The story of progress of otology

Abstract

INTRODUCTION History is always fascinating to read. The story of how things were discovered, the way good and bad about them were learnt, and how the past knowledge and skills was used in the invention of newer things is never boring to read. History is not just a narration of events of the past; it is a science by itself, written with an art. Knowledge of the history makes us cleverer and wiser. Every medical field has its own history and otorhinolaryngology is not an exception. This article tries to cover the major sequence of events and the progress made in the field of otology, a subspecialty dealing with the diseases of the ear. It is only in the early 20th century that we saw the evolution of otorhinolaryngology prior to which, the specialty was studied as otology and laryngology separately. Early otologists were considered as surgeons and the laryngologists as physicians.[1] Recent advances in the field has now divided the specialty into subspecialties. However, otology is still the most important part of the ear, nose, and throat (ENT) curriculum in any university. The main reason for otology to remain in the forefront is its fascinating history and the scope for advanced learning. In this article, an attempt has been made to take the reader through the progress made in the field of otology from the time of its evolution to the present era. For easy reading, the historical aspects have been discussed from the earliest time of its development, century-wise, to the present era. EARLIER TIMES The term otology is derived from the Greek word "Óus." Descriptions of the ear are available in the prehistoric age, before 4000 BC.[2] Ebers Papyrus, one of the most famous medical papyri, described the clinical problems associated with ear and Edwin Smith Papyrus gave the description of the temporal bone injuries.[3] Ebers and Brugsch papyri described otitis media as "fire in the heart of the ear" and its treatment with honey.[12] Hippocrates, the father of medicine, at around 400 BC had given the description of tympanic membrane and mastoid air cells. He had also given the description of acute and chronic otitis media as the causes of deafness.[4] Empedocles (504-443 BC), a Greek philosopher, described the cochlea, which he called "ko'cloV," referring to a seashell of the Mediterranean region.[5] Aristotle (384-322 BC) created a theory on hearing, which postulated that the inner ear was a resonating chamber that vibrated in response to sound.[6] His theory persisted unchallenged till Cotugno demonstrated the inner ear has only fluid in the 18th century. In the first century AD, Rufus of Ephesus gave the present anatomical names to parts of the external ear. Galen, (130-200 AD) the personal physician of the Roman Emperor Marcus Aurelius, described the auditory nerve. He, however, thought that it originated in the middle ear.[7] Galen was also known for the medical and surgical treatments of many ear conditions. MIDDLE AGES The results of a dissection by Vesalius of Padua, Italy performed in 1543 contributed to the anatomical knowledge of the middle ear including oval and round windows, malleus, and the incus.[7] Filippo Ingrassia (1510-1580), a native of Sicily, described the stapes in 1546.[8] Later, Bartolomeo Eustachi (1520-1574) described the Eustachian tube, semicircular canals, and cochlea [Figure 1] and wrote the earliest book on the anatomy of the ear. He suggested blowing out strongly while holding the mouth and nose closed, forcing air to pass into the tympanum by way of the Eustachian tube as a treatment of deafness.[9] Gabriele Fallopius (1523-1562) gave a description of the fallopian canal, tympanum, vestibule, and the cochlea[7] [Figure 2]. Du Verney, personal physician of the French royal family, published a book with impressive drawings of the inner ear anatomical structures [Figure 3]. He showed that the Eustachian tube was not an avenue of breathing but provided the source of air into the middle ear.[4] He, howeve