it is im- 
portant to remove any pressure on the ossicle, 
that may exist and to prevent infection of the 
middle ear. Each case must be treated on 
its own merits and as far as possible non- 
interference with the healing processes should 
be observed. If a blood clot is present over 
or around the perforation it should not be 
disturbed except when the middle ear is 
already infected, the case being then treated 
as an ordinary otitis media suppurativa. We 
have two points through which the ossicles 
may be reposited to their normal position ; 
either through the external auditory canal or 
Eustachian tube, the former being far pre- 
ferable as there is no danger of infecting the 
middle ear and the drumhead is under our 
visual control. 
When the membrane is thickened and re- 
tracted and at the same time the Eustachian 
tube is impervious to the passage of air from 
the naso-pharynx, as was the condition in this 
case, an artifical perforation of the drum 
head by equalizing the intra-tympanic press- 
ure, will frequently increase the hearing. 
To a certain extent this took place here, but 
on account of the force exerted by the un- 
skillful attempts of the patient to relieve the 
deafness, the damage to the parts was in- 
creased, inasmuch as the stapes has been 
forced into the oval window, so preventing 
the proper conduction of the sound waves to 
the inner ear.