Imperforate Auditory Canals. 
BY 
SETH S. BISHOP. M.D., 
J^W*®®*-**" 
SURGEON TO THE ILLINOIS CHARITABLE EYE AND EAR INFIRMARY, 
CHICAGO, ILL. 
Read before the Tenth International Medical Congress t 
at Berlin. 
Reprinted from the "Journal of the American Medica! 
Association." 
CHICAGO : 
Printed at the Office of the Association 
1890. Imperforate Auditory Canals. 
BY 
SETH s. BISHOP, M.D., 
SURGEON TO THE ILLINOIS CHARITABLE EYE AND EAR INFIRMARY, 
CHICAGO, ILL. 
Read before the Tenth International Medical Congress, 
at Berlin. 
Reprinted from the "Journal of the American Medical 
Association." 
CHICAGO : 
Printed at the Office of the Association 
1890. IMPERFORATE AUDITORY CANALS. 
American medical books on the ear contain so 
little on the subject of congenital and traumatic 
anomalies of the external auditory canal, that it 
seems fair to infer that they are of uncommon oc- 
currence in this country. 
Only the following four cases of complete and 
permanent imperviousness of the external meatus 
have come under my observation during a practice 
of fourteen years, eight of which have afforded 
me quite a respectable experience in hospital and 
dispensary work. 
Case i was a man 32 years old, who applied for 
treatment August 15, 1883. Several years previ- 
ously he had been run over by a railroad train, 
that severed the auricle from the head. The sur- 
geon in attendance is said to have had no hopes 
of the man's recovery, but sewed the auricle to 
the side of the head, to make the subject appear 
more presentable at his funeral. The result was 
that union of the parts took place in such a man- 
ner as to completely close the external auditory 
canal, and deprive the patient of any use of that 
ear. However, the fact that the auditory nerve 
had retained its integrity was established by a 
careful application of the hearing tests. I there- 
fore cut away the scar tissue sufficiently to ob- 
tain a channel of nearly the natural size. There 
was only a slight discharge following the opera- 4 
tion, and when the patient left the city for his 
home two weeks later, his hearing in that ear was 
good for ordinary conversation. 
The result showed that the drum and auditory 
nerve had been uninjured by the accident, and 
nothing was needed to restore the usefulness of 
the organ beyond opening the door for the admis- 
sion of sound. 
Case 2.-A girl 8 weeks old was brought to my 
clinic October io, 1885. There was a congenital 
deformity of one auricle, and absence of the ex- 
ternal auditory meatus of the same ear. The au- 
ricle was rudimentary, and doubled forward upon 
itself. It appeared shrunken and pinched, and 
had a large, hard nodule and several indentations 
in that part of the helix that corresponds to the 
key-stone of an arch. 
It is interesting to note, in this connection, that 
the mother attributed the deformity of the auricle 
to the fact that, about the fifth month of gestation, 
her elder child bit the mother's ear severely, at 
just that point that corresponds to the greatest 
auricular deformity in the baby. 
At the point where the canal ought to have 
been, there was a depression or cul-de-sac that 
yielded to pressure, and imparted to the touch an 
impression as if there were an opening in the bone 
beneath. 
Four months later, careful tests led me to be- 
lieve that the child could hear with that ear. I 
operated to correct, as far as possible, the deform- 
ity of the auricle, and to ascertain if there were 
any bony meatus. On cutting down into the cul- 
de-sac where the canal should have been, I found 
nothing but a depression in the bone. No bony 
canal could be found, and I did not consider that 
further operative interference would be justifiable. 
However, I maintained a sufficient opening to 5 
give quite a respectable appearance of an exter- 
nal meatus. 
Case j.-An infant 14 months old, healthy and 
apparently normal, except in respect to one ear. 
There was no opening where the external canal 
should have been, and, although the patient ap- 
peared to hear on that side, the parents were un- 
willing that an exploratory opening should be 
made. I saw the case several years ago, but have 
never heard from it since. 
Case /.-Locomotive engineer, 32 years old, 
was referred to me through the courtesy of Dr. 
Fitch, of Rockford, Ill. When 3 years old he 
was run over by a wagon, that detached the auri- 
cle and tore off part of the cheek. The auricle 
was stitched over the meatus, and completely 
closed it with dense fibrous tissue. The patient 
stated that he had never since been able to hear 
with that ear, but the tests showed that the nerve 
was sensitive to sound. 
About ten years ago, he suffered intense pain 
in the ear for two weeks. This was followed by 
a purulent discharge from a pin-hole perforation 
in the adventitious tissue at the highest point of 
the mouth of the external meatus. The discharge 
had continued ever since, being copious and mal- 
odorous. The exit for pus was so minute that 
accumulations produced considerable pain. At 
such times he pressed above and in front of the 
ear, and alternately pulled and pushed the auricle 
in a sort of pumping process, to work the pus out. 
He succeeded in this manner, and by the aid of 
the Valsalvian experiment, in evacuating the pus 
cavities. 
I operated by means of the paracentesis needle, 
followed by a triangular-shaped bistoury. The 
meatus was filled with tough cicatricial tissue for 
about three-fourths its depth. After opening up 6 
the canal and cauterizing it with chromic acid, I 
inserted a vulcanized rubber tube, and retained it 
in position by antiseptic dressings. 
After the operation he could hear my watch i 
inch, and ordinary conversation n feet distant. 
After several treatments with the Eustachian cath- 
eter and external applications, the patient resumed 
his occupation. When he returned again the canal 
had contracted, and granulations had extruded 
the rubber tube by one-half its original insertion. 
Under a io per cent, solution of cocaine I curetted 
and cauterized the canal, and recovered the ground 
lost. Subsequently, however, the same experience 
was repeated, and the canal was allowed to close; 
but by this time the discharge had diminished to 
a few drops in the twenty-four hours, and the foul 
smell had disappeared. 
I had already begun dilating the old perforation. 
Through this I could pass a probe upward into the 
mastoid cells, and inward parallel to the roof of 
the external meatus, to the tympanic attic. I pro- 
posed a more radical operation for the excision of 
all the occluding tissue, which would enable me 
to discover and remove any carious bone that 
might be present; but he was so well satisfied 
with the almost complete cessation of the dis- 
charge, that he refused, and returned to his vo- 
cation. 
We found that after dilating the original open- 
ing, he retained his hearing nearly, though not 
quite, as well as it was through the tube. 
The remarkable circumstance in this case is, 
that the perceptive apparatus and the conducting 
mechanism should retain their functions after 
twenty-nine years of apparent disuse. But I ap- 
prehend that, although the patient was uncon- 
scious of any hearing power in this ear, it was 
sufficiently responsive to sound-vibrations of a 7 
major character to give the conducting apparatus 
exercise, and to keep the nerve sensitive. The 
nature of his business lends color to this view, 
for its environments abounded in vibrations which 
would be imparted to every organ in his body. 
If anything in nature is calculated to arouse a 
dormant auditory nerve, I should imagine that 
nothing but Gabriel's trumpet would surpass the 
clanging of bells and the tooting of whistles. 
Some of our authorities speak of imperforate 
external auditory canals as though they might be 
of frequent occurrence ; but among the records 
of the Illinois Charitable Eye and Ear Infirmary 
at Chicago, embracing more than 8,000 cases of 
diseases of the ear, I find but one case of closure 
from exostosis, three cases of congenital absence 
of the meatus, and three of traumatic closure. 
Of course, we have found numerous cases of nar- 
rowing, and various irregularities of the canal, 
from causes that are not uncommon. 
A reference to the following authorities will 
bear me out in my inference that congenital and 
traumatic anomalies of the external auditory 
canal are infrequent in America : 
Roosa mentions the occurrence of congenital 
absence of the canal, but does not treat of trau- 
matic closure. He records no operations to form 
an external meatus. 
Burnett speaks of the possibility of closure, but 
cites only membranous and osseous formations as 
the cause. None of my cases were of that kind, 
two being congenital and two traumatic. 
Green's edition of Schwartze speaks of congen- 
ital atresia, or imperforation, and stenosis, or con- 
striction, of the canal, as "specially frequent." 
Turnbull mentions congenital absence of the 
meatus, rudimentary auricle, and exostoses, but 
not as being frequent. 8 
Mittendorf does not treat of the subject. 
Jones also ignores it. 
Pomeroy does not deal with the subject, al- 
though he mentions exostoses. 
Sexton's book on the ear is silent on the subject. 
Von Troeltsch has seen congenital absence of 
the meatus, speaks of the difficulties of operation, 
and discourages it, unless one can with certainty 
find the bony canal. 
Buck has nothing on the subject, but mentions 
membranous closures. 
Congenital cases have been reported by the fol- 
lowing authors: Moos, Knapp, Jager, Weicker, 
Robb, Hessler, Zaufall, Steinbriigge, Zuckerhandl 
and Michel. 
Politzer's classical work on the ear advises an 
" operation in congenital atresia of the external 
auditory meatus only when it has been with cer- 
tainty ascertained, by careful examination, that 
it is a case of congenital thin walled septum at 
the entrance to the ear. When the atresia extends 
far inwards, so that the canal cannot be made out, 
or only a solid cord, operation must be avoided, 
as irrational and dangerous. 
Virchow's Archives, Bd. 30, S. 221, and Bd. 
32, S. 518, says : " Congenital anomalies of 
the external ear and its neighborhood are to be 
referred to early disturbances in the closure of the 
first branchial cleft, and are often associated with 
fistulae of the other branchial clefts, cleft palate, 
and other forms of arrest of development in the 
facial bones-as, for instance, with unilateral at- 
rophy of the face." 
70 State St.