History of Otology

1 History of Otology


 


 


 


 


 


 


 


 


 




Definition

With the progress of medicine, otology has evolved into its own true subspecialty within otolaryngology/head and neck surgery. The inception of neurotologic surgical approaches and the development of the cochlear implant into a generally accepted treatment modality have helped (neur) otologic medicine to its current state of success.


Closely Related Topics

• Auditory physiology of the inner ear—see p. 300


• Ménière disease—see p. 188


• Surgery for cochlear implants—see p. 328


• Neurotologic approaches to the medial temporal bone—see p. 338


Introduction

Many of the achievements in otology are linked to the history of medicine and are as important today as when they were first introduced. This is an outline review of otology’s legacy. Interestingly, the scope of (neur) otology has gradually expanded from relatively focused ear care to medical and surgical management of disorders of the ear, hearing, balance, facial nerve, temporal bone, lateral base of skull, and related central nervous system structures including the cerebellopontine angle, brainstem, and central auditory, vestibular, and facial nerve pathways. The inception of new technologies has vastly improved anatomic and functional assessment and outcomes for patients with chronic ear disease, skull base tumors, and sensorineural hearing loss.


A timeline of the history of otology is shown in Fig. 1.1, together with illustrations of some of the major contributors.


Ancient Medicine

Because of the sturdy nature of the temporal bone, the organs of hearing were inaccessible and knowledge was limited by what was readily visible. In the times of ancient medicine, Aesculapius, Aristotle (382–322 BC), and Galen (AD 121–199), ear disease was treated with herbal remedies and surgical care was limited to trauma of the auricle and to the removal of foreign bodies from the ear canal. However, in the fourteenth century, scientists began laying the framework for future ear studies. Jacopo da Carpi (1470–1550) dissected several hundred cadavers and published an anatomy commentary entitled Anatomi Carpi Isgogae. This text described two small ossicles adjacent to the tympanic membrane within the tympanic cavity. Da Carpi theorized that vibrations from the outside caused the ossicles to move against each other and thus provide a base for the conductive sound apparatus (see p. 27).


Renaissance

During the Renaissance, the anatomy and the organs of hearing were first described systematically. Andreas Vesalius (1514–1564) (Fig. 1.1) in 1543 published De fabrica, the first significant collection of medical illustrations. Even though his knowledge of the ear structures was limited, he identified and named the malleus and the incus (see p. 12). He also identified the tensor tympani and described the anterior position of the oval window compared with the more posterior position of the round window. Most surprising, however, is his oversight of the stapes. Vesalius’s major contribution was his suggestion that the organ of hearing should be removed from the skull for further study and investigation. Bartholomeus Eustachius (1520–1574) (Fig. 1.1) in 1563 published Opuscula anatomica, which contained a complete description of the tensor tympani. He established that the chorda tympani was a branch of the facial nerve. He also contributed to the study of the cochlea with descriptions of the spiral lamina and the modiolus. His most significant contribution was the structure that bears his name “the tube of Eustachio” (see p. 9). Eustachius described the cartilaginous and bony portions, its oval shape, and its course from the anterolateral skull base to the nasopharynx. Gabriele Falloppio (1523–1562) is recognized as outstanding among Renaissance anatomists for his perceptive observations and comparisons. He described the facial canal and the chorda tympani; he recognized the separate origins of cranial nerves VII and VIII. He gave clear descriptions of the tympanic membrane, semicircular canals, and sphenoid sinuses, and he is given credit for discovering and naming the stapes.


Clinical Otology

Otology’s first clinical primer was published by Guichard Duverney (1648–1730) entitled Traite de l’Organe de l’Ouie. Duverney introduced the arrangement of ear diseases according to the structures affected. His three-part format consisted of (1) the anatomy of the ear, (2) the physiology of hearing, and (3) the pathology of the organ of hearing.Duverney also compared the cochlea to a musical instrument wherein the wider parts vibrate more slowly (low-pitched tones) and the narrow parts more quickly (high-pitched tones). Antonio Valsalva (1666–1723) (Fig. 1.1) published in 1704 what was considered the authoritative text on the ear for more than a century. In the book he described ankylosis of the stapedial footplate secondary to ossification, preventing oscillation of the stapes (otosclerosis). Domenico Cotugno (1736–1822), at the age of 24, gave his dissertation on the fluid of the inner ear and its use in the conduction of hearing. Jean Marie Itard (1774–1838) published a two-volume treatise on the maladies of the ear and hearing. Volume I dealt with anatomy, physiology, and pathology of the ear. Volume II presented patient histories and analyses of the appearance of the corresponding pathology. Sir William Wilde (1815–1876) (Fig. 1.1) developed the first otologic practice. He was the first to identify the cone of light in the anteroinferior portion of the tympanic membrane (see p. 46). He also developed new ear instruments such as the speculum, aural snare, and probes. Wilde was also the first to incise and drain a mastoid abscess. The German contribution to otology came through Samuel von Sommer-ring and his anatomic atlas of 1806. The models and illustrations were so accurate they could be used today. Prosper Ménière (1799–1862) (Fig. 1.1) laid emphasis on the role of the inner ear in producing vertiginous attacks (see p. 188). He began his study of temporal bones in patients with episodic vertigo, hearing loss, and tinnitus and found an inner ear abnormality.


Apr 14, 2018 | Posted by in NEUROSURGERY | Comments Off on History of Otology
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