the ear of a boy by a tutor. In another case the ear was hit by a bolster while the boys were engaged in a playful contest. In both of these cases the rent was found to be on the lower part of the membrane. Toynbee also relates a case which is of interest on account of the nervous symptoms produced by it. A young man of seventeen, while shooting, in endeavoring to force his way through a hedge, got a twig into the right auditory canal. It produced sudden and severe pain, followed by bleeding. Mi*. Toynbee saw the patient a week afterward. The pain speedily subsided ; but for days after the accident there was 'a feeling * Test-book, p. 28. <Callout type="warning" title="Potential Nerve Damage">on the same side of the tongue as if something cold had been rubbed over it ; the taste on that side also was im- paired.</Callout> The sensibility of the tongue to touch was, how- ever, unimpaired. The chorda tympani nerve was probably injured in this case ; for the same sensations are sometimes caused when a bit of cotton or woolen is brought in contact with the cavity of the tympanum and with the nerve. <Callout type="important" title="Chorda Tympani Function">The function of the chorda tympani is probably chiefly in connection with that of taste, and not of hearing.</Callout> Professor Flint* relates a case which sustains this view. A soldier received a gunshot wound, the ball passing through the head, entering just above the ala of the nose, on the left side, and emerging behind the mastoid process of the right temporal bone. The wound healed, with the usual symptoms of com- plete facial paralysis on the bright side. The buccinator and orbicularis oculi were completely paralyzed. The hearing was perfect. The sense of taste was entirely abolished in the anterior portion of the tongue on the right side. These facts were verified by Professor Dalton of this city. Experiments upon dogs and cats, and other animals, also show, according to Flint, that the chorda tympani influences taste ; for sections of the root of the fifth pair, or of the chorda tympani, is followed by loss of taste in the anterior portion of the tongue. The chorda tympani is given off from the facial, as it passes vertically downwards at the back of the tympanum, about a quarter of an inch before its exit from the stylo-mastoid foramen. It ascends from below upwards in a distinct canal, parallel with the aquseduct of Fallopius, and enters the cavity of the tympanum through an opening between the base of the pyramid and the attachment of the membrana tympani. It becomes covered by mucous membrane, and passes forward through the tympanic cavity between the han- dle of the malleus and the vertical crus of the incus (see Fig. 44, on p. 194), and then passes out of the cavity, through the canal of Hugier, at the inner side of the Glaserian fissure. It then passes downward, between the two pterygoid muscles, and meets the gustatory nerve at an acute angle, and communicating with this it passes to the submaxillary gland ; after joining the submaxillary ganglion it terminates in the lingualis muscle. Its anatomy seems to indicate that it has very little to do with the function of hearing. It merely passes through the tympanum, withoiut supplying any of its tissues, as has already been described in the chapter on the anatomy of the middle ear. Claude Bernard also performed experiments upon the chorda tympani of cats and Albino rats, by cutting out the facial nerve at its exit from the stylo- mastoid foramen. In from six to ten days the terminal twigs of the lingualis nerve, and the nerve fibres coming from the chorda tympani were found to * The Physiology of Man, The Nervous System, p. 157. <Callout type="risk" title="Degeneration Risk">have undergone fatty degeneration.</Callout> Degenerated nerve fibres were also found in the tip of the tongue, but not in the papillae. There were also degenerated nerve fibre in the submucous tissue.* Severe vomiting sometimes causes a rupture of the drum- head, as does strangulation by hanging. The cases of rupture that occur during whooping-cough, and sneezing or blowing the nose, are not properly to be considered in the present chapter ; for when the membrana tympani is ruptured in such cases, there is usually, if not always, some pre-existing catarrh of the Eustachian tube and tympanic cavity. I have seen seve- ral such cases, but in all of them I have been able to trace disease of the middle ear as having preceded the breaking of the drum-head. The great accumulation of mucus caused by the catarrhal inflammation will be very apt to cause a rupture by mechanical pressure from within upon a distended mucous membrane and fibrous layer, unless the cavity be emptied by means of the catheter or Politzer's method. In countries where punishment is meted out in exact pro- portion to the amount of personal injury done to the person assaulted, blows upon the side of the head which result in rupture of the membrana tympani are made the subject of careful medico-legal examination.* In order to determine the cause of a rupture of the mem- brana tympani, it must be seen within a few hours of the injury ; for suppuration may occur soon after it has occurred, when it will be impossible to decide whether it had a trau- matic or spontaneous origin. A traumatic rupture of the membrana tympani, especially one arising from the perforation of the membrane by a sharp instrument, is much more apt to cicatrize promptly, without suppuration, than one that has been perforated in the course of inflammation of the middle ear. The force of large waves upon the side of the head in sea- bathing, is not an uncommon cause of rupture of the mem- bran a tympani. I have seen such cases, and one where both membranes were ruptured. A wave is sometimes allowed to strike upon the membrane with great violence, and if it do not break it, it will at least excite an inflammatory action* Physicians who practice at the sea-side, should warn their patients of this danger from surf-bathing. Long Branch and Newport, furnish every year a certain contingent of aural patients from this cause. A little care in not allowing the waves to strike the side of the head in full force, or plugging the meatus lightly with cotton, will be found to be a sufficient protection from the severity of the waves. If water be allowed to stay in the auditory canal for some time, it becomes a source of conges- tion ; but such causes of diseases of the middle ear are more appropriately considered in a subsequent chapter. Dr. C. H. Burnett* of Philadelphia, has lately reported a case of evulsion of the membrana tympani, from the splashing of mud into the ear by a horse while the patient was crossing the street. The patient was 39 years old, and consulted Dr. Burnett three days after the accident. Ha stated that his ear was sound until the mud came into it. Upon returning to his shop — he was a machinist — he was examined by some of his comrades, who said they saw foreign objects in. the meatus, which they proceeded to extract with chips and mechanics small tools. Several 'little white pebbles' were taken, out, which were probably the ossicles. Great impairment of the hearing of the ear followed. The patient was very pale, anxious and bathed in cold perspiration when he visited Dr. Burnett. A watch that should have been heard 40 feet was only heard 5cm. The tuning-fork placed on the vertex was heard very distinctly in the injured ear. On examination, Dr. Burnett found the meatus uninjured. A small piece of mud was adherent to the antero-superior quadrant of the periphery of the membrana tympani. The membrane was entirely destroyed, except a very narrow bor- der. There were no ossicles visible. The inner wall of the * Monatsschrift fur Ohrenheilkunde, No. 1, 1873, from Comptes Rendus, Hebdom. des Seanees de l'Academie des Sciences, T. lsxv., No. 27. Paris, 1872. <Callout type="tip" title="Ear Protection">The inner wall of the tympanum was fully exposed to view. The mucous membrane was healthy, but slightly abraded on the promontory.</Callout> Twenty days after, without treatment, patient was free from pain and ' ruddy and cheerful.' The border of the membrana tympani had become adherent to the promontory. Of course the hear- ing power was not improved, thanks to the care of his surgical comrade, who so carefully removed the ' white pebbles ' from -his ear. The explosion of a bag of gas near the ear, may also cause a rupture of the membrana tympani. Dr. J. Orrte Green,* of Boston, reports such a case. The patient, who was preparing for an exhibition in which an oxy-hydrogen light was to be used, was standing a few feet from the bag, and with his left side towards it at the time of the explosion. The immediate effect was some slight confusion of intellect, which soon passed off; but the next day the left ear began to be painful, and on blowing the nose, air whistled through it. Dr. Green saw the patient twelve days after the accident, and found the membrana tympani red and swollen, and on the posterior segment just behind the umbo, a rupture 1\ lines long, nearly perpendicular, through which purulent matter could be forced by Valsalva's method of inflation. H. D. ?6g. Dr. Green states that this patient had previously suffered from impaired hearing and mucous rales in his ears. Many of the cases of rupture of the drum-head on record, if the antecedents had been inquired into, would undoubtedly ex- hibit the same condition of things. The assistant of the patient whose case has just been quoted, suffered at the same time from the explosion of a bag of gas, and also received rupture of the membrane, which resulted in a purulent inflammation of the tympanic cavity. He was treated by Dr. Henry L. Shaw of Boston. In both of these cases the rupture healed perfectly, and the hearing power was partially restored. In Dr. Green's case it became \. Dr. Green saw two other cases in which the patients suf- fered from the concussion of the same accident. It caused a loud buzzing in the ear and confusion in the head. The * Transactions of the American Otological Society, 1872. <Callout type="warning" title="Potential Hearing Loss">The tuning-fork became a valuable assistant to diagnosis in cases of rupture. Its vibrations will be heard more distinctly in the injured ear than the other, if the labyrinth be not injured.</Callout> A simple rupture usually heals in a few days with- out great injury to the hearing. A suppurative process may result, however, and become chronic, when the treatment should be the same as that of any other similar affection arising spon- taneously. Treatment. — We can do very little indeed, in the way of treatment, if no inflammatory symptoms, such as pain or swell- ing, occur. Above all, we should not disturb the ear immedi- ately after the occurrence of the injury, as is sometimes mis- takenly done, by syringing it. There is a very prevalent dis- position in the profession, to syringe the ear in every case of aural disease that presents itself; but no ear should be syringed without a good and sufficient reason. When inflammatory symptoms occur, they should be treated by leeches, the warm douche, and by the other means that will be detailed in the chapter on Acute Inflammation of the Middle Ear. Mean- while the ear should be protected from the cold air, by a bit of cotton placed in the meatus, and the patient should be kept under careful but not meddlesome observation. FKACTURE OF THE HANDLE OF THE MALLEUS. This rare accident has been described by Meniere, Yon Troltsch, and Weir.* The history of the case of the second- named author is as follows : A man accidentally thrust a pen-handle which he held in his hand into his ear, in con- sequence of knocking his elbow against a door. The severe pain caused him to faint. After he recovered, he found that he heard badly from the injured ear, and he suffered from tinnitus of that side. Von Troltsch saw the case a year after, and from the peculiar slanting position of the handle of the malleus, and from the fact that it was uncommonly thick under the short process, he diagnosticated a united fracture of the manubrium. Hyrtl, is quoted by Von Troltsch, as having described such a united fracture in the malleus of a prairie dog. This frac- ture was also situated just under the neck of the malleus. The membrana tympani of this animal is, according to Hyrtl, very superficially situated. Dr. Weir's case is one of ununited fracture. f A man, aged 32, came to Dr. Weir's clinique, at the New York E}Te and Ear Infirmary, on May 11, 1867, and gave the following history : Four months previously he fell into an open area- way, a distance of about fifteen feet. He became uncon- scious, and remained so for nearly sixteen hours. He had been informed that his right ear bled for about an hour. * Von Troltsch on the Ear, 2d American Edition, p. 151. f Transactions American Otological Society. <Callout type="important" title="Ununited Fracture">The watch was heard upon the affected side when pressed firmly upon the ear. The drum membrane was normal in color ; but there was an irregularity in the handle of the malleus.</Callout> The bone was found to be fractured a short distance below the short pro- cess, presenting the appearance shown in the engraving. The broken ends of the bone were completely and transversely displaced. Fig. 57. When Dr. Weir caused the patient to perform the Valsal- vian experiment, the fragments came into apposition, and the line of the bone became regular ; but the posterior portion of the membrana tympani projected unduly forward froni want of support. In a few moments the displacement recurred, with corresponding sinking of the posterior of the drum mem- brane. Dr. Weir's colleagues — Drs. Hackley and Simrock — thought that a faint whitish line, posterior to the malleus, might be a cicatrix from a laceration of the drum-head. The patient did not return to the Infirmary.
Key Takeaways
- Chorda tympani injury can affect taste and hearing
- Traumatic ruptures heal faster than those from inflammation
- Surfers should protect ears from waves to avoid rupture
Practical Tips
- Use cotton earplugs when swimming or in areas with strong water splashes.
- Avoid syringing the ear unless there are inflammatory symptoms like pain or swelling.
- Be cautious of foreign objects entering the ear and seek medical attention if they do.
Warnings & Risks
- Ruptures from severe blows can cause hearing loss and nerve damage.
- Inflammation leading to rupture is often preceded by middle ear disease.
- Explosions near the ear can cause serious injuries, including ruptured eardrums.
Modern Application
While the specific techniques for treating ear injuries have evolved, understanding the anatomy and potential risks of tympanic membrane damage remains crucial. Modern survivalists should be aware of these risks in environments where head trauma or exposure to loud noises are common.
Frequently Asked Questions
Q: What are the symptoms of a ruptured eardrum caused by an explosion?
Dr. Green reported that after an explosion, the patient experienced pain and air whistling through the ear when blowing the nose. The tympanic membrane became red and swollen with a rupture visible behind the umbo.
Q: Can a ruptured eardrum heal on its own?
A simple rupture usually heals in a few days without significant injury to hearing, but a suppurative process may result and become chronic. Treatment should be similar to other middle ear infections.
Q: What are the potential long-term effects of chorda tympani nerve damage?
Chorda tympani damage can lead to impaired taste sensation on the anterior portion of the tongue, as seen in Professor Flint's case where a soldier lost his sense of taste after a gunshot wound.