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.

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.

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.

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.

The coronoid insertion of the human masseter muscle was well described in the 18th century.

INTRODUCTION: A recent paper in Annals of Anatomy (The human masseter muscle revisited: First description of its coronoid part) claimed to have discovered a previously unrecognized anatomical component of the deep layer of the masseter muscle. The goal of this study is to emphasize the importance of undertaking comprehensive exploration of the historical literature before asserting primacy of an anatomical discovery. METHODS: A search was conducted of historical texts describing the anatomical structure of the masseter muscle, spanning the 18th, 19th, and early 20th centuries. Historical sources were obtained via Google Books, the Internet Archive, and the digital collections of Stanford Lane Library Medical History Center, Paris University Numerical library Medica (France), and the State Library of Bavaria (Germany). Contemporary anatomical studies were identified via PUBMED search RESULTS: Rather than a "first description" of newly discovered anatomical feature, the paper we comment upon has added important anatomical details of the length, width, thickness, and fiber orientation of coronoid portion of the deep layer of the masseter. As early as the 18th century, anatomists had described the masseter as possessing a three rather than two-layer structure with a deep layer which inserts on the coronoid process. DISCUSSION: Assertions of primacy (ie. "first description") of an anatomical structure in the 21st century necessitates a diligent search of literature, including sources which were published during the era when anatomical studies reigned supreme at the forefront of medical science. Systematic scanning of historical medical material has made older texts widely and freely available and digital translation tools have helped to remove language barriers. It is important to study original articles as secondary citations of historical material are less reliable. Without rigorous historical investigation, assertions of primacy cannot be made with confidence.

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.

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!

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.

Ductus Reuniens and Its Possible Role in Menière's Disease.

OBJECTIVE: After 160 years the true underlying cause of Meniere's disease remains enigmatic. The aim of our study is to discuss the possible implication of an obstruction of the ductus reuniens as a cause in Menière's disease. METHODOLOGY: We first conducted an historical study of the description of the ductus reuniens. We then reviewed the literature regarding ductus reuniens obstruction in animal experiments, human post-mortem studies and living ear imaging. We completed its description by modern microCT imaging. Limited knowledge on the fate of dislodged saccular otoconia is summarized. The possible implications for Meniere's attacks are discussed. RESULTS: Victor Hensen was the first to describe the ductus reuniens in 1863. He described its length and width and predicted that saccular otoconia might enter the ductus and the cochlea. On microCT the narrowest width of the human ductus reuniens was 0.14 mm. The literature reports cochlear endolymphatic hydrops occurring after animal experimental obstruction of the duct. Human postmortem studies have confirmed saccular otoconial clumps entering the ductus and the cochlea. A postmortem study has shown sites of endolymphatic obstruction, and imaging speculates on blockages in ears with Meniere's disease. Dislodged utricular otoconia can be in clumps of otolithic membranes. CONCLUSION: Blockages of the ductus reuniens and at other endolymphatic system sites appear to be a feature in Meniere's disease ears. The blockages have been postulated to be saccular otoconia either causing or aggravating hydrops. This could be consistent with observed nystagmus reversals during attacks as the endolymphatic sac attempts to clear the hydrops and the otoconia.

A Critical Evaluation of "The Ear that Hears Badly" in the Ebers Papyrus.

OBJECTIVE: The Ebers papyrus (1,550 BC) is one of the most complete medical papyri of Ancient Egypt. It contains a few paragraphs about otology, about both treatments of the external ear and ideas concerning the ears and deafness. Over the years, many scholarly interpretations of these paragraphs have been made by learned Egyptologists and academic historians of otology. They do not always agree and have often been critical of each other. This historical review compares and contrasts all the main published academic translations of the Ebers papyrus by looking at the original document and their interpretations. METHODOLOGY: Historical research, based on the various translations of the Ebers papyrus. RESULTS: Eight complete translations of the whole Ebers manuscript have been analyzed. Four of these contain transliteration of the hieroglyphics. The hieroglyph associated with the ear is a pictogram of a cow's ear. It has two possible interpretations. It can mean the ear itself but it can also be used to denote either deafness or hearing. CONCLUSION: Insights into the early Egyptians perception of the ear may be obtained, but study of primary references shows that there is scant evidence of knowledge of anatomical details in the Ebers papyrus.

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.

History of Mastoidectomy: PubMed, Best Matches, Secondary References, and Inaccuracies.

OBJECTIVE: PubMed is the world's largest online collection of biomedical literature citations. A PubMed search (October 11, 2019) using the medical subject heading terms "history" and "mastoidectomy" was conducted. The heading "best matches" listed as first article "A brief history of mastoidectomy," a very relevant free full text. The aim of this study is to validate or not the relevance attributed to this study as the first article listed in best matches. METHODOLOGY: All the references of the article mentioned before 1860 were checked, further completed with other original sources, and studied again, with particular attention to their extracted quotes. RESULTS: Surprisingly, this article contains many inaccuracies, notably concerning Galen, Lucas van Leyden, Paré, Riolan the Younger, Justus von Berger, Jasser, Dezeimeris, Wilde and Toynbee. This was most certainly related to blind trust of some secondary references. CONCLUSION: Never trust secondary references. This article also raises questions on the validity and the relevance of the best matches algorithm in PubMed.

Adam Politzer (1835-1920) and the cochlear nucleus.

The year 2020 marks the centenary of the death of the great otologist Adam Politzer (1835-1920). From his descriptions of the cochlear nucleus between 1878 and 1908, we can gain insight into how contemporary otologists were beginning to embrace contributions from the neurosciences into their specialty. It is clear that this amalgamation was gaining momentum in the last part of the nineteenth century. The impressive clarity of Politzer's textbook (which went into several editions) secured Politzer's place in the history of otology as one of the founding fathers of his specialty.

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.

History of Myringotomy and Grommets: A Perpetuation of Inaccuracies?

This letter discuss the inaccuracies contained in the recent paper about history of myringotomy and grommets.