The Great Figures in the History of

Otology

Fernanda Muñoz ProtoENT Resident

Son Espases Hospital

Descriptions of battle injuries

on the temporal region and its effect on hearing and language of the wounded. The frequency of bleeding

from the ear in head injuries is mentioned and regarded as an unfavourable sign.

Many references to injuries of the nose.

Edwini Smith Egyptian Papyrus(3000-2500 B.C)

Edwini Smith Egyptian Papyrus

Contains prescriptions for diseases of the ear:

“For an ear that is suppurating, olive oil, frankincense and sea salt syringed into the ear;"

“For an ear that hears badly, red lead and resin, grind to a powder, rub in fresh olive oil and apply to the ear."

It is possible that the existence of the eustachian tubes were known, as it is stated 108 in the Papyrus,

'the breath of life passes by the right ear, the breath of death by the left ear."

Ebers Egyptian Papyri(1500 B.C)

Ebers Egyptian Papyri

The first to describe the tympanic

membrane "a dry thin spun web," and he connected it

with the organ of hearing.

Case reports of cases of otitis, and one of his aphorisms reads: "Children suffer from ear discharge,

adults from deafness.“

Father of MedicineHippocrates  

460 – 370 B.C Kos, Greece

"An insect must first be killed with vinegar, and

then removed with a probe, the patient should be encouraged to sneeze, or better still, he should be bound to a table with the affected ear downwards, and the table should then be forcibly struck with a hammer so that the foreign body may be shaken out of the ear.”

Injuries of the external ear:

Careful suturing of the skin, if broken.

If intact and a swelling occurs below it, the ear is to be opened from behind and a window cut in the cartilage.

Aulus Cornelius Celsus 

25 B.C – 50 A.D Rome

Some of his writings were centuries

in advance of their time. He advised that carious bone should

be removed after making an incision behind the ear. The first reference to mastoid

operative surgery, but centuries were to pass before his advice was put into practice.

Claudius Galen

130 - 216 A.C Pergamon (Modern

Bergama, Turkey)

Professor of Anatomy

at Padua. Revolutionized

anatomy. He gave a detailed

description of the malleus and incus, two of the small bones in the middle ear.

Andreas Vesalius

1514–1564Brussels, Habsburg

Netherlands(modern-day Belgium)

He wrote the first textbook devoted to

the ear. He gave an accurate description of

the eustaquian tube its structure and position, but made no mention of its function.

He described: The internal and anterior muscles of

the malleus and the stapedius, The anatomy of the cochlea.

Bartolomeo Eustachi

1500 or 1514 –1574San Severino, Italy

He described and named some of the

following structures: The inner and middle ears. The chorda tympani, trigeminal,

auditory and glossopharyngeal nerves. He described the bony canal for the

facial nerve which bears his name.

His knowledge was mainly anatomical, as he regarded purulent discharge from the ear as "excrement of the brain."

Gabriele Falloppio

1523-1562Modena, Italy

French anatomist 1683: Eustachian tube was not an avenue

of breathing, but existed simply as a means of renewing the air within the tympanum.

He compared the cochlea to a musical instrument suggesting that the lower tones were perceived by the basal coil.

Pus was often found in the tympanum even when the brain was normal, so the pus could not have come from the brain as was the accepted theory at that time.

Guichard Joseph Duverney

1648-1730Freur, France

German physician and physicist.

Measured the speed at which the signal is carried along a nerve fiber.

High tones were perceived in the basal coil, and the low- tones by the apical portion.

Hermann von Helmholtz

1821-1894Potsdam, Germany

He wrote Tractatus de Aure Humana.

He coined the term Eustachian tube.

1704: First in demostrate the ankylosis of the stapes.

Valsalva Maneuver

Inflating the middle ear by closing the mouth and nose and forcing air up the eustachian tubes.

"Gangrenous pus does not taste good“

Antonio María Valsalva

1966-1723 Imola, Italy

1760: Petit successfully opened the mastoid in a case of

suppuration, but the pathology not being understood, the operation was tried for cases of deafness without suppuration.

Astley Cooper observed cases of perforation of the tympanic membrane with little deafness: Deafness due to eustachian obstruction might be relieved by

puncturing the tympanic membrane.

Twenty years later, Itard gave the true indications for the operation: Presence of exudate in the middle ear which was unable to

escape.

Otitis Media

Eustachian tube catheterisation (1724), Myringotomy or piercing of the ear drum

(1801) Early attempts at mastoidectomy (1774) were

Until anaesthetics and antisepsis were introduced.

Main surgical treatments until the middle of the 19th

century

1800 in London, UK. The first firm to begin commercial

production of the ear trumpet. Rein also sold hearing fans,

and speaking tubes. These instruments helped amplify

sounds, while still being portable.

Frederick C. Rein

Surgeon, anatomist, neurologist, and

philosophical theologian

Difference between sensory nerves and motor nerves in the spinal cord.

1821: Published anatomic diagrams of the facial nerve and the innervation of the facial muscles.

Described Bell's palsy.

Sir Charles Bell

1774 - 1842 Edinburgh, Scotland

Dissections of over two thousand ears.

1841: Described otosclerosis and demonstrated ankylosis of the stapes of the oval window in 160 temporal bones.

His findings that the organ of hearing itself was intact in otosclerosis, led surgeons to investigate the possibility of bypass the middle ear obstruction and reach the intact cochlea by surgery.

Joseph Toynbee

1815–1866, Lincolnshire, UK

Father of Oscar Wilde.

He was the first to teach otology in the United Kingdom, and students came from all over the world, particularly America.

His name is still associated with the method of treating mastoiditis by a post-aural incision-Wilde's Incision.

Sir William Wilde

1815 -1876Dublin, Ireland

1893:  Described the features of Otosclerosis:

Abnormal new bone formation in the ottic capsule disorder and he named it.

He developed surgical instruments:

Ear perforator, surgical knife, grommets for the ventilation after paracentesis.

Politzer's method to restore permeability to the Eustachian tube by using an insufflator.

Politzer's otoscop

Acoumeter for measuring hearing acuity

2 early acoustical hearing aids.

Ádám Politzer

1835 - 1920Alberti, Hungary

1861: He described a syndrome of sudden

vertigo linked to progressive hearing loss and tinnitus.

He defined these discomforts as caused by a problem in the inner ear, as previously considered a form of epilepsy.

Stopped patients affected by this disease being treated as mentally ill.

1874: Jean-Martin Charcot named Meniere’s Disease.

Prosper Menière

1799 -1862Angers, France

 In the mid-1800s, a young man with otosclerosis was noted

to have hearing improvement following a skull fracture.

Post-mortem examination of his temporal bones revealed a fracture through the horizontal semicircular canal.

Kessel attempted to create a similar fistula in patients with otosclerosis using a hammer and gouge.

In 1876, Kessel removed the stapes and covered the oval window with scar tissue. These early attempts at treatment failed.

Johannes Kessel (1839 Salzen Hessen)

Discovered what he called the caloric reaction. Syringing fluid to a patient and the patient

experienced vertigo and nystagmus with cold water and to the opposite direction with warmed water. “The direction of flow of the endolymph was providing

the propioceptive  signal to the vestibular organ.” This observations made surgical treatment of vestibular

organ diseases possible. 1914: Nobel Prize in Physiology or Medicine  for his work

on the Physiology  and pathology of the vestibular apparatus.

He also investigated other aspects of equilibrium control, including the function of the cerebelum.

Robert Bárány

1876-1936Vienna, Austria-

Hungary

1929: Opening in the lateral semicircular

canal covered by a tympanic membrane muco-cutaneous flap.

1937: He published the first successful case of fenestration for treatment of deafness caused by Otosclerosis.

This operation was described in 2, 3 or more stages to combat infection.

Maurice Sourdille

1885-1961 Nantes, France

Tumarkin reported that decompression stylomastoid artery was

necessary for the proper treatment of Bell's palsy.

Balance and Duel described the decompression of the distal portion of the facial nerve in the stylomastoid foramen.

Sterling Brunell performed the first facial nerve repair with a graft for the recovery of facial muscle movement.

Bell’s Palsy 1930’s

Long Island Medical School.

1.5 mts tall.

He visited the Manhattan Eye and Ear Infirmary, Mount Sinai, Columbia, and NYU residency programs.

One stage fenestration of the lateral semi-circular canal operation for otosclerosis.

Dental drill for mastoidectomy.

Precursor to the operating microscope, he employed a bright headlight and magnifying loops so he could see well. 

Julius Lempert

1891-1968 Lublin, Poland

ENT in Mount Sinai hospital.

1952: Rosen accidentally mobilised the stapes during routine stapes mobility test of the ossicular chain before fenestration. He found a significant, immediate hearing improvement.

He design a new surgical technique: Rosen mobilization. Fracture of the anterior crus

Remove portion of the footplate

Mobilization the rest of the footplate anteriorly

However, he did not receive widespread acclaim in his own country.

Samuel Rosen

1897- 1981Syracuse, US

Hardvard Medical School in 1928. ENT in Massachusetts Eye and Ear Hospital in Boston

>400 articles in medical journals, edited the Archives of Otolaryngology for 10 years, and wrote the textbook Surgery of the Ear (1959), which remains in print.

His medical career spanned 70 years: he continued to see patients until a week before his death.

First physician to use an operating microscope in delicate ear surgery in the US.

George E. Shambaugh Jr.  

1903 –1999 Chicago US

He studied chemistry and physics.

He was offered a by Barany (he dismissed because of the hard Swedish winters). He went to Harvard and the Hawaii.

He was able to observe that the basilar membrane moves like a surface wave when stimulated by sound.

The placement of each sensory cell (hair cell) along the coil of the cochlea corresponds to a specific frequency of sound (the so-called tonotopy).

1961: Nobel Prize for discovering the physical mechanism that occurs in stimulating the cochlea.

Békésy audiometer operated by the patient.

Georg von Békésy

1899-1972Budapest, Hungary

He developed and invented the Cochlear implant. Dentist He earned a medical degree from the University of

Southern California after two years in the US Navy. 1946 he co-founded The House Ear Institute with

his older half brother, Howard House (physician, otologist)

1961: First cochlear implantation. Unsuccessful because it was rejected by the patient's body.

1969: Successfully implanted longer lasting model.

William P. House

1923 – 2012Kansas City, US 

Hardvard Medicine School. ENT in "Massachusetts Eye and

Ear Infirmary" en Boston 1956: He performed the first successful reconstructive

stapedectomy. Removed the stapes, covered the oval window with a vein graft

and inserted a prosthesis to replace the diseased stapes bone. The patient’s hearing was restored and she heard well for long

time.

He has pioneered numerous techniques in the treatment of hearing loss and dizziness, developed many instruments and prostheses.

Performed > 40,000 stapedectomies, (> 90% success rate) His technique, perhaps with some modifications, is still

practiced worldwide.

John J. Shea, Jr.

1924 –2015Memphis, Tennessee

Thanks!