A Biographical Journey Through the History of Ear Reconstruction.

This historical literature review of ear reconstruction differs from much of the published literature in that it focuses on the biographies of the innovators and evangelists of ear reconstruction rather than specific techniques. A biographical account of ear reconstruction demonstrates the importance of surgeons as artists, scientists, technicians, politicians, and most importantly carers of this special and fascinating group of patients who benefit from this technically challenging form of reconstruction.

Georg von Békésy and Bruce Mer: Early Pioneers of Endoscopic Ear Surgery.

The binocular operative microscope has been the workhorse of otologic and neurotologic surgeons since the 1950s. Since its advent, however, surgeons recognized that the operative microscope could not "look around corners" and its line-of-sight technology required soft tissue and bony dissection to enable light to reach the surgical plane. Endoscopic technology has evolved to address many of the limitations of operative microscopy. While the endoscope is often viewed as a recent development in otologic surgery, in the following historical article, we highlight the contributions of two mid-20th century pioneers of endoscopic ear surgery: Georg von Békésy and Bruce Mer. In the 1940s, Dr von Békésy envisioned an endoscope for determining stapes mobility. Dr Mer, with a team of engineers, created an otoendoscope to perform some of the first endoscopic ear procedures in the 1960s. Lessons gleaned from von Békésy and Mer's research include the need for counterculture thinking and the challenges of pioneering ideas beyond technical capacity.

Gangliformis Intumescentia and Beyond: Antonio Scarpa and His Core Contribution to Neuroanatomy, Neurosurgery, and Otoneurosurgery.

Nearly 250 years ago, Antonio Scarpa became a professor of anatomy and surgery only 2 years after he graduated from the University of Padua. The young lecturer soon became one of the most renowned anatomists in Italy and a director of the Faculty of Medicine at the University of Pavia. He worked in the fields of general surgery and ophthalmology. Several anatomic structures have been named after him, mainly Scarpa fascia and Scarpa triangle. His interest in neuroanatomy was ardent, despite being occasionally neglected. Scarpa's contributions to the fields of neurosciences have been significant. He was the first to describe the round window and the secondary tympanic membrane, and he eventually focused on the auditory and olfactory organs. Notably, the vestibular ganglion is now known as Scarpa ganglion. Scarpa's magnum opus was the book Tabulae Neurologicae, in which he described the path of several cranial nerves including the vagus nerve and innervation of the heart. Since his death in 1832, Scarpa's head has been preserved at the University History Museum of the University of Pavia. In this historical vignette, we aim to describe Antonio Scarpa's troubled life and brilliant career, focusing on his core contributions to neuroanatomy, neurosurgery, and otoneurosurgery.

[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.

[Maurice Sourdille, otologist of Nantes, famous and unknown]. / Maurice Sourdille, otologiste nantais, célèbre et inconnu.

Fenestration was the first surgical operation to improve deaf persons affected by otosclerosis. Its story is on a par with Maurice Sourdille's. Not only this author had perfected this surgery even before the use of antibiotics and audiometry but he was a forerunner in the field of ear surgery and in medical otology.

[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.

Dorothy Wolff: A Pioneer in Otopathology.

Dorothy Wolff, PhD, was an inspirational anatomist, pathologist, auditory physiologist, and surgical innovator. Though little known, she worked throughout the mid-20th century in the midst of a revolution in otologic surgery, influencing well-known otologists such as Julius Lempert, MD, Phillip E. Meltzer, MD, and Richard Bellucci, MD. Wolff's seminal work included pathologic studies of the operated human ear, which provided the anatomic basis for effective modern techniques of surgical hearing rehabilitation. Wolff also developed and refined multiple animal models of otologic pathologies that are still in use today. As an independent, innovative, and ambitious scientist, Dorothy Wolff succeeded in pioneering surgical otopathology to the benefit of us all.

The aborted early history of the translabyrinthine approach: a victim of suppression or technical prematurity?

OBJECTIVE: To ascertain the reasons translabyrinthine (TL) approach to acoustic neuroma, initially attempted in 1911, became relegated to obscurity for nearly half a century. STUDY DESIGN: A scholarly review of more than 40 publications in German and English from the late 19th to the mid-20th century. LITERATURE SUMMARY: Surgeons who first contemplated approaching the cerebellopontine angle recognized that the shortest route from the surface was through the petrous bone. In the late 19th century, otologic surgeons devised numerous procedures to deal with infection in and around the semicircular canals. This familiarity led R. Panse of Dresden to propose (but not actually perform) a TL approach (1904). F.H. Quix of Utrecht performed the first pure TL approach (1911), but others before him had used petrosectomy to augment the suboccipital approach. Subsequent TL attempts by other surgeons met with variable results. Devastating criticism of the method was proffered by leading acoustic neuroma surgeons of the day such as H. Cushing (1921) and W. Dandy (1925). The most important criticisms were that the approach provided only a deep and narrow field of action, was surrounded by major vascular structures, and led to great difficulty with cerebrospinal fluid leakage. HISTORICAL PERSPECTIVE: The literature on this subject is replete with erroneous citations. Panse is often miscited as having performed the first surgery. It has also become traditional to give Quix great credit, even though his procedure failed to remove much of the tumor. Poor outcome and intense criticism led surgeons to abandon the TL approach until W.F. House, armed with operating microscope and high-speed drill, successfully resurrected it in the 1960s. He concisely summarizes the pioneers' efforts: "They had the ideas and desire, but not the technical tools."

Robert Froriep (1804-1861) and his seven otologic copperplate engravings: survey of otology at the beginning of the 19th century.

Robert Froriep published 487 Chirurgischen Kupfertafeln (surgical copperplate engravings). Seven of them, entitled Morbi aurium, are related to otology. They concern catheterization and injection of eustachian tube, surgery of the external auditory canal, anatomic relations of the different parts of the ear and perforation of the tympanic membrane, examination and cleaning of the external auditory canal, examination and perforation of the tympanic membrane, catheterization and injection of the eustachian tube, and again, injection through the eustachian tube. The aim of this study is to present these engravings and their correlations with the original related otologic publications. They provide a very good insight into the different instruments used in otology and their modifications in the first part of the 19th century.

Anesthesia, antisepsis, microscope: the confluence of neurotology.

Neurotology and skull base surgery slowly emerged out of a confluence of interrelated disciplines and technologies over the past century to become the field that we know today. Its formation required the marriage of neurosurgery and otology, the introduction of the operating microscope, and advances in surgical technique, anesthesia, and radiology. Along the way, the field also began involving specialists within ophthalmology and craniofacial and plastic and reconstructive surgery. Lastly, and perhaps most importantly, the formation of neurotology and skull base surgery required pioneering surgeons who were willing to push the boundaries of their training, sometimes under the ridicule or scorn of the medical establishment. This historical overview focuses upon the origins of the specialty, from the birth of otology and neurosurgery up through the last quarter century.

Lucae's Springy Pressure Probe to Mobilize the Ossicular Chain: Rise and Fall of an Ingenious Instrument.

OBJECTIVES/HYPOTHESES: In 1884, Johann Constantin August Lucae (1835-1911), a German otologist from Berlin, introduced a new "method to mechanically treat chronic troubles of the mobility of the hearing organ transmission apparatus." It consisted in the use of a springy pressure probe to directly mobilize the handle of the malleus. The aim of this study is to trace the invention, clinical use, technological modifications, and ultimate extinction of this instrument. METHOD: Review of Lucae's publications, comments by his colleagues, and trade catalogues published between 1880 and 1940. RESULTS: Lucae presented at least six different models of his springy pressure probe during his career. Some of his colleagues modified it. The success rate was much disputed, and the instrument died with Lucae. CONCLUSION: Lucae's spring pressure probe is another example of the ingenuity of man to try to find a solution when confronted with an unclear and unresolved otological problem.

Virtuosity with the Mallet and Gouge: the brilliant triumph of the "modern" mastoid operation.

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 for diagnostic purposes, to control chronic ear disease, or for otologic and neuro-otologic procedures. Earlier works led the way to the Wilde postauricular incision, which gave rise to Schwartze mastoidectomy. Stacke's technique of mastoidectomy was practiced for some time before Bondy, Heath, and Bryant introduced the modified radical mastoidectomy. By the 1930s, the mastoidectomy had evolved into a generally accepted otologic procedure. Endowed with a rich history, the future of mastoid surgery promises to be equally momentous.

The History and Evolution of Surgery on the Vestibular Labyrinth.

The history of surgery on the vestibular labyrinth is rich but sparsely documented in the literature. The story begins over a century ago with the labyrinthectomy in an era that consisted exclusively of ablative surgery for infection or vertigo. Improved understanding of vestibular physiology and pathology produced an era of selective ablation and hearing preservation that includes semicircular canal occlusion for benign paroxysmal positional vertigo. An era of restoration began with a discovery of superior semicircular canal dehiscence and its repair. The final era of vestibular replacement is upon us as the possibility of successful prosthetic vestibular implantation becomes reality.

Birth and Evolution of Chiselling and Drilling Techniques for Removing Ear Canal Exostoses.

The main surgical techniques used to remove ear canal exostoses are drilling and/or, chiselling. The aim of this study was to identify the origins and subsequent evolution of, the surgical removal of ear canal exostoses in the 19th century. A critical review and, compilation of primary and secondary historical sources was conducted. Two techniques for removal of exostoses were developed in the latter part of the 19th century and have largely remained unchanged. This demonstrates the importance of that era in the history of ear surgery.

[Galvanocautery in the 19th century otorhinolaryngology service]. / Galwanokaustyka na uslugach XIX-wiecznej otorynolaryngologii.

The essence of galvanocautery, the such instruments as loops, cauteries and others are presented first of all. The achievements of such doctors as Albrecht Theodor Middeldorpf (1824-1868), Victor von Bruns (1812-1883), Friedrich Eduard Voltolini (1819-1889) and others in development of galvanocautery are depicted. The observations of such Polish physicians as Antoni Bryk (1820-1881), Jan Sedziak (1861-1932) and Zygmunt Srebrny (1860-1941) were very valuable. The good points and shortcomings of galvanocautery and principles of post-operational procedures are pointed out. The use of galvanocautery in otorhinolaryngology especially in strictures of external auditory meatus, aural polyps, aural granulations, in hypertrophy of nasal concha, nasal polyps, in atresia of nasal cavities, in hypertrophy of palatine tonsils, in tumors of naso-pharyngeal cavity, in tuberculosis laryngis are described with full particulars.

A century of eighth nerve surgery.

STUDY DESIGN: A scholarly review of over 70 original papers from the late 19th and early 20th centuries. RESULTS: Although many neurotologists consider vestibular nerve section to be a recent innovation, eighth nerve division dates back to the dawn of intracranial surgery. Although surgery of peripheral nerves (e.g., repair after injury) is ancient, intracranial nerve surgery began in the latter part of the 19th century with fifth nerve division for tic douloureux. By analogy, it was reasoned that hyperactivity of the eighth nerve (initially tinnitus and later vertigo) could be relieved by dividing this nerve. In 1898, Fedor Krause (1856-1937) of Berlin attempted the first eighth nerve section. This patient, as did many during this era, died shortly after the operation. Most of the survivors had facial palsy. These innovative early surgeons used a variety of approaches, including the suboccipital, middle fossa, and transtemporal routes. After an initial burst of excitement during the first decade of the century, poor results led to few procedures being performed through the second and third decades. Throughout this era, there was much debate about the relative merits of labyrinthectomy (introduced by Milligan and Lake in 1904) as opposed to eighth nerve division. In the late 1920s, the prolific Walter E. Dandy (1886-1946) of Baltimore repopularized eighth nerve section and ultimately performed 607 procedures between 1927 and 1946. Although Dandy achieved a high vertigo control rate and reduced the mortality rate to <1%, he had a high rate of facial nerve weakness (9.1% transient, 4.2% permanent). Remarkably, the latter outcome was never published in his numerous papers on the subject, but was first revealed in a 1951 retrospective survey, which appeared some 5 years after his death. Selective division of the vestibular fibers was introduced by Kenneth G. McKenzie (1892-1963) of Toronto in 1931. At least 11 sizable series appeared in the literature before the introduction of microsurgical vestibular nerve section by William F. House (b. 1923) of Los Angeles in 1960. CONCLUSIONS: The introduction and progressive refinement of eighth nerve section played a central role in the evolution of operative neurotology. Many of the most vigorous debates of recent years (e.g., the choice of operative route, the optimal site of division, and the relative role of inner ear surgery vs. nerve surgery) have antecedents in the controversies of the distant past.

The history of neuro-otology. A personal perspective.

I realize I practiced otology and neuro-otology during a golden era, but I have to admit that I didn't appreciate how important it was until I sat down to outline this article. How fortunate I was to have lived and practiced during these developing years of neuro-otology. How fortunate to have worked with the likes of Howard and William House, James Sheehy, James Crabtree, David Austin, and John Shea. How fortunate to have had the opportunity to teach residents and fellows in association with my private practice. So I envy the young otologist-neuro-otologist and the future you have. You stand on the brink of great discoveries. And like my generation, you stand on the shoulders of giants. Good luck.

[Maurice Sourdille and the operating microscope]. / Le microscope opératoire et Maurice Sourdille.

The authorship of the operating microscope appears to be shared by Nylén, who had the idea of using a microscope for ear surgery and Gullstrand, who invented the slit-lamp and who was probably the counsellor of Hölmgren in his work on operative field magnification. Hölmgren was the first to use an operating binocular magnifying glass and Sourdille created the first binocular magnifying glass designed for microsurgery.