A brief history of otorhinolaryngolgy: otology, laryngology and rhinology

Rev Bras Otorrinolaringol 2007;73(5):693-703. REVIEW ARTICLE A brief history of otorhinolaryngolgy: otology, laryngology and rhinology João Flávio Nogueira Júnior 1, Diego Rodrigo Hermann 2, Ronaldo dos Reis Américo 3, Iulo Sérgio Barauna Filho 4, Aldo Eden Cassol Stamm 5, Shirley Shizuo Nagata Pignatari 6 Keywords: history of medicine, otorhinolaryngology. Summary E ars, nose and throat have intrigued humanity since immemorial times. Treatments for the larynx, the nose and the ear and also surgeries were practiced by Greek, Hindu and Byzantine doctors. In the 20th century clinical and surgical innovations were incorporated, thanks to new anesthesia techniques, antibiotics, radiology and new technologies. Aim and method: show the evolution of this science throughout the times, recognizing important persons in otology, rhinology and laryngology. Results and conclusion: Understanding the evolutions in clinical and surgical anatomy, physiology, treatment modalities, and the personalities that lead to these advances is of great importance for the evolution of medical science. Otorhinolaryngology has a very rich history, with important collaborators and personalities in the history of medicine. The specialty was one of the first to use local anesthesia for procedures, pioneer in treatments with devices that recouped hearing and the use of microscopes in surgeries. Few medical specialties had suffered as many changes and scientific developments in these last decades as Otorhinolaryngology had, with the advantage of incorporating technologies such as endoscopy, radiology, microsurgery and information technology. MD. ENT resident - Hospital Prof. Edmundo Vasconcelos. MD. ENT resident - Hospital Prof. Edmundo Vasconcelos. 3 MD. ENT resident - Hospital Prof. Edmundo Vasconcelos. 4 Otorhinolaryngologist, Otology Fellow - HCFMUSP, PhD Student in Otorhinolaryngology - HCFMUSP. 5 PhD in Otorhinolaryngology - UNIFESP, Head of the Otorhinolaryngology Center - São Paulo - Hospital Prof. Edmundo Vasconcelos. 6 PhD in Otorhinolaryngology - Escola Paulista de Medicina - UNIFESP, Head of the Pediatric Otorhinolaryngology Department - Otorhinolaryngology Center - São Paulo / Hospital Professor Edmundo Vasconcelos. Centro de Otorrinolaringologia de São Paulo - Hospital Professor Edmundo Vasconcelos. Send correspondence to: Rua Borges Lagoa, 1450 3º Andar Prédio dos Ambulatórios Vila Clementino São Paulo 04038-905. Paper submitted to the ABORL-CCF SGP (Management Publications System) on March 22th, 2006 and accepted for publication on March 29th, 2007. cod. 1801. 1 2 BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY 73 (5) SEPTEMBER/OCTOBER 2007 http://www.rborl.org.br / e-mail: 693 INTRODUCTION space within the inner ear, which vibrated in response to sound. Pure air was implanted in the ear as the person was born, and congenitally deaf people did not have this air implanted there. As time passes, people would lose this pure air, thus reducing hearing1. During the Roman Empire, medicine used Greek knowledge and many of their teachings, and incorporated new discoveries. Cornelius Celsus, in the 1st century A.D., was the first to describe a tonsillectomy, doing it with his own fingers, and some new treatment options for tinnitus, foreign bodies in the outer ear canal and surgeries for external ear canal atresias1. Galeno, personal physician of the Roman Emperor Marcus Aurelius, dissected the ears of dogs and monkeys. Even without a microscope, he was able to dissect the inner ear and called the structure he found “Creta Labyrinth”, admitting his ignorance as to the functioning of such organ1. After the fall of the Roman Empire, very little was added to the existing medical knowledge on otology in the Middle Ages. It was only in the XVI century, during the renascence, that paintings and sculptures helped in anatomical studies, from people like Leonardo da Vinci, Michelangelo, Eustachio, Fallopius, amongst others1. Nose, throat and ears have intrigued human kind since immemorial times. Greek, Hindu and Byzantine physicians already practiced treatment and surgeries on the nose, throat and ears. In the XX century, clinical and surgical innovations were incorporated thanks to new anesthetic techniques, antibiotics and radiology being added to the technology. OBJECTIVE AND METHODS To show the development of this science along time, acknowledging important personalities in otology, rhinology and laryngology by means of a literature review. OTOLOGY Earlier times In one of the best-known scientific documents, Ebers’s scrolls, from Egypt, there are descriptions of battle wounds on temporal bones, and how they affected hearing and speech. In the Egyptian pharmacopedia, from approximately 1,500 B.C., there is a chapter called: “Medications for the hard of hearing ear “, where one may find treatment for tinnitus, dizziness and hypocusia1. In Greece, physicians and philosophers concocted primitive anatomical studies and theories, in an attempt to explain diseases and how our bodies worked. Alcmaeon of Croton, a physician considered the father of neuroanatomy, imagined that hearing happened thanks to air movements that penetrated the ear and hit the brain in a specific site which was responsible for hearing. He thought that hearing was the result of a concussion that altered the position of the brain, making these airways hit another region1. Empedocles, Greek philosopher, known for numbering the four basic elements (fire, air, earth and water), was the first to describe the cochlea. He called the structure “κόχλος”, the name of a seashell found in the Mediterranean region. However, his discovery intrigued him more for the perfect and singular shape of that anatomical structure than its function or relation with hearing1. With merely empirical treatments, Hippocrates, was also interested in otology, however himself and his disciples were more concerned with the relations ear infections had with other organs, especially the brain and tonsils1. Aristotle, one of the best-known Greek philosophers, even without anatomical knowledge, created a theory on hearing. He believed there was a resonating XVI Century During this period, Berengario de Capri and Ingrassia from Naples - Italy, described the malleus, the incus and the stapes. Eustachio accurately described for the first time the tensor tympani muscle, identified the corda tympani as a nerve and not as a blood vessel, and the structure that has his name, the tube, described in the paper “De Auditus Organis”, where he even divides it in bony and cartilaginous parts1. Versalio, in 1543, described the oval and round windows, and also the malleus and the incus. Fallopius, from the famous medical school of Padua, discovered and explored the facial nerve canal. It was he who described and named the tympanum, for its similarity with a drum. In the paper “De morbo gallico” he described the high intensity tinnitus that may happen in advanced syphilis stages1. Fa (...truncated)