The History of Pediatric and Adult Hearing Screening.

OBJECTIVES/HYPOTHESIS: To document the history of hearing seeing in children and adults. STUDY DESIGN: A literature search in all languages was carried out with the terms of hearing screening from the following sources: Pub Med, Science Direct, World Catalog, Index Medicus, Google scholar, Google Books, National Library of Medicine, Welcome historical library and The Library of Congress. METHODS: The primary sources consisting of books, scientific reports, public documents, governmental reports, and other written material were analyzed to document the history of hearing screening. RESULTS: The concept of screening for medical conditions that, when found, could influence some form of the outcome of the malady came about during the end of 19th century. The first applications of screening were to circumscribe populations, schoolchildren, military personnel, and railroad employees. During the first half of the 20th century, screening programs were extended to similar populations and were able to be expanded on the basis of the improved technology of hearing testing. The concept of universal screening was first applied to the inborn errors of metabolism of newborn infants and particularly the assessment of phenylketonuria in 1963 by Guthrie and Susi. A limited use of this technique has been the detection of genes resulting in hearing loss. The use of a form of hearing testing either observational or physiological as a screen for all newborns was first articulated by Larry Fisch in 1957 and by the end of the 20th century newborn infant screening for hearing loss became the standard almost every nation worldwide. CONCLUSIONS: Hearing screening for newborn infants is utilized worldwide, schoolchildren less so and for adults many industrial workers and military service undergo hearing screening, but this is not a general practice for screening the elderly. LEVEL OF EVIDENCE: NA Laryngoscope, 131:S1-S25, 2021.

Correction to: The Developing Concept of Tonotopic Organization of the Inner Ear.

The email address for Robert J. Ruben should be rruben@montefiore.org.

The Developing Concept of Tonotopic Organization of the Inner Ear.

This study aims to document the historical conceptualization of the inner ear as the anatomical location for the appreciation of sound at a continuum of frequencies and to examine the evolution of concepts of tonotopic organization to our current understanding. Primary sources used are from the sixth century BCE through the twentieth century CE. Each work/reference was analyzed from two points of view: to understand the conception of hearing and the role of the inner ear and to define the main evidential method. The dependence on theory alone in the ancient world led to inaccurate conceptualization of the mechanism of hearing. In the sixteenth century, Galileo described the physical and mathematical basis of resonance. The first theory of tonotopic organization, advanced in the seventeenth century, was that high-frequency sound is mediated at the apex of the cochlea and low-frequency at the base of the cochlea. In the eighteenth and nineteenth centuries, more accurate anatomical information was developed which led to what we now know is the accurate view of tonotopic organization: the high-frequency sound is mediated at the base and low-frequency sound at the apex. The electrical responses of the ear discovered in 1930 allowed for physiological studies that were consistent with the concept of a high to low tone sensitivity continuum from base to apex. In the mid-twentieth century, physical observations of models and anatomical specimens confirmed the findings of greater sensitivity to high tones at the base and low tones at the apex and, further, demonstrated that for high-intensity sound, there was a spread of effect through the entire cochlea, more so for low-frequency tones than for high tones. Animal and human behavioral studies provided empirical proof that sound is mediated at a continuum of frequencies from high tones at the base through low tones at the apex of the cochlea. Current understanding of the tonotopic organization of the inner ear with regard to pure tones is the result of the acquisition over time of knowledge of acoustics and the anatomy, physical properties, and physiology of the inner ear, with the ultimate verification being behavioral studies. Examination of this complex evolution leads to understanding of the way each approach and evidential method through time draws upon previously developed knowledge, with behavioral studies providing empirical verification.

Dr Ross McIntire, otolaryngologist, and his care of President Franklin D. Roosevelt.

The role that otolaryngologist Ross McIntire, MD, played in the care of Franklin Delano Roosevelt, 32nd President of the United States, was documented by reviewing primary source material pertaining to the relationship of McIntire and Roosevelt. This included material from various archives including the Franklin D. Roosevelt Presidential Library at Hyde Park, New York; United States National Archives; and numerous autobiographies and diaries. McIntire's belief in the value of confidentiality and to provide information only on a need-to-know basis is consistent with the strategy that he had devised earlier for protecting his patient's privacy. In the context of his time and his position, Dr McIntire served his patient and his country well by making appropriate medical and wise personal judgments. The career of Dr Ross T. McIntire, otolaryngologist and personal physician to the 32nd president of the United States, engenders a sense of honor to our profession.

The Fox and the Crow: Predatory Open Access Journals in Otolaryngology.

Otolaryngologists regularly receive invitations from open access otolaryngology­head and neck surgery journals to submit papers or to join the editorial board. Some of these journals are considered "predatory." There has been no published attempt to see if bogus otolaryngological articles would be accepted by such journals. We sent a fake article describing a supposed otosclerotic lesion localized in the fallopian tube and surgically treated by phacoemulsification of the stapes to 41 such journals. Eight journals accepted the paper, 7 requested structural revision, 2 requested revision even though the reviewer recommended rejection, 4 rejected the paper only because they found it had already been published by another open access journal (without the authors' knowledge), and 2 rejected the paper. Eighteen journals had not responded after 6 weeks. A contemporary retelling of the poem "The Fox and the Crow" concludes our article, which illustrates predatory practices among specific open access otolaryngology journals.

Randomized controlled studies and the treatment of middle-ear effusions and tonsillar pharyngitis: how random are the studies and what are their limitations?

OBJECTIVE: To determine the applicability and external validity of randomized control studies (RCTs) in the light of patient susceptibilities and vulnerabilities to the sequelae of otitis media with effusion (OME) and tonsillar pharyngitis (T&A) and the composition of their cohorts. STUDY DESIGN: RCTs for OME and T&A were analyzed to determine which intrinsic and extrinsic susceptibilities to the otolaryngic disease and its sequelae were included or excluded and the composition of the cohort. METHODS: A Medline and a Science Direct search were performed for all RCTs concerning OME and T&A through 2007. The articles selected to be included in this study are the OME RCTs that reported language and/or hearing outcomes and the T&A RCT studies in which the outcome measure was infection, alleviation of airway obstruction, and/or quality of life. These were analyzed for their inclusion or exclusion of intrinsic and extrinsic susceptibilities to the otolaryngic disease and their sequelae and the composition of the cohort. The pertinent otolaryngologic literature was assessed to determine applicable risk factors. RESULTS: The analysis of the inclusion or exclusion of risk factors showed that for OME 0 percent were included and 16 percent were excluded, and there were no data for 84 percent. The T&A findings were similar in that 1 percent of risk factors were included, 8 percent excluded, and there were no data for 92 percent. Both the OME and the T&A cohorts data were similar in that approximately half of the suitable candidates completed the study; 25 percent of the OME and 13 percent of the T&A enrolled subjects were either withdrawn or placed into a different experimental group. On the average, with data available, it took 4.6 years to recruit the OME sample and 5.5 years to recruit the T&A sample. CONCLUSION: The results of RCTs for these conditions are only applicable to narrowly defined and highly circumscribed populations. They cannot be generalized to the entire patient population because of their limited external validity. Future RCT protocols should be designed to control for the intrinsic and extrinsic susceptibilities that result in a propensity to acquire the disease and/or an exacerbation of the disease's sequelae. These studies would determine the most effective strategies for preventing disorders and/or their deleterious sequelae.

Language development in the pediatric cochlear implant patient.

OBJECTIVE: To access the long-term outcomes of children implanted during most sensitive period for language development. STUDY DESIGN: Literature review. METHOD: An initial PubMed search was carried out using the search terms language development and cochlear implant resulted in 1149 citations. A second search was carried out on the initial citations using the criterion of implantation in the period of birth to 24 months, which identified 386 articles. These were analyzed to determine those studies in which linguistic outcome was measured at least three or more years following implantation. RESULTS: Twenty-one reports published from 2004 to 2017 that met the criteria. The range of follow-up was from 3 years to an excess of 10 years. Four => 10-year follow-up reports were consistent in showing that the earlier the subject is implanted the better the outcome. Many, but not all, of these children did obtain age-appropriate language. There were 17 reports with follow-up from 3 to less than 10 years. In 7 of the 11 studies, the children's expressive language was reported to have reached an age level of less than 80%. The results for receptive language showed that 4 of the 11 studies found that the children achieved a receptive language age level of less than 80%. There were 8 studies which documented the effect of implantation before 12 months of age and between 12 and 24 months of age and they all found that the earlier the implantation, the better the outcome for language. CONCLUSION: The cochlear implant is efficacious in the amelioration of receptive and expressive language deficits in most congenitally deafened children implanted before the age of one. The language outcomes for those implanted after the age of one decline as the age of implantation increases. LEVEL OF EVIDENCE: N/A.

The history of the glomus tumors - nonchromaffim chemodectoma: a glimpse of biomedical Camelot.

CONCLUSIONS: Guild's initial 231 word report was the source of a stream of positive consequences; the glomus story is a paradigm of the utility of basic science. BACKGROUND: The glomus tumor has had a number of different names, including glomus jugulare, glomus tympanicum, nonchromaffin paraganglioma, and carotid body tumor. Although they have occurred throughout the ages, glomus tumors were neither recognized nor understood until Harry Rosenwasser read Stacy Guild's report of 1941. MATERIALS AND METHODS: The pertinent literature from the 18th century to the present was reviewed. RESULTS: Stacy Guild's pursuit of basic scientific knowledge laid the foundation for a chain of clinical and scientific advances that continue to the present and will continue to have positive effects into the future. Guild's brief basic science note of 1941 was used through the scholarship of Rosenwasser to define a clinical entity that had not been recognized. This new nosology, rapidly adopted worldwide, provided a biological basis for the rational grouping of patients and analysis of their ills. Subsequent to this, it was noted that many of these tumors occurred in families, apparently transmitted as an autosomal dominate but occurring primarily in the males. Further study based on these observations led to the identification of a genetic mechanism of inheritance: genomic imprinting. A further advance of the synergetic relationship between the environment - oxygen tension/altitude - and the mutation explains Guild's 1953 observations that all patients, without any sexual predominance, have glomus bodies but not all have tumors.

Otology at the Academy of Gondishapur 200-600 CE.

OBJECTIVE: To investigate the way in which otology was practiced at the Academy of Gondishapur in ancient Persia from 200 to 600 CE. METHOD: The pertinent literature, using German and English translations of Latin, Greek, Arabic, and Sanskrit documents, was identified and reviewed through the indices of available books and through a PDF search for the following topics: auricle, deaf, deafness, dizziness, ear, hearing, medicine, otitis, pinna, punishment-ear, speech, surgery, vertigo, and voice. RESULTS: The medical school at the Academy of Gondishapur followed the medical and surgical practices of Greece and Rome and, in the 6th century, incorporated those from India as detailed in the Shutra Samhita. This shutra, which originated during the first millennium BCE, detailed many interventions, among which one of the most unusual was the use of a pedicle cheek flap to restore the pinnae. The use of the pedicle flap for pinna restoration appears not have been reported in literature again until 1931, by Jacque Joseph. CONCLUSION: During the period of late antiquity, medical knowledge of both the east and west was preserved and taught in Persia. Among surgical interventions used during the first millennium BCE in India, knowledge of which passed, through the shutra, to the Sasanian Empire in the 6th century CE, was use of the pedicle cheek flap for pinna reconstruction. Even as late as the Renaissance, the pedicle flap was not known to surgeons in the West, and a pedicle flap, though not a cheek flap, was first incorporated into Western medical practice during the 1930s.

The adenoid: Its history and a cautionary tale.

The existence of the adenoid first appears to have been noted by Conrad Victor Schneider in 1661. James Yearsley reported in 1842 one case in which he improved hearing by removal of a mucus membrane from behind the uvula, which indicates some appreciation of a relationship of the nasopharynx to ear disease. Hans Wilhelm Meyer, in 1868, was the first to demonstrate the relationship of the adenoid to ear disease and to develop an effective, although somewhat difficult, surgical operation to remove the adenoid. Removal of the adenoid became rapidly accepted worldwide as a treatment for many morbidities, including otitis, speech problems, cognitive problems, and sleep apnea. Until the 1920s, adenoidectomy often was performed as a staged procedure and without general anesthesia. Early tools and techniques included use of the bare fingernail, a finger ring knife, a curette, and electrical desiccation. From the mid-1930s to the early 1960s, radiation therapy of the adenoid was in extensive use, both for children and in caring for army aviators and navy submarine crews during WWII. The effectiveness of surgical adenoidectomy for hearing loss led to a belief that radiation, which had been found to ablate lymphoid tissue, would be equally effective, and led to the wide-spread use of radiation. Ultimately, 500 thousand to 2.5 million children and adults were estimated to have been treated with radiation, and follow-up studies found increased risk for cancer. Furthermore, a follow-up study by Stacey R. Guild (1890-1966), published in 1950, on a very large sample of children who previously were reported to have had their hearing loss diminished through radiation, found that irradiation had produced no effect on high-tone loss. Thus, irradiation was both useless and harmful. Acceptance of authority, which can lurk within medical culture, led to the development of a tragically misguided management of adenoid disease. Laryngoscope, 127:S13-S28, 2017.

Sign language: its history and contribution to the understanding of the biological nature of language.

CONCLUSION: The development of conceptualization of a biological basis of language during the 20th century has come about, in part, through the appreciation of the central nervous system's ability to utilize varied sensory inputs, and particularly vision, to develop language. OBJECTIVE: Sign language has been a part of the linguistic experience from prehistory to the present day. Data suggest that human language may have originated as a visual language and became primarily auditory with the later development of our voice/speech tract. Sign language may be categorized into two types. The first is used by individuals who have auditory/oral language and the signs are used for special situations, such as communication in a monastery in which there is a vow of silence. The second is used by those who do not have access to auditory/oral language, namely the deaf. MATERIAL AND METHODS: The history of the two forms of sign language and the development of the concept of the biological basis of language are reviewed from the fourth century BC to the present day. RESULTS: Sign languages of the deaf have been recognized since at least the fourth century BC. The codification of a monastic sign language occurred in the seventh to eighth centuries AD. Probable synergy between the two forms of sign language occurred in the 16th century. Among other developments, the Abbey de L'Epée introduced, in the 18th century, an oral syntax, French, into a sign language based upon indigenous signs of the deaf and newly created signs. During the 19th century, the concept of a "critical" period for the acquisition of language developed; this was an important stimulus for the exploration of the biological basis of language. The introduction of techniques, e.g. evoked potentials and functional MRI, during the 20th century allowed study of the brain functions associated with language.

Valedictory--why pediatric otorhinolaryngology is important.

The importance of the care given by the pediatric otolaryngologist to the individual child encompasses the traditional purposes of medicine. This field has its special focus on interventions that preserve, restore and/or otherwise improve hearing, speech, voice, gustation, olfaction, deglutition, respiration, appearances, etc. The value-added dimension of pediatric otolaryngology is of essential importance because it enhances communication-language--through the vehicles of hearing, voice, and speech. This critical role is manifest in two ways. The first relates to the economic bases of society. Comparison of the consequences of communications disorders in three different countries ranging, currently, from one very highly dependent upon communication skills (The Netherlands), to one highly dependent upon communication skills (the United States), to a developing nation less dependent upon communication skills (the Philippines) is presented. All three nations are adversely affected economically and socially by communication disorders. It is estimated that the United States loses between 2.5 and 3% of its gross domestic product from the economic sequel of communication disorders. It also appears that communication disorders contribute to crime, since the prevalence of communication disorders is many times greater in populations of juvenile delinquents than in the general population. Communication disorders may act synergistically with diminished economic and social resources and other factors in the causes of violent behavior and crime.

Five children--vignettes of language disorders.

The pediatric otolaryngologist cares for children who have abnormal language as a primary or secondary deficiency. Five children, each with a different form of language disorder, are presented. These are children with specific language impairment (SLI) expressive, pervasive developmental delay (autism), expressive language delay associated with severe to profound hearing loss early in life, language delay secondary to a moderate to severe hearing loss diagnosed late and not cared for, and language delay secondary delay secondary to social deprivation and otitis media with effusion.

The promotion of academic pediatric otolaryngology by journal peer review.

The professional journal promotes and sustains academic departments through several mechanisms that include peer review, editing, timing, and solicitation of works. The ways in which peer review strengthens and augments academic pediatric otolaryngology are through: the creation of new knowledge; knowledge transfer-teaching; the establishment and development of quality medical/surgical standards; scholarship; and the fostering of the development of the next generation of academic physicians is detailed.

Development of otorhinological care of the child.

During the last third of the 20th century, pediatric otolaryngology became a defined specialty in many nations, resulting in focused training, fellowships, societies, journals, textbooks, etc. This development occurred as a result of an interaction between the changing sociological and economic status of the child and medical advances. In this paper the history of the status of children is investigated during the Reformation/Counter-Reformation, Enlightenment and Romantic periods, and during the recent era of Entitlement, and an analysis is made of the relationships between otolaryngological care of children during these periods, including a consideration of selected medical advances made during the 17th to 21st centuries, and the evolving status of children. Advances in education of the deaf, understanding the role of the adenoid and care of the airway were applied to the child patient not directly, as it may sometimes seem to physicians caring for a patient in a hands-on fashion, but rather via the bridge of the social and economic context of the time. This interactive process created a special body of knowledge that is now applied in a society that places a high value on the child. In the second half of the 20th century, i.e. during the period of Entitlement, the otolaryngological needs of the child became a demand, based in part upon a need for care of airway pathology in the premature infant, which fostered the establishment of pediatric otolaryngology as a specialty.

Morell Mackenzie's The Hygiene of the Vocal Organs: a study in longevity or durability.

INTRODUCTION: Morell Mackenzie's The Hygiene of the Vocal Organs: A Practical Handbook for Singers and Speakers (1886), is his only work that has been continually published into the 20th century. Why is this? METHOD: The bibliographic history and details of all the editions from the first in 1886 until the ninth and last in 1928 were examined. Reviews and all other commentary about the book were ascertained though literature and library document searches. RESULTS: The book is still in use as the first edition is available online from the Cornell University library, and that hard copy was last taken out from that library on December 19, 1986, and returned with the fine paid on January 8, 1987. It was translated and published in Swedish, French, German, and Spanish. All of the editions are small, inexpensively bound, and printed on inexpensive paper so the cost was minimal in contradistinction to other works on the voice which are larger and expensive. To make it accessible for performers and practitioners, the contents of the earlier editions were modified by placing the technical, anatomical, and physiological information as an appendix. The book was in part criticized by Manuel Garcia in Felix Semon's German journal, Internationales Centralblatt fur Laryngologie, Rhinologie und verwandte Wissenchaften, McKenzie answered these critiques in the seventh edition and noted that Garcia did not know German and that the translator, Semon, was an antagonist. Mackenzie is emphatic in his advice to avoid singing when there's any sign of vocal difficulty. CONCLUSION: The medical advice was, on the whole, good common sense and provided substantial authority for a person to decline a performance-how grateful the singers must have been for that! The Hygiene of the Vocal Organs: A Practical Handbook for Singers and Speakers was, for the professional voice users-singers, actors, speakers, and for their teachers and physicians, a useful, concise, small, inexpensive, and authoritative book. With these virtues noted, we can well understand why it remained in circulation and use for a century. In terms of the dissemination of ideas, this heretofore neglected work may be Mackenzie's most long-lasting contribution to laryngology.