Abstract
The fact that prosthetic devices applied within the ear often produce noticeable improvement in the hearing is well known. Artificial drums, 1 patches over perforations of the tympanic membrane, 2 and tamponades properly inserted into the middleear cavity 3,4 have all proved effective in selected cases. Substantial evidence has accumulated indicating that (in cases with large tympanic perforations, radical mastoid cavities, etc.) obstructing the pathway to the round window can increase acuity. 5,6 Guild noted that hearing seemed less impaired in the face of marked damage to middle-ear structures when the round-window niche was filled with scar tissue, 7 and Hughson 8 developed a surgical procedure for obstructing the round-window niche with transplanted fascia. Most recently, Kobrak has developed the technique of applying a bland ointment to the round-window niche in cases where there is conductive loss with extensive destruction of the drum membrane. 9,10 Kobrak's technique has the advantage
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