Otology: Quick Historical Review

The physicians of Egypt may have been the first medical specialists:

Imhotep, 30th century BC,

Breasted ,Edwin Smith Papyrus (3000-2500), earliest known scientific document, includes several descriptions of temporal bone fractures,

Maxims of Ptahhotep (2400 BC) indicate that they were aware of presbycusis ,

The Ebers Papyrus, a sacred Egyptian pharmacopoeia (1500 BC), contains a chapter entitled: "Medicines for the Ear With Weak Hearing".

The first acoustician among the early Greek Natural Philosophers seems to have been the philosopher-mathematician-musician Pythagoras (Croton, Magna Graecia, Southern Italy) ( 6th Century BC). His particular contribution to acoustics was to establish the law relating the pitch of a musical note produced by a monochord to the length of its vibrating string.

Of the same city and century was the physician Alcmaeon who made the first anatomical dissections. to be remembered as the progenitor of neuroanatomy and physiology. he was the first to take note of the cranial nerves and first to recognize the brain as the seat of the intellect.

The Sicilian Philosopher Empedocles , founding father of chemistry because it was he who devised the long-lived theory of the 4 elements : earth, water, air and fire. It is possible that he discovered (or imagined) the cochlea ( giving the name of the spiral-shelled murex). Empedocles is said to have taught that hearing occurs when air strikes that part suspended within the ear that is coiled like the shell of a snail.

Plato(427-347 BC) characterized sound as a shaking of the air.

Aristotle (384-322 BC) received both credit and blame for the doctrine of "implanted air" which dominated thought about he ear anatomy for 2000 years, :"the air inside the ear  (inner ear) is lodged fast within walls to make it immovable..."  . Not until 1760 that Cotugno of Naples showed the implanted air to be a hoary Greek myth. In his De Sensu and Di Memoria he attributed to hearing a greater share in the development of intelligence than to vision, the blind are more intelligent than deaf-mutes.

Hippocrates (460-377 BC) ( Island of Cos), lie mainly in the realm of ear disease and its treatment. One of his recorded anatomical observations has to do with the external canal, which leads a bone of extraordinary hardness, whereas the surrounding bone is full of air spaces. He also recognized the tympanic membrane describing it as a "cobweb" and especially suited by its dryness for the reception of sounds.

A Roman anatomist of the 1st century AD, Rufus of Ephesus gave the names pinna, lobe, helix, concha ... to the various features of the external ear.

Aulus Cornelius Celsus is the most important Roman medical writer and the first medical historian. He included chapters on Aurium morbi, otitis, deafness, tinnitus and foreign bodies in the ear. He included brief chapters on Morbi aurium chirurgici  including atresia of the external ear canal and injuries to the cartilage of the pinna.

Galen (130-200 AD), his chief contribution seems to have been the introduction of the term labyrinth. Politzer suggested it was more an expression of ignorance than of understanding of the complex structures within the petrous bone.  He recognized the value of the pinna as a collector of sound. He was able to differentiate, for the first time, between the facial and the auditory nerves and to follow the course of the former through its canal in the temporal bone to its exit at the styloid process.

A long series of great anatomists appeared in Italy during the 16th century, beginning with:

Bartolomeo Eustachi (1510-1574), Filippo Ingrassia (1510-1580), Andreas Vesalius (1514-1564), Gabriele Falloppia (1523-1562), Girolamo Fabrizi (1537-1619), Guilio Casseri (1561-1616) and several others.

Vesalius, perhaps unaware of his predecessors , reported his own discovery of the malleus and the incus, but he did not mention the stapes, which, as he later admitted, he had failed to notice.

Filippo Ingrassia (1510-1580), a native of Sicily, was also at one time a professor at Padua, known throughout Italy as "Sicilian Hippocrates", is given credit for discovering the stapes.

For the discovery of the  Malleus and Incus, credit given to Berengario da Carpi (1470-1550).

 Bartolomeo Eustachi (1510-1574) supported the teaching of Galen in opposition to those of Vesalius. His greatest contribution was his precise description of the tube , the only structure that actually bears his name. In the Tabulae, he showed a longitudinal section through the temporal bone, with the tympanic cavity, the semicircular canals, and the spiral of the cochlea properly located.

Gabriele Falloppia (1523-1562) was a professor of anatomy at Padua, was hailed as the "Aesculapius of his century". Recounting his discovery and exploration of the Fallopian aqueduct or facial canal in his brief work, Observationes anatomicae, published in 1561 shortly before his death, he gave also a careful account of the middle ear cavity, naming it for the first time the tympanum., described the ossicles, the vestibule and the cochlea, pointing out that there is little change in the size of these structures  after birth.

Giulio Casseri (1561-1616) started at Padua as diener  and assistant to Fabrizi. He can be regarded as perhaps the earliest  comparative anatomist i his field. He also gives the first exact description of the round window membrane, previously seen by the Florentine Guido Guidi (the Vidius of the Vidian nerve), who had been one of the teachers of Vesalius at Paris.

Constanzo Varoli (1543-1575), a neuroanatomist of Bologna, his name is attached to the pons, and gave the first clear description of the stapedius muscle.

Claude Perrault (1613-1688) described the "spiral membrane" as soft and flexible, attached only to the modiolus and not to the opposite wall. He also had theories of noise-induced and presbyacusic loss of hearing.

Jean Mery (1645-1722), anatomist and surgeon of the Hotel-Dieu, rediscovered the membranous spiral lamina, which had been seen by Eustachi to divide the cochlea into 2 scalae but had since been forgotten.

Guichard Joseph Duverney (1648-1730) called attention to the width of the osseous spiral lamina, which gradually narrows from the base to the apex.

The philosopher Francis Bacon (1561-1626) was aware of auditory masking and overexposure, he described the design of an "ear spectacle" or ear trumpet.

Thomas Willis (1622-1675), in his De anima brutorum, was the first to recognize the cochlea as the true organ of hearing and to mention the possibility of diplacusis. In his Cerebri anatome, he demonstrated the origins of the facial, auditory, and accessory nerves. He also suggested a theory of the distribution of tones in the cochlea that preceded that of Duverney.

Gunther Christoph Schelhammer (1649-1712). Using a musical instrument held between the teeth, he anticipated the 19th century otologists with their tuning forks. Politzer pointed out that a similar test of hearing had been proposed by Hieronimo Capivacci (alias Capo di Vacco) of Padua, who died in 1589.

Antonio Maria Valsalva (1666-1723), whose teacher was the great histologist Maecello Malpighi (1628-1691) and whom  Valsalva succeeded as professor of anatomy, published ten superb plates with illustrations, among them dissections of the outer, middle, and inner ear. He recognized the importance of the ossicular chain as a series of levers transmitting sound to the oval window. in one case of deafness, he was able to demonstrate disarticulation of the incudo-stapedial joint; in another case, he described ankylosis of the stapes. Valsalva went beyond Duverney, pointing to the membranous portions of the labyrinth, rather than the spiral osseous lamina, as the sites of termination of the branches of the auditory nerve, and regarded them as receptors for sound. He was more than a century in advance of Helmholtz.

Giovanni Battista Morgagni (1682-1771) reported the effects of experimental perforation of the tympanic membrane in a dog. He considered the relation between otitis media and brain abcess.

The work of Domenico Cotugno (1736-1822) of Naples and Antonio Scarpa (1747-1832) of Modena and Pavia gave the coup de grace to Aristotle's implanted air theory. It is based on a departure from tradition: the dissection of the fresh rather than the macerated temporal bone. Cotugno described both the cochlear and the vestibular aqueducts and the clear liquid (perilymph) that he had seen filling the bony labyrinth. He was not aware of the membranous labyrinth within.

In fact, the presence of fluid in the labyrinth already had been noted almost 20 years earlier by Theodor Pyl of Greifswald in his dissertation published in 1742.

Antonio Scarpa called the round window a secondary tympanic membrane.  He presented his discovery of the membranous labyrinth, including the "spiral passage" (cochlear duct), filled of fluid (endolymph). 

The anatomy of the ear and its nomenclature were clarified by Gilbert Breschet (1784-1845). Taking as his model the taxonomic achievements of Carl von Linne in Sweden , he defined vague old terms with precision and coined important new ones, among them endolymph, perilymph, helicotrema, otolith, and otoconia.

Johannes Muller (1801-1858) recognized the importance of that physical principle in audition when he discussed the transmission of sound from one medium to another, and the contribution of tense membranes, such as those of the ear drum and the round window.

Friedrich Rosenthal (1780-1829) found the canal in the modiolus that carries his name and contains the spiral ganglion.

Emil Huschke (1797-1858) of Jena, discovered the zona dentata of the limbus during his study of the avian inner ear and is thus remembered for "Huschke's teeth".

Alfonso Corti (1822-1876) was born at Gambarana in Lombardy, he described for the first time the sensory epithelium resting on the basilar membrane as well as the tectorial membrane, the stria vascularis, the spiral ganglion... Upon the death of his father, Corti succeeded to the family title, he withdrew completely from scientific activity and medicine, even refusing to be called by the bourgeois title of Doctor.

Ernst Reissner (1824-1875), reported in 1852 his discovery of the vestibular membrane, which separates the cochlear duct from the scala vestibuli and bears his name as eponym.

Otto Friedrich Deiters (1834-1863) of Bonn, discovered not only the highly specialized cells that sustain the outer hair cells and the reticular lamina of Corti's organ, but also the large multipolar cells of the lateral vestibular nucleus, which bears his name.

Arthus Boettcher (1831-1889) was the first to furnish a description of the reticular lamina itself. The darker staining cells resting on the basilar membrane throughout the basal turn are his. They are covered by the pale cells near the outer sulcus, first pictured by Matthias Claudius (1821-1869) of Copenhagen. Closer to the reticular lamina are the darkish cells that are called after Viktor Hensen (1835-1924) of Kiel, to whom we also owe the ductus reuniens, linking the cochlea and the saccule.

Magnus Gustav Retzius (1842-1919) employed with great skill the method of microdissection of the labyrinth.

Hermann Ludwig Ferdinand von Helmoltz (1821-1894). Among his contributions, his studies on the mechanism of the tympanic membrane and the ossicular chain...

Theodore Bast

Barry Anson

E.G. Wever

Georg von Bekesy (1899-1972)

Joseph Toynbee (1815-1866)

CS Hallpike (1900-1979)

Imrich Friedmann

Stacy Guild (1890-1966)

Harold Schuknecht (1915-1996)

Karl Wittmaack (1876-1972)

Harvey Fletcher (1884-1978)

S Smith Stevens (1906-1973)

Raymond Carhart (1912-1975)

Hallowell Davis (1896-1993)

Theodor Walsh (1900-1971).

VESTIBULAR PHYSIOLOGY

Marie-Jean-Pierre Flourens (1794-1867) , in 1824 he reported that he had cut individual semicircular canals in pigeons and had observed dramatic effects on the motions of the head and on the behavior of the birds. Had inspired Prospere Meniere (1799-1862) in his recognition of what had long been termed "apoplectiform cerebral congestion" and is now known as Meniere's disease.

J Breuer ( Vienna, 1873), Ernest Mach ( Prague, 1873) and A. Cum Brown (Edinburgh, 1874) independently reached the conclusion that the semicircular canals constitute the sense organ for rotation.

de Cyon (Paris, 1878) related the direction of nystagmus to the stimulation of the individual canals.

J.R. Ewald (Strassburg, 1892) showed that nystagmus in either direction can be evoked by stimulation of either labyrinth.