150 years ago: Schwartze's 1873 mastoidectomy and its implementation over the following 2 years.

BACKGROUND: In 1873, Hermann Schwartze and Adolf Eysell described a new surgical technique for treating mastoid disease using a mallet, chisels, and gouges of various sizes instead of trephines or drill instruments also called "modern mastoidectomy." On the 150th jubilee of this landmark article, we pay tribute by studying the reception and implementation of mastoidectomy in the 2 years following its publication. METHODS: The commentaries published in the otological and medical literature between the second part of 1873 to the end of 1875 were studied with an emphasis on the three specialized otological journals and the otological textbooks that existed during this period. RESULTS AND CONCLUSION: The princeps paper Ueber die künstliche Eröffnung des Warzenfortsatzes ("On the artificial opening of the mastoid process") by Hermann Schwartze and Adolf Eysell published in 1873 was rapidly disseminated in the medical literature for nearly 1 year, and then entered a phase of evaluation followed by a phase of extension and implementation, before finding its definitive place in the history of mastoid process surgery.

Fascia Temporalis as Tympanic Graft: A Swedish and German Story.

Fascia temporalis is the most widely used graft for reconstruction of the tympanic membrane. Its story began at the turn of the 1960s. Some historical reports credit the American otolaryngologist Lloyd A. Storrs (1922-1989), to be the first user of this material in tympanoplasty in 1961. In fact, this is not quite exact. Based only on primary sources, this study demonstrates that Urban Örtegren (1921-1991), a Swedish otolaryngologist in Lund, began using fascia temporalis to reconstruct the tympanic membrane already in 1957. He was followed by Hans Heermann (1900-1996), a German otologist of Essen in 1958. Fascia temporalis as a tympanic graft is thus a Swedish and German story.

Neurocutaneous syndromes in art and antiquities.

Neurocutaneous syndromes are a group of genetic disorders affecting the skin, the central and peripheral nervous system, and the eye with congenital abnormalities and/or tumors. Manifestations may also involve the heart, vessels, lungs, kidneys, endocrine glands and bones. When people with these disorders are portrayed in works of art, physicians have speculated on possible diagnoses. In particular, many figures have been labeled as possibly having a neurocutaneous disorder, sometimes distorting the popular conception of these diseases. We review numerous documents, drawings, prints, lithographs, xylographs, and portraits which span the ages from antiquity to the era of the pioneers behind the eponyms, depicting a large spectrum of neurocutaneous disorders.

Otorhinolaryngology as "Made in Germany" since 1921: an international perspective.

In 2021, the German Society of Otorhinolaryngology, Head Neck Surgery celebrates the 100th anniversary of its foundation. The aim of this research is to present the main advances and innovations developed in Germany since 1921-as selected and studied from outside Germany, first in other languages and then in German, hence an international "Made in Germany"-that either directly or indirectly expanded or impacted the development of Otorhinolaryngology (ORL). This gives an unusual but extremely interesting perspective on the history of ORL in Germany. However, events that are too recent to have already entered into the history of ORL are not discussed, not least due to the often huge difficulties in actually identifying the main protagonists. In all, 11 landmarks regarded to be "Made in Germany" and which have had a major impact on the development of ORL since 1921 are presented. Some of these are well known, some not, but their importance must not be underestimated. They are presented here in chronological and specific sections: 1. Indisputable glasses to observe nystagmus; 2. Most monumental ORL encyclopedia ever published; 3. Histology of the inner ear is efficient; 4. Introduction of antibiotics to treat ORL infections; 5. Color atlas of ORL pathologies as support for teaching; 6. Tympanoplasty concept revolutionizes surgery of the ear; 7. Zeiss operating ear microscope broadens the surgical field; 8. Microlaryngoscopy suspension technique defines a new era in laryngeal surgery; 9. Septum resection becomes septum correction; 10. Karl Storz nasal endoscope opens up new surgical techniques; 11. The history of ORL must belong to ORL. This research demonstrates that Germany played a major role in and has had a profound impact on advances in ORL since 1921, a real otorhinolaryngological "Made in Germany."

History of otorhinolaryngology in Germany before 1921.

In 2021, the German Society of Otorhinolaryngology, Head and Neck Surgery is celebrating the 100th anniversary of its foundation. The aim of this article is to present the main inventions and progress made in Germany before 1921, the date the society was founded. Three chronological periods are discernible: the history of otorhinolaryngology (ORL) in Germany until the beginning of the 19th century, focusing mainly on the development of scattered knowledge; the birth of the sub-specialties otology, laryngology (pharyngo-laryngology and endoscopy), and rhinology in the 19th century, combining advances in knowledge and implementation of academic structures; and the creation of the ORL specialty at the turn of the 20th century, mainly concentrating on academic organization and expansion. This period was crucial and allowed for the foundation of the German Society of Otorhinolaryngology, Head and Neck Surgery on solid ground. Germany played an important role in the development and progress of ORL internationally in the 19th century with such great contributors as Anton von Tröltsch, Hermann Schwartze, Otto Körner, Rudolf Voltolini, and Gustav Killian to mention a few.

Otorhinolaryngologists nominated for the Nobel Prize 1901-1940.

PURPOSE: Several scholars with links to ENT have received the Nobel Prize in physiology or medicine. This overview takes into account ENT Nobel nominees, who never received the award. METHODS: Drawing a comparison on the nominations collected in the archive of the Nobel Committee for physiology or medicine in Stockholm, the Nobel archive database and secondary literature; the paper analyzes for the first time the nominations of Hans Schmid (Stettin), Hermann Gutzmann (Berlin), Karl Wittmaack (Hamburg), and Chevalier Jackson (Chicago). We also bring up nomination letters written by prominent German nominators such as Hermann Schwartze (one of the founders of this journal) and August Lucae. RESULTS: Hans Schmid was the first surgeon to be brought up in a Nobel Prize nomination for an ENT procedure (1901), but since he had passed away 5 years earlier he was not evaluated by the Nobel Committee. Hermann Gutzmann was a strong candidate in 1917 and reached the shortlist because of his pioneering work on stutter, but no Nobel Prize in physiology or medicine was awarded that year. In the 1930's, both Karl Wittmaack and Chevalier Jackson were repeatedly nominated for ENT research. CONCLUSION: Nobel Prize nominations are to date underused sources that shed new light on some scholars in ENT history.

Some unpublished documents and unusual portraits of Anton von Tröltsch (1828-1890), one of the founders of this journal.

Anton Friedrich Baron von Tröltsch (1829-1890) was a very famous German otologist in Würzburg in the second part of the 19th century. The aim of this study is to present some unpublished documents related to his biography: a 4-page autobiographical unsigned text probably written for his habilitation in 1861, a 4-page autobiographical letter sent by von Tröltsch to the editors of the Brockhaus-Conversations-Lexikon in 1872, a unique album of portraits of the main otologists of the second part of the 19th century, collected for his 1886 Privat Docent jubilee anniversary, and a portrait of unknown origin. They are discussed with other unusual portraits. These new documents demonstrate at least two major points. One, von Tröltsch was aware of his qualities and the importance of his work in otology but he was not boastful. Two, he was really loved and respected by its colleagues, nearly 150 of them came just for a one-day ovation in Würzburg for his 25th Privat Docent Jubilee and his retirement from his otological practice. Von Tröltsch was and remains an example for all otologists.

What generated the creation of the Archiv für Ohrenheilkunde, the predecessor of this journal, 150 years ago?

At the beginning of 1864, von Tröltsch in Würzburg, Politzer in Vienna, and Schwartze in Halle, published the Archiv für Ohrenheilkunde, the first scientific journal devoted entirely to the diseases of the ear. As a very few details exist about the creation of this journal, three different contextual and influential aspects were studied to understand the generation of this journal: the means to transmit medical knowledge and the respective place of specialized medical journals; the concept of medical specialty and the establishment of otology as a specialty; and the level of otological knowledge and the need to have its proper journal. This research allows one to demonstrate that the creation of the Archiv für Ohrenheilkunde in 1864 arrived at the right historical moment. The timing was contextually appropriate in the general history of medicine and the favorable movement to the creation of medical specialties and specialized journals. It was not an event linked to hazard, but correlated with, first the vacant place laid for a specialized journal in otology, second, otology was almost established but still not recognized as a specialty and third otological knowledge was sufficiently broad to necessitate publishing its progress in its own specialized journal.

The Archiv für Ohrenheilkunde (Archive of Otology): a structural analysis of the first 50 years (1864-1914).

In 1864, Anton von Tröltsch in Würzburg, Hermann Schwartze in Halle/Saale, and Adam Politzer in Vienna founded the Archiv für Ohrenheilkunde (Archive of Otology), the ancestor of the European Archives of Oto-Rhino-Laryngology and Head and Neck. It was the world's first journal solely devoted to otology, and thus to otorhinolaryngology. The aim of this study was to analyse the structure of this journal and its contents during the first 50 years of its publication, until it definitively became an otorhinolaryngological journal in 1915. A total of 2,271 articles were registered during this time. They were classified according to content topic, article type, and the number of figures and graphs that they contained. Almost three-quarters of the articles were related to purely otological topics, as implied by the journal's title. Until the turn of the twentieth century, the majority of the articles were original papers or case reports. The number of original papers declined over the decades in favour of case reports. One-third of each volume usually consisted of a vast variety of items, such as congress announcements, conference proceedings, and book reviews. The journal also maintained a wide variety of scientific and current social and political subjects. Otological reviews and conference proceedings were key landmarks of the journal. All of these various papers provided an overview of the historical organisation and development of otology between 1864 and 1914. At that time, the Archiv für Ohrenheilkunde was a leading national and international journal.

[Short introduction to the history of otorhinolaryngology and craniofacial surgery]. / Petite introduction à 'histoire de l'otorhinolaryngologie et chirurgie cervico-faciale (ORL).

OHNS is a medical specialty born at the end of the 19th century. It is the congruence of otology and laryngology, rapidly associated with rhinology. It went through three chronological steps: construction in the second part of the 19th century, consolidation in the first part of 20th century and extension in the second part of the 20th and beginning of the 21st century. Scientifically, OHNS was set out into five partially layered phases: bedside teaching, introduction of anatomopathology, invention of clinic experiments, expansion of surgery, and use of highly technological advances. The increase of knowledge became progressively exponential due to concomitant progress. It lead to a renewal of the subdivision of the specialty into otology, rhinology, laryngology, head and neck surgery, pediatric OHNS, otoneurology, facioplastic surgery, and phoniatry in the last decades of the 20th century.

Targeted treatment of cancer with radiofrequency electromagnetic fields amplitude-modulated at tumor-specific frequencies.

In the past century, there have been many attempts to treat cancer with low levels of electric and magnetic fields. We have developed noninvasive biofeedback examination devices and techniques and discovered that patients with the same tumor type exhibit biofeedback responses to the same, precise frequencies. Intrabuccal administration of 27.12 MHz radiofrequency (RF) electromagnetic fields (EMF), which are amplitude-modulated at tumor-specific frequencies, results in long-term objective responses in patients with cancer and is not associated with any significant adverse effects. Intrabuccal administration allows for therapeutic delivery of very low and safe levels of EMF throughout the body as exemplified by responses observed in the femur, liver, adrenal glands, and lungs. In vitro studies have demonstrated that tumor-specific frequencies identified in patients with various forms of cancer are capable of blocking the growth of tumor cells in a tissue- and tumor-specific fashion. Current experimental evidence suggests that tumor-specific modulation frequencies regulate the expression of genes involved in migration and invasion and disrupt the mitotic spindle. This novel targeted treatment approach is emerging as an appealing therapeutic option for patients with advanced cancer given its excellent tolerability. Dissection of the molecular mechanisms accounting for the anti-cancer effects of tumor-specific modulation frequencies is likely to lead to the discovery of novel pathways in cancer.

Bell's Palsy and Its Semantic Change over Time.

BACKGROUND: From 1821 to 1829, Sir Charles Bell presented cases of facial paralysis from infection, trauma, and unknown causes. As such, "Bell's palsy" initially referred to facial palsy of any etiology. Today, the term is reserved for idiopathic peripheral facial palsy. The objectives of this analysis were to establish when the eponym came to vogue and delineate the semantic shift from its original definition to its current one. METHODS: Extensive review of available 19th and 20th century literature mentioning "Bell's palsy" and "Bell's paralysis." RESULTS: Historical accounts have eponymously attached Bell's name to facial paralysis as early as the 1840s-Bell's palsy was first used to describe cases of facial palsy of any cause. In 1886, Gowers characterized Bell's palsy as a "neuritis usually within the Fallopian Canal," distinguishing it as a separate etiology. Over the next decades, the definition narrowed to peripheral facial paralysis from cold exposure or unknown causes. By the 1940s, its natural history was well described-an acute, unilateral, idiopathic, and usually self-limited peripheral facial palsy. CONCLUSION: The semantic change of a word over time can tell us a remarkable story of its history and origins. Absence of a discrete lesion, lack of proven treatment, and good prognosis without intervention distinguished Bell's palsy from other causes of facial paralysis. Over time, the definition has narrowed from a facial palsy of any cause to an idiopathic peripheral facial palsy. Recent evidence supporting Bell's palsy as a viral mononeuritis may have driven its recent semantic change toward this specific etiology.

Is the promontory a promising site to diagnose otitis media in paleopathology? A search for evidence.

OBJECTIVE: The promontory of the middle ear was recently suggested to be an appropriate site for diagnosing otitis media (OM) in archaeological bones by endoscopic inspection. The present study scrutinized the underlying assumption that a bulgy, irregular promontorial surface represents a pathological condition. MATERIALS: We compared an allegedly healthy individual and an allegedly diseased individual in skeletal remains of two human individuals from the early Medieval period in Germany. METHODS: The specimens were studied using microscopic analyses of thin ground sections. RESULTS: The osseous architecture of the three-layered promontorial wall was the same in both specimens. Both the contour of the resorption front of the middle layer and the thickness of the overlying outer periosteal layer showed some variation, resulting in an either smooth or a bulgy promontorial surface, while signs of resorptive or proliferative changes at the periosteal surface were missing in both cases. CONCLUSIONS: Our results suggest that an irregular promontorial surface represents normal variation in the development of the otic capsule rather than a pathological condition. We therefore conclude that the promontory is not an appropriate site for diagnosing OM in archaeological bone. SIGNIFICANCE: The study contributes to evidence-based diagnoses in paleo-otological studies. Our assumption is in line with clinical and experimental findings indicating that the otic capsule is protected against bone remodeling. LIMITATIONS: Only two specimens were studied. SUGGESTIONS FOR FURTHER RESEARCH: SEM-studies to detect more subtle changes to the promontorial surface.

Hajek and Hirsch: Otolaryngology Pioneers of Endonasal Transsphenoidal Pituitary Surgery.

OBJECTIVE: To evaluate the historical descriptive origins of the extracranial transnasal transsphenoidal route to the sphenoid sinus and sella turcica focusing on the works of two otolaryngologists: Markus Hajek (1861-1941) and Oskar Hirsch (1877-1965). DATA SOURCES: A collection of primary references of author publications, and contemporary references and textbooks. REVIEW METHODS: Primary references were reviewed with specific focus on surgical routes to the sphenoid sinus and sella turcica. Chronology was cross-referenced with contemporary publications by contemporaries. Translations from German were conducted by author AM when necessary. RESULTS: Markus Hajek elegantly described the surgical approach to the posterior ethmoids and sphenoid sinus in 1904 using a transnasal route. Building on this foundation, Oskar Hirsch described the fully extracranial endonasal transethmoid transsphenoidal approach in 1909. He was first to describe surgical entrance to the sella using this exclusively unilateral endonasal route, which he demonstrated on a cadaver. He reports performing this procedure on a live patient in April, 1910, under local anesthesia in stages over 5 weeks. For better exposure, Hirsch consolidated his method with Killian's submucosal window resection of the posterior nasal septum allowing for bilateral access to the sphenoid sinus and sella, and completed a single stage procedure on a patient in June 1910. CONCLUSION: Oskar Hirsch was the first to describe and perform a stepwise surgical approach to the sella using an exclusively extracranial, endonasal, transethmoid, and transsphenoidal approach. He built upon his mentor Markus Hajek's approaches to the posterior ethmoid cells and sphenoid sinus. LEVEL OF EVIDENCE: NA: Background information, synthesis from multiple sources emphasizing factual information Laryngoscope, 133:807-813, 2023.

Tympanoplasty Before Tympanoplasty: Alea Jacta Erat!

OBJECTIVES: Tympanoplasty is the most common ear surgery performed throughout the world. As its basic principles remain the same since its introduction, many publications usually explain, in the introduction, that tympanoplasty has been a successful technique since the 1950s. The aim of this historical notice is to go back to the origin of the word tympanoplasty, and its final introduction as a specific defined surgical concept. MATERIAL AND METHOD: Historical study based solely on original publications in different languages. RESULTS: The term tympanoplasty was first used by Hirch in 1912 for an operation for chronic adhesive catarrh of the middle ear. It was revived by Wullstein in 1952. One Polish, Miodonski, and three German otologists played an important role in the development of the actual concept and definition of tympanoplasty: Moritz, Zöllner and Wullstein, the two latter being recognized as worldwide dispensers of the technique. CONCLUSION: The history of the term tympanoplasty can be divided into two periods: the first being 1912 to 1913 with its first use for an operation to treat chronic adhesive catarrh of the middle ear, and the second 1952 to 1955, with its revival and definitive implementation in the surgery of the ear based on the concept of protection of the round window and construction of an effective sound-transmitter system through the oval window. Nevertheless, the concept of tympanoplasty was already established in 1950 but not surgically definitively implemented: alea jacta erat-the die was cast!

Jean Riolan the Younger (1580 - 1657) and the Trepanation of the Mastoid Process: More Than a Suggestion?

INTRODUCTION: The Parisian anatomist Jean Riolan the Younger (1580 - 1657) is usually associated with the first proposal to surgically open the mastoid for certain ear pathologies with varying degrees of accuracy. The purpose of this historical research is to go back to the original texts and try to understand what probably prompted Riolan the Younger to suggest the surgical opening of the mastoid, thus paying him the correct tribute and restoring him to his rightful place in the history of mastoid surgery. METHODOLOGY: Review of the published secondary literature on the history of the surgical opening of the mastoid, completed by a detailed study of most of the original works written by Riolan the Younger. RESULTS: The study of Riolan the Younger's original texts shows that he suggested the perforation of the mastoid process for three different clinical situations: whistling in the ear, deafness at birth, and deafness related to a blockage of the eustachian tube. These three suggestions were made between 1629 and 1649. No one before him had made such suggestions. This study also shows that Riolan the Younger did not propose to open the mastoid process in case of ear infection. CONCLUSION: Riolan the Younger must be considered as the true initiator of this surgery and thus must take its proper place in any history of surgical opening of the mastoid.

Centenary memorabilia of Adam Politzer.

Adam Politzer (1835-1920) was one of the greatest otologists of all time. On the 100th Anniversary of his death, this paper pays tribute to his legacy to our specialty and examines various memorabilia made during those hundred years in his honour. Items as diverse as book plates, postage stamps and postcards stand alongside commemorative medals, busts and plaques, all bearing witness to his legendary status and contribution to our specialty.