Tracing the Origins of "Cauliflower Ear" and Its Earlier Names over Two Millenia.

OBJECTIVES: The post-traumatic ear deformity, known today as cauliflower ear, has been described since antiquity. It has long been associated with pugilistic sports (wrestling, boxing) as well as among the mentally ill. The aim of this study is to present the various terms used since antiquity to describe these traumatic deformations of the auricle and to trace the origin of the modern moniker "cauliflower ear." METHODS: Historical study, only based on original documentation accessed through personal libraries and universities repositories, completed with online sources and etymological dictionaries. RESULTS: We were able to identify no fewer than 39 names for the deformity. The term cauliflower ear is of relatively recent origin. It was coined in the first decade of the 20th century, initially in the popular press and subsequently adopted by the medical profession. CONCLUSION: Ironically, the deformity has only superficial resemblance to a cauliflower. The vegetable, which is part of the cabbage family, has a symmetrical and highly ordered fractal geometry with well-circumscribed excrescences. Cauliflower ear, by contrast, notably lacks symmetry and its rounded protuberances flow into one another. Although somewhat a misnomer, the term is deeply rooted in both popular and medical culture. LEVEL OF EVIDENCE: N/A Laryngoscope, 131:E1315-E1321, 2021.

Water-related occupations and diet in two Roman coastal communities (Italy, first to third century AD): correlation between stable carbon and nitrogen isotope values and auricular exostosis prevalence.

The reconstruction of dietary patterns in the two Roman imperial age coastal communities of Portus and Velia (I-III AD) by means of stable isotope analysis of bone remains has exposed a certain degree of heterogeneity between and within the two samples. Results do not correlate with any discernible mortuary practices at either site, which might have pointed to differential social status. The present study tests the hypothesis of a possible connection between dietary habits and occupational activities in the two communities. Among skeletal markers of occupation, external auricular exostosis (EAE) has proved to be very informative. Clinical and retrospective epidemiological surveys have revealed a strong positive correlation between EAE development and habitual exposure to cold water. In this study, we show that there is a high rate of occurrence of EAE among adult males in both skeletal samples (21.1% in Portus and 35.3% in Velia). Further, there is a statistically significant higher prevalence of EAE among those individuals at Velia with very high nitrogen isotopic values. This points to fishing (coastal, low-water fishing) as the sea-related occupation most responsible for the onset of the ear pathology. For Portus, where the consumption of foods from sea and river seems to be more widespread through the population, and where the scenario of seaport and fluvial activities was much more complex than in Velia, a close correlation between EAE and fish consumption by fishermen is less easy to establish.

[Joseph Toynbee--otologist, scientist, philanthropist]. / Joseph Toynbee--otolog, naukowiec, filantrop.

Joseph Tonbee's life's work may be summarized in the words of William Wilde: "The labours and investigations of Mr. Toynbee have affected more for aural pathology than those of all his predecessors either in England or on the continent". Some idea of the extent of his researches is given by the fact that he dissected some 2.000 ears. These preparations formed the Toynbee Collection in the Museum of the Royal College of Surgeons of England. He wrote the results of his researches in a catalogue that includes the description of 1,659 human ears. This catalogue forms the basis of modern otology for all time. This purely pathological catalogue was completed in 1860 with the publication of a more clinical book, "The Diseases of the Ear: their Nature, Diagnosis and Treatment". Toynbee appears to have been the first to describe the pathological changes in otosclerosis. In his book "Diseases of the Ear" he described the condition clearly, recognizing "anchylosis of the stapes to the fenestra ovalis" in 136 temporal bones. He also aligned the subjective, visual and ausculatory tests for Eustacchian tubal patency which we use today. Adam Politzer wrote: "Toynbee was the first who realized in otology that therapeutic progress depends on the knowledge of anatomy". But Toynbee was also active on other fields. Politzer, in his lecture in Vienna in 1914 said: "Toynbee was as outstanding a savant as he was a philanthropist. In addition to his scientific activity, he considered it a sacred task to dedicate his spare time to the improvement of living and health conditions of the poorer classes." Tragic enough, Toynbee's zeal for clinical experimentation went too far. Seeking to help his patients by devising a treatment to allay their tinnitus, he conceived the idea of introducing a mixture of chloroform and prussic acid into the tympanic cavity by means of Valsalva maneuver. When he made the first trial on July 7, 1866, with himself as a subject, he was found dead on the couch in his consulting room.

[Wladyslaw Sciborowski (1833-1903) and Otorhinolaryngology]. / Wladyslaw Sciborowski (1833-1903) a Otolaryngologia.

The professional and scientific activities of Wladyslaw Sciborowski (1833-1903), an eminent Varsovian physician at the St. Alexander Hospital in Wilanów, a doctor of forensic medicine in Cracow and balneologist in Szczawnica are shortly outlined. He was a person actively engaged in works of Cracovian Medical Society especially his Balneological Committee. Sciborowski's successful treatment of many otorhinolaryngological diseases published at "Medical Weekly" ("Tygodnik Lekarski") are described in some more detail. His article on rhinolaryngological instruments was very interesting. The achievements of Wladyslaw Sciborowski were a valuable source of information for the physicians specializing in otorhinolaryngology.

[The tempestuous history of middle ear operation]. / Burzliwa historia operacji ucha srodkowego.

The paper is a review of primary and secondary historical and scientific literature concerning the surgical treatment of the middle ear diseases. The development of mastoid surgery can be traced through the past 4 centuries. Once used as a means of evacuating a postauricular abscess, it has evolved to become a method for gaining entry into the middle ear to control acute and chronic ear diseases, or for treatment of otogenic complications. Earlier works led the way to the postauricular "Wilde incision", which gave rise to Schwartze mastoidectomy. Oscar Wilde's ultimate demise from an otogenic meningitis appears all the more ironic when one considers the role his father, Sir William Wilde, played as one of the founding fathers of modern otology. The death of baron von Berger after mastoidectomy performed for treatment of tinnitus and hypacusis, stopped the further development of surgical procedures for about hundred years. The Joseph Toynbee's "Diseases of the ear" was the first work about ear diseases on a pathologic anatomical base, and fundamental for otology of the German speaking countries in the nineteenth and early twentieth centuries. Otology was emerging as a specific specialty. Von Tröltsch was the first surgeon, who proposed the antral opening through the external ear canal. When Schwartze and his assistant, Eysell, published their paper: "On the Artificial Opening of the Mastoid Air Cells," a century or so had passed since the few previous attempts to remove the tegmen of the mastoid had been reported. One of the greatest otologists of the 19th century was Adam Politzer, His influence on the 50 years of otology has never been equaled. It is in his honor that the International Society of Otology bears his name.

[What Edmund Modrzejewski (1849-1893) contributed to the Polish otiatrics?]. / Co Edmund Modrzejewski (1849-1893) wniósl nowego do polskiej otiatrii?

The professional and scientific activities in the area of otiatrics of Edmund Modrzejewski (1849-1893) are presented. Modrzejewski's education in otology in Vienna and other places is strongly pointed out. His achievements in the treatment of many diseases of the ear are depicted. Modrzejewski is shown as a one of the pioneer of treatment of deaf-mutism in Polish territories. His publishing activity is also depicted.

Ossicular calisthenics: Pneumomassage of the tympanic membrane.

OBJECTIVES/HYPOTHESIS: Throughout the latter portion of the 19th and early 20th centuries, pneumomassage devices were widely used by otologists to treat a variety of ear diseases. The so-called eardrum massagers produced a regular, repetitive, oscillatory movement through modifying the air pressure in the ear canal. The goal of this study was to trace the invention, clinical use, technological diversification, abandonment, and ultimate resurrection of tympanic pneumomassage. METHOD: Review of the 19th- and early 20th-century medical journals, texts, and trade catalogs concerning the tympanic pneumomassage. RESULTS: In 1884, the Belgian otologist Charles Delstanche introduced what he called a rarefacteur, and 5 years later he introduced the masseur du tympan. This lead to a frenzied development of imaginative mechanical and electrical pneumassagers with a goal to exercise the tympanic membrane and ossicles to overcome contraction and rigidity. Tympanic pneumomassage rose to prominence in mainstream otology as a treatment for otitis media, chronic deafness, and tinnitus. After gradually fading out of the otological practice by the 1930s, pneumomassage was reintroduced in the 1980s after a half century of obscurity, this time as a novel invention notably for the treatment of Menière's disease. CONCLUSION: The golden era of pneumomassage illustrates the ingenuity of otologists and medical instrument makers in creating a proliferation of clever devices, as well as how highly touted treatment methods may become widely adopted by practitioners despite the lack of efficacy. It also noteworthy that historic therapeutic methods are sometimes reintroduced for purposes not envisioned by their original makers. LEVEL OF EVIDENCE: N/A. Laryngoscope, 126:1180-1186, 2016.

Sir Charles Alfred Ballance: contributions to otology and neurotology.

STUDY DESIGN: A review of primary and secondary historical and scientific literature concerning the life and writings of Sir Charles Alfred Ballance (1856-1936). RESULTS: Sir Charles Alfred Ballance was a pioneer in otology and neurotology, responsible for many "firsts" in the field, including the complete removal of a cerebellopontine angle tumor with significant patient survival and grafting the mastoid cavity with epithelium to speed healing. He was a strict abdicator of the complete mastoid operation with ligature of the jugular vein and drainage of the lateral sinus, and he advanced many other neurotologic procedures during his lifetime. He successfully sectioned the VIIIth cranial nerve, relieving a patient from intractable vertigo, developed a meticulous system for treating the complications of suppurative infections of the mastoid, diligently studied facial nerve reanastomosis, and was the first to perform a spinal accessory to facial nerve anastomosis for the relief of facial palsy. Ballance published over 75 original articles and was the primary author on two landmark books concerning temporal bone and neurologic surgery. He was the leader of many surgical societies and maintained a life of research and science until his death. CONCLUSION: Sir Charles Ballance was a pioneer in neurotologic and skull base surgery and greatly advanced the field during its inception. This work focuses on the otologic and neurotologic endeavors of Sir Charles Alfred Ballance, bringing his accomplishments into modern relief.

The operation and death of Henry Schliemann.

Henry Schliemann's reputation as an archeologist, a linquist, a financial genius and a scholar is seldom recognized by Americans. His discovery of the ruins of Troy changed Homeric myths and legends into history and made him the founder of Aegean archeology. Recent popular books on Schliemann sketchily describe him otologic problems which eventually led to his death of an otogenic brain abscess. From a number of bibliographic sources, the details of Schliemann's ear history and the final months of his illness are recounted. The important information of Schliemann's ear operation by the famous Professor Swartze is presented.

The paleopathology of an Aleutian mummy.

A multidisciplinary team examined an Aleutian mummy from the collection of the Peabody Museum of Archeology and Ethnology of Harvard University, Cambridge, Mass. The mummy, dating from the early 18th century, was of a middle-aged woman who had suffered from pulmonary and ear infections, atherosclerosis, pediculosis, and degenerative joint disease. Another finding was anthracosis, common in ancient bodies and related to indoor heating and cooking fires. Skeletal lead was not found, in contrast with the high levels seen in modern persons. No neoplasms were identified, again consistent with the results of previous studies of ancient human remains. Such comparisons of ancient and modern morbidity and mortality provide a historical perspective on the evolution and cause of human disease.

A translation of: The scientific progress of otology in the past decennium (until late 1862) by Hermann Schwartze: pathology and therapy of the external ear.

In 1863, Anton von Tröltsch, Adam Politzer, and Hermann Schwartze began the first journal dedicated solely to disorders of the ear, Archiv für Ohrenheilkund (Archives of Otology). In the inaugural edition, Hermann Schwartze, the youngest of the three, took on the responsibility for summarizing all the prevailing advances in otology recorded in the previous 10 years leading up to its publication. This work represents a concise summary of all major advances and theories regarding diseases of the ear circa 1863, providing a valuable window on the practice of otology during its inception as an independent subspecialty. In this first of an anticipated two-part article, we provide a translation of what is perhaps the most interesting portion: pathology and therapy of the outer ear and middle ears. The second part of the manuscript will translate the pathology and treatment of inner ear disorders. It is hoped that this work will spark contemporary otologists not only to reflect how far we have come as a subspecialty but also to reflect what we still must accomplish as physicians and scientists.

Otology through the ages.

Recounted are some, not all, of the most significant contributions to otology. The history of otology has, for the most part, followed the history of medicine: Little was known of otology by the ancient physicians, but their work must be reviewed to appreciate the progress that has been made. Most of the otology produced during the Middle Ages was limited to those structures that were readily accessible; otologic surgery was confined to trauma and removal of foreign bodies from the external auditory canals. Examination of the ear began after studies of the ear by Italian anatomists during the seventeenth century. It was not until the end of the eighteenth century that magnification was used so that the minute anatomic details could be observed. The clinical specialty of otology started in France (1850s), emerged as a scientific specialty in England, and received explosive progress from the German-speaking countries at the end of the nineteenth century. Otology has a remarkable background.

William Wright, aurist: nineteenth century pneumatic practitioner and a discoverer of anesthesia.

William Wright (1773-1860) was Surgeon-Aurist in Ordinary to Her Majesty Queen Charlotte of England. One interesting feature of his otologic practice was his employment of gases and vapors in treating deafness and other disorders of the ear. Among aeroform substances that he advocated for such uses were nitrous oxide and ether--gases that were destined to become anesthetic agents in another quarter of a century. Wright made the observation that inhalation of ether vapor would suppress the cough elicited by instrumentation of an inflamed and sensitive ear canal. He used ether inhalation beginning about 1820 in his practice for this purpose, and in so doing appears to have administered some of the earliest anesthetics on record.

Jaws revisited: Costen's syndrome.

Although James Costen was not the first to ascribe ear pain, tinnitus, impaired hearing, and even dizziness to temporomandibular joint dysfunction, he developed an integrated and systematic approach ascribing the symptoms to dental malocclusion. He wrote extensively on it, and a few years after his original article, the term Costen's syndrome came into general use. Recently, the use of the eponym has decreased, as dental malocclusion has assumed a lesser role in explaining many of the symptoms formerly ascribed to it.

The history of intratympanic drug therapy in otology.

The application of drugs through the eardrum and into the middle ear to treat various otologic disorders has recently gained wide-spread popularity. Despite the relatively recent interest in this technique, if one considers any application of medication into the middle ear as intratympanic therapy, the roots of this method can really be considered to date back to antiquity. This article presents the development of intratympanic drug therapy from early times through the nineteenth century.

Joseph Toynbee and his son Arnold: unpublished manuscript written by Adam Politzer.

In 1914, Adam Politzer (1835-1920) was invited to the Viennese Toynbee Hall to give a lecture. To prepare for his lecture, Politzer wrote a manuscript of 22 pages, seven of them are particularly interesting concerning biographical information on Joseph and Arnold Toynbee. These seven pages are presented in translation from German to English. Politzer particularly emphasizes the social qualities of these two men. This manuscript is representative of his high regard for Joseph and Arnold Toynbee. It completes the few existing biographies of Joseph Toynbee.

Clinical otosclerosis and auditory exostoses in ancient Europeans (investigation of Lithuanian paleoosteological samples).

The purpose of this investigation was to establish the incidence of clinical otosclerosis and auditory exostoses in Lithuanian paleopopulations. The total sample consists of 4080 skulls, dating from the Neolithic to the C17th-C18th A.D., investigated visually, under magnification and radiologically. Eight cases of clinical otosclerosis and 22 of auditory exostoses were identified. The general epidemiology of otosclerosis (0.19 +/- 0.08 per cent) was established to be similar to contemporary populations. This suggests that there are no new aetiological factors attributable to our modern society. Clear diminution of the incidence of auditory exostoses from the 1st to the 2nd millenium A.D. (3.46 +/- 0.76 per cent, against 0.06 +/- 0.04 per cent, p < 0.001) and definite sexual differences (males: 1.21 +/- 0.28 per cent; females: 0.17 +/- 0.10 per cent, p < 0.001) were also noted. In general, auditory exostoses were found much more frequently than in recent populations.

Otology in the Bible and Talmud.

The present paper is an English translation of the chapter of Otology in Preuss's classic book Biblisch-Talmudische Medizin. Described in the Talmud are a variety of anatomical ear abnormalities such as double ear, pierced ears, small ears, cut off ears, and pendulous ears. A slave whose ear was wounded had to be freed. Compensation for injury to the ear and to hearing is clearly noted. Remedies for earache are mentioned. The legal status of a deaf-mute, and the relationship of deafness to muteness are also discussed in the Talmud.

[Guichard Joseph Duverney (1648-1730), first French otologist in the 17th century]. / Guichard Joseph Duverney, premier otologiste français au XVIIe siècle.

PURPOSE OF STUDY: Study and understand the role of Guichard Joseph Duverney in the history of French otology. METHOD: Study of the different works and articles published about him, linked with reading his principal writings. RESULTS: Duverney published one of the first complete works on otology titled Traité de l'organe de l'ouïe (Treatise of the organ of hearing) in 1683. Following a first part containing numerous new notions of anatomy, Duverney developed in the second part a theory of hearing very similar to that of von Helmholtz. In the third part, he finally cover several pathologies of the ear without great innovation. Translated into many languages, this book became the book of reference for all the otologists of the 17th and 18th centuries. CONCLUSION: Duverney is rightly considered to be the first French otologist of the 17th century and also, as certainly one of the first European otologists.