This presentation discusses the history of middle ear reconstructive surgery

1. History of surgery for hearing
Balasubramanian Thiagarajan

2. Bezold's warning
 Patient faces more danger in the hands of
an incompetent surgeon who does not
know the intricate details of variable
anatomy of important structures that crowd
within a narrow space inside the temporal
bone.
 Anatomy of this region is also highly
variable
 Only by performing repeated temporal bone
dissections a surgeon could become safe
enough to operate in this area

3. Era of bravado
 In 1930's majority of paediatric surgeries
performed were mastoid operations.
 URI and acute ear infections followed by
complications like meningitis and brain
abscess was common. Surgery was
invariably performed to prevent these
complications
 History is replete with examples of several
children saved by performing mastoid
operations

4. Antibiotic era
 In 1928 Flemming discovered the wonder
antibiotic Penicillin. This ushered in the
antibiotic era
 Domagk in 1932 discovered sulphanilamide
opening up new avenues
 The effectiveness of these antibiotics
literally closed the doors for surgeons to
such an extent that surgery for ear
infections were condemned by International
congress of Otology

5. Ear surgery becomes constructive
 Advent of antibiotics made destructive ear
surgeries more constructive
 The number of mastoid surgeries
performed for acute otitis media became
rare
 Ear infections could be controlled /
prevented by use of these effective
antibiotics

6. Hearing preservation surgeries
 1899 Korner demonstrated that TM could
be left in place even during drastic mastoid
operations thereby conserving hearing
 1910 Bondy described his famous Bondy's
operation where pars tensa was left intact
in the presence of attic perforation
 1879 Kessel demonstrated the famous
stapes mobilisation procedure to treat
stapes fixation

7. Cont...
 1911 Barany attempted surgery as
treatment for otosclerosis
 1912 Jenkins attempted to improve hearing
by surgery in patients with otosclerosis
 1914 Holmgren joined the bandwagon of
surgeons attempting to improve hearing by
performing surgery for otosclerosis

8. Era of magnification
 1921 Nylen of Holmgren clinic first used
monocular operating microscope during ear
surgeries
 Holmgren on realizing the importance of
magnification devised binocular operating
microscope
 Using magnification and aseptic technique
he is credited to have performed the first
lateral canal fenestration with improvement
in hearing

9. Tympanolabyrinthopexy
 Sourdille inspired by Holmgren's lateral canal
fenestration technique performed lateral
canal fenestration as a staged procedure.
 He used skin flap from external auditory
meatus to cover the fenestra
 This produced a lasting improvement in
hearing with minimal risk of inner ear
infections

10. Sourdille's inspiration
 On hearing Sourdille's inspiring lecture at
New york academy of medicine 1937
Lempert started using the procedure
extensively in the US.
 Lempert modified lateral canal fenestration
procedure into a single step one
 Lepert used loupe for magnification during
the procedure

11. Shambaugh's contribution
 Shambaugh Jr performed nearly 5000 lateral
canal operations and was responsible for
standardizing the procedure
 In 1940 he innovated the use of operating
microscope
 He used diamond drill and continuous saline
irrigation during the surgery

12. Stapes mobilisation
 1879 Kessel was the first to perform this
procedure for stapes fixation due to
otosclerosis
 1953 Rosen reintroduced this procedure and
after initial success, failure rate became
unacceptable due to refixation of stapes
 Mobilisation procedure turned the focus back
to oval window instead of fenestration
procedures
 1956 John Shea used stapedectomy surgery
which is still practiced

13. Tympanoplasty
 With the advent of operating microscope
reconstruction of middle ear conduction
mechanism became popular
 1950 Moritz used pedicled flaps to construct
a closed middle ear cavity in patients with
CSOM
 1955 Zollner and Wullstein popularized the
concept of tympanoplasty
 Various middle ear prosthesis were designed
to reconstruct the sound conduction
mechanism

14. Thank you