Another well-known name in otology is Antonio Valsalva. He wrote a book called Tractatus de Aure Humana, published in 1704. He was the first to demonstrate ankylosis of the stapes at post-mortem. 'rhe significance of this observation was not appreciated for over a century. His name is associated with the test of inflating the middle ear by closing the mouth and nose and forcing air up the eustachian tubes. rhe eustachian catheter was invented by Edine-Gilles Guyot, a postmaster at Versailles. He succeeded in relieving his own deafness by the use of a curved tube passed into the mouth and behind the palate. Nearly twenty years later, Archibald Cleland, a Scottish military surgeon, recommended passing a silver tube via the nose and syringing with water. It did not occur to him that air might be blown in.
He studied medicine and philosophy in Bologna. He was taught by Marcello Malpighi, who is known as the founder of microscopic anatomy.
In 1705, he was appointed professor of anatomy at Bologna. He was later chosen as president of the Academy of the Sciences.
Valsalva taught Giovanni Battista Morgagni who edited Valsalva’s complete writings and published a biography on Valsalva, both in 1740.
In 1709, Valsalva married Elena Lisi. As he lost his health, he lost his sense of smell, but he recognized the prodromal symptoms, in the form ofdyslalia, of the disease that would eventually cause his death from stroke at Bologna in 1723.
The Valsalva family donated a collection of dried anatomical specimens to be used for educational purposes to the Institute of Sciences founded in 1711. The wear of this material that followed possibly inspired the work of the Bolognese school of wax modeling and the artists Ercole Lelli and Giovanni and Anna Morandi Manzolini. This new anatomic collection includes models of the heart and lungs and is today presented at the Museum of Anatomy. Valsalva was described as a skillful surgeon and excellent physician, a meticulous anatomist with high scientific integrity, and a man of great kindness. Morgagni wrote ". . . there is nobody of those times who goes ahead of him, very few who are his equals."
Research Opera, 1741 His main interest was the middle and internal ear, including the muscles of the external ear and the pharyngeal muscles.
Valsalva named the Eustachian tube and described its function and that of its muscle. He showed the connection between the mastoid cells and thetympanic cavity, and made observations on physiologic and pathologic processes of the ear. De aure humana tractatus published in 1704 contains a description of the Valsalva maneuver and patency test of the auditory tubes. A skilled anatomist, Valsalva conducted many autopsies on deceased patients. During the 17th century, lacking chemical tests and knowledge of disease transmission mechanisms, he sometimes tasted the fluids he encountered in cadavers in an effort to better characterize them. "Gangrenous pus does not taste good", he wrote, "leaving the tongue tingling unpleasantly for the better part of the day." Valsalva device in spacesuits The Valsalva device is a device used in spacesuits to allow astronauts to equalize the pressure in their ears by performing the Valsalva maneuverinside the suit without using their hands to block their nose. It has also been used for other purposes, such as to remove moisture from the face.
In the nineteenth century, otology made great strides. Joseph Toynbee gave otology a scientific basis by his beautiful dissections of over two thousand ears, these formed the Toynbee Collection in the Museum of the Royal College of Surgeons, which was destroyed by enemy action in 1941. He described otosclerosis and demonstrated ankylosis of the stapes of the fenestra avolis in 160 speci. rnens.
In 1938, Lempert of New York described a one-stage operation with approach through the meatus. In 1940 and 1941, he described further modifications, and in 1942 Shambaugh of Chicago added the use of constant irrigation, and the use of a binocular dissecting microscope when drilling the external canal. This is the type of operation which is being done to-day.
Biography He went to school in Budapest, Munich, and Zürich. He studied chemistry in Bern and received his PhD in physics on the subject: "Fast way of determining molecular weight" from the University of Budapest in 1926. He then spent one year working in an engineering firm. He published his first paper on the pattern of vibrations of the inner ear in 1928. He was offered a position at Uppsala University by Róbert Bárány, which he dismissed because of the hard Swedish winters. Before and during World War II, Békésy worked for the Hungarian Post Office (1923 to 1946), where he did research on telecommunications signal quality. This research led him to become interested in the workings of the ear. In 1946, he left Hungary to follow this line of research at theKarolinska Institute in Sweden. In 1947, he moved to the United States, working at Harvard University until 1966. After his lab was destroyed by fire in 1965, he was offered to lead a research laboratory of sense organs in Honolulu, Hawaii. He became a professor at the University of Hawaii in 1966 and died in Honolulu. He became a well-known expert in Asian art. He had a large collection which he donated to the Nobel Foundation in Sweden. His brother, Dr. Miklós Békésy (1903-1980), stayed in Hungary and became a famous agrobiologist who was awarded the Kossuth Prize. Research Békésy developed a method for dissecting the inner ear of human cadavers while leaving the cochlea partly intact. By using strobe photography and silver flakes as a marker, he was able to observe that the basilar membrane moves like a surface wave when stimulated by sound. Because of the structure of the cochlea and the basilar membrane, different frequencies of sound cause the maximum amplitudes of the waves to occur at different places on the basilar membrane along the coil of the cochlea. High frequencies cause more vibration at the base of the cochlea while low frequencies create more vibration at the apex. He concluded that his observations showed how different sound wave frequencies are locally dispersed before exciting different nerve fibers that lead from the cochlea to the brain. He theorized that the placement of each sensory cell (hair cell) along the coil of the cochlea corresponds to a specific frequency of sound (the so-called tonotopy). Békésy later developed a mechanical model of the cochlea, which confirmed the concept of frequency dispersion by the basilar membrane in the mammalian cochlea. But this model could not provide any information as to a possible function of this frequency dispersion in the process of hearing. In a posthumous 1974 article looking back over progress in the field, he remarked "In time, I came to the conclusion that the dehydrated cats and the application of Fourier analysis to hearing problems became more and more a handicap for research in hearing," referring to the difficulties in getting animal preparations to behave as when alive, and the misleading common interpretations of Fourier analysis in hearing research.
The great figures in the history of otology
Fernanda Muñoz Proto
Son Espases Hospital
Descriptions of battle
injuries on the temporal
region and its effect on
hearing and language of the
The frequency of bleeding
from the ear in head injuries
is mentioned and regarded
as an unfavourable sign.
Many references to injuries
of the nose.
Edwini Smith Egyptian Papyrus
Edwini Smith Egyptian Papyrus
Contains prescriptions for diseases of the ear:
“For an ear that is suppurating, olive oil,
frankincense and sea salt syringed into the ear;"
“For an ear that hears badly, red lead and resin,
grind to a powder, rub in fresh olive oil and apply
to the ear."
It is possible that the existence of the eustachian
tubes were known, as it is stated 108 in the
'the breath of life passes by the right ear, the
breath of death by the left ear."
Ebers Egyptian Papyri
Ebers Egyptian Papyri
The first to describe the tympanic
"a dry thin spun web," and he connected it
with the organ of hearing.
Case reports of cases of otitis, and one of
his aphorisms reads:
"Children suffer from ear discharge,
adults from deafness.“
Father of Medicine
460 – 370 B.C
"An insect must first be killed with vinegar, and
then removed with a probe, the patient should be
encouraged to sneeze, or better still, he should
be bound to a table with the affected ear
downwards, and the table should then be forcibly
struck with a hammer so that the foreign body
may be shaken out of the ear.”
Injuries of the external ear:
Careful suturing of the skin, if broken.
If intact and a swelling occurs below it, the
ear is to be opened from behind and a
window cut in the cartilage.
Aulus Cornelius Celsus
25 B.C – 50 A.D
Some of his writings were centuries
in advance of their time.
He advised that carious bone should
be removed after making an incision
behind the ear.
The first reference to mastoid
operative surgery, but centuries were
to pass before his advice was put
130 - 216 A.C
Professor of Anatomy
He gave a detailed
description of the
malleus and incus, two
of the small bones in
the middle ear.
He wrote the first textbook devoted
to the ear.
He gave an accurate description of
the eustaquian tube its structure and
position, but made no mention of its
The internal and anterior muscles of
the malleus and the stapedius,
The anatomy of the cochlea.
1500 or 1514 –1574
San Severino, Italy
He described and named some of
the following structures:
The inner and middle ears.
The chorda tympani, trigeminal,
auditory and glossopharyngeal
He described the bony canal for the
facial nerve which bears his name.
His knowledge was mainly
anatomical, as he regarded
purulent discharge from the ear as
"excrement of the brain."
1683: Eustachian tube was not an
avenue of breathing, but existed simply
as a means of renewing the air within the
He compared the cochlea to a musical
instrument suggesting that the lower
tones were perceived by the basal coil.
Pus was often found in the tympanum
even when the brain was normal, so the
pus could not have come from the brain
as was the accepted theory at that time.
Guichard Joseph Duverney
German physician and physicist.
Measured the speed at which the signal
is carried along a nerve fiber.
High tones were perceived in the basal
coil, and the low- tones by the apical
Hermann von Helmholtz
He wrote Tractatus de Aure Humana.
He coined the term Eustachian tube.
1704: First in demostrate the ankylosis of
Inflating the middle ear by closing the
mouth and nose and forcing air up
the eustachian tubes.
"Gangrenous pus does not taste good“
Antonio María Valsalva
1760: Petit successfully opened the mastoid in a case of
suppuration, but the pathology not being understood, the
operation was tried for cases of deafness without
Astley Cooper observed cases of perforation of the
tympanic membrane with little deafness:
Deafness due to eustachian obstruction might be relieved
by puncturing the tympanic membrane.
Twenty years later, Itard gave the true indications for the
Presence of exudate in the middle ear which was unable to
Eustachian tube catheterisation (1724),
Myringotomy or piercing of the ear drum (1801)
Early attempts at mastoidectomy (1774) were
Until anaesthetics and antisepsis were introduced.
Main surgical treatments until
the middle of the 19th century
1800 in London, UK.
The first firm to begin commercial
production of the ear trumpet.
Rein also sold hearing fans,
and speaking tubes.
These instruments helped amplify
sounds, while still being portable.
Frederick C. Rein
Surgeon, anatomist, neurologist, and
Difference between sensory nerves and
motor nerves in the spinal cord.
1821: Published anatomic diagrams of the
facial nerve and the innervation of the facial
Described Bell's palsy.
Sir Charles Bell
1774 - 1842
Dissections of over two thousand ears.
1841: Described otosclerosis and
demonstrated ankylosis of the stapes of
the oval window in 160 temporal bones.
His findings that the organ of hearing itself
was intact in otosclerosis, led surgeons to
investigate the possibility of bypass the
middle ear obstruction and reach the intact
cochlea by surgery.
Father of Oscar Wilde.
He was the first to teach otology in the
United Kingdom, and students came from
all over the world, particularly America.
His name is still associated with the
method of treating mastoiditis by a post-
aural incision-Wilde's Incision.
Sir William Wilde
1893: Described the features of Otosclerosis:
Abnormal new bone formation in the ottic
capsule disorder and he named it.
He developed surgical instruments:
Ear perforator, surgical knife, grommets for the
ventilation after paracentesis.
Politzer's method to restore permeability to
the Eustachian tube by using an insufflator.
Acoumeter for measuring hearing acuity
2 early acoustical hearing aids.
1835 - 1920
1861: He described a syndrome of sudden
vertigo linked to progressive hearing loss
He defined these discomforts as caused by
a problem in the inner ear, as previously
considered a form of epilepsy.
Stopped patients affected by this disease
being treated as mentally ill.
1874: Jean-Martin Charcot named
In the mid-1800s, a young man with otosclerosis was noted
to have hearing improvement following a skull fracture.
Post-mortem examination of his temporal bones revealed a
fracture through the horizontal semicircular canal.
Kessel attempted to create a similar fistula in patients with
otosclerosis using a hammer and gouge.
In 1876, Kessel removed the stapes and covered the oval
window with scar tissue. These early attempts at treatment
Johannes Kessel (1839 Salzen Hessen)
Discovered what he called the caloric reaction.
Syringing fluid to a patient and the patient
experienced vertigo and nystagmus with cold water and
to the opposite direction with warmed water.
“The direction of flow of the endolymph was
providing the propioceptive signal to the vestibular
This observations made surgical treatment of vestibular
organ diseases possible.
1914: Nobel Prize in Physiology or Medicine for his work
on the Physiology and pathology of the vestibular
He also investigated other aspects of equilibrium control,
including the function of the cerebelum.
1929: Opening in the lateral semicircular
canal covered by a tympanic membrane
1937: He published the first successful
case of fenestration for treatment of
deafness caused by Otosclerosis.
This operation was described in 2, 3 or
more stages to combat infection.
Tumarkin reported that decompression stylomastoid artery was
necessary for the proper treatment of Bell's palsy.
Balance and Duel described the decompression of the distal
portion of the facial nerve in the stylomastoid foramen.
Sterling Brunell performed the first facial nerve repair with a
graft for the recovery of facial muscle movement.
Bell’s Palsy 1930’s
Long Island Medical School.
1.5 mts tall.
He visited the Manhattan Eye and Ear Infirmary,
Mount Sinai, Columbia, and NYU residency
One stage fenestration of the lateral semi-circular
canal operation for otosclerosis.
Dental drill for mastoidectomy.
Precursor to the operating microscope, he
employed a bright headlight and magnifying loops
so he could see well.
ENT in Mount Sinai hospital.
1952: Rosen accidentally mobilised the stapes during
routine stapes mobility test of the ossicular chain
He found a significant, immediate hearing
He design a new surgical technique: Rosen
Fracture of the anterior crus
Remove portion of the footplate
Mobilization the rest of the footplate anteriorly
However, he did not receive widespread acclaim in
his own country.
Hardvard Medical School in 1928.
ENT in Massachusetts Eye and Ear Hospital in
>400 articles in medical journals, edited
the Archives of Otolaryngology for 10 years, and
wrote the textbook Surgery of the Ear (1959), which
remains in print.
His medical career spanned 70 years: he continued
to see patients until a week before his death.
First physician to use an operating microscope in
delicate ear surgery in the US.
George E. Shambaugh Jr.
He studied chemistry and physics.
He was offered a by Barany (he dismissed because of the
hard Swedish winters). He went to Harvard and the Hawaii.
He was able to observe that the basilar membrane moves
like a surface wave when stimulated by sound.
The placement of each sensory cell (hair cell) along the coil of
the cochlea corresponds to a specific frequency of sound (the
1961: Nobel Prize for discovering the physical mechanism
that occurs in stimulating the cochlea.
Békésy audiometer operated by the patient.
Georg von Békésy
He developed and invented the Cochlear implant.
He earned a medical degree from the University
of Southern California after two years in the US
1946 he co-founded The House Ear Institute with
his older half brother, Howard House
1961: First cochlear implantation. Unsuccessful
because it was rejected by the patient's body.
1969: Successfully implanted longer lasting
William P. House
1923 – 2012
Kansas City, US
Hardvard Medicine School. ENT in "Massachusetts Eye and
Ear Infirmary" en Boston
1956: He performed the first successful reconstructive
Removed the stapes, covered the oval window with a vein graft
and inserted a prosthesis to replace the diseased stapes bone.
The patient’s hearing was restored and she heard well for long
He has pioneered numerous techniques in the treatment of
hearing loss and dizziness, developed many instruments and
Performed > 40,000 stapedectomies, (> 90% success rate)
His technique, perhaps with some modifications, is still
John J. Shea, Jr.