Otitis media with effusion: Politzer's 100 year legacy.

Otitis media with effusion has been the subject of a number of recent studies. It was first recognised during the second half of the 19th century, when Adam Politzer (1835-1920) of Vienna was one of the leading otologists of this period and a founding father of the specialty. He had emphasised in his textbook the importance of tympanoscopy, which had led to the recognition of what was then known as 'catarrh of the middle ear' as a clinical entity. Politzer's original illustrations and concise accounts give a clear image of the contemporary state of knowledge of the condition and its treatment, which includes myringotomy, adenoidectomy and the insertion of tympanostomy tubes. From his textbook we can also glean insight into the evolution of both otology as a specialty and OME in particular.

Nasopharyngeal radium irradiation: The lessons of history.

In the Netherlands, nasopharyngeal radium irradiation was started in 1945. The indications included refractory symptoms of otitis media with effusion and other adenoid-related disorders after adenoidectomy. It was considered a safe and effective therapy. Its use decreased sharply in 1958, following a worldwide media avalanche around the dramatic events in the treatment of a 5-year-old child in Utrecht, enhancing the widespread fear of radioactivity. This case history illustrates the powerful role of the media in medical decision-making.

The tympanostomy tube: an ingenious invention of the mid 19th century.

The introduction of the tympanostomy tube in the treatment of otitis media with effusion in the mid 20th century completely revolutionized its therapy. Nevertheless, it was not a new idea. The aim of this research is to elucidate the origin of prosthetic middle ear ventilation in the mid 19th century. A review of primary sources revealed at least seven different models of tympanostomy tube which were manufactured between 1845 and 1875. These included: Frank's gold tube, Lincke's rubber tube, Bonnafont's silver cannula, Politzer's hard rubber drain, Miot's metallic eyelet, Voltolini's gold ring, and Bonnafont's eyelet. Study of these early innovations shows that all of the technical and surgical principles of the tympanostomy tube were known in the mid 19th century. Widespread introduction into otological practice did not occur until the mid 20th century invention of the operating microscope.

The glue ear 'epidemic': a historical perspective.

This paper explores the historical context of the dramatic rise in surgery for glue ear in the mid-20th century, and questions the published assertion that this represented a manufactured 'epidemic'. In examining historical sources, the reader's theoretical viewpoint greatly influences their conclusions: the sustained rise in treatment for glue ear may be seen as the advance of science in a golden age or the resistance of insular professionals to reason in the light of new scientific study methods. Current views on the practice of medicine, consumerism, science and standardisation, rationing and the nature of 'truth' all affect the way that we see this period. Technological advances clearly allowed better diagnosis and more effective treatment, but these did not appear to drive an 'epidemic', rather they were developed to meet the pre-existing challenges of otological practice. The proposition that an 'epidemic' was created does not appear to have any solid grounding. Society's perception of what constitutes disease and what needs treatment may have evolved, but the prevalence of other important diseases changed dramatically over this time period, and a real change in the epidemiology of glue ear cannot be dismissed. In defining the case for and against surgical treatment, a solely positivist, quantitative worldview cannot give us a complete picture of benefit and risk to individuals, families and society at large.

Serous otitis media in the 20th and 21st centuries: evolving views and treatments.

CONCLUSIONS: The historical study of serous otitis media (SOM) demonstrates steps in recognition of the disease, shifts in prevalence, and relationships between the disease's affect and evolving economic bases of society. OBJECTIVE: SOM, although noted in early Roman and Arabic medicine, was only identified as a distinct and significant pathology in the last half of the 20th century. This paper examines the development of understanding of SOM, and ways in which it has been cared for during the 20th and 21st centuries. MATERIALS AND METHODS: The medical literature from antiquity to the present was reviewed for mention of otological conditions that related to SOM. For this report, the primary source of each notation was examined. RESULTS: The first part of the 20th century saw little change from earlier times in the recognition or treatment of SOM. Our current 21st century conceptualization and concern for SOM has come about from five advances: antibiotics, the rediscovery of the tympanostomy tube, the clinical use of middle ear impedance, the association of a history of otitis with linguistic deficiency, and recognition of the significance of transformation to a communication-based economy.

History of myringotomy and grommets.

The first recorded myringotomy was in 1649. Astley Cooper presented two papers to the Royal Society in 1801, based on his observation that myringotomy could improve hearing. Widespread inappropriate use of the procedure followed, with no benefit to patients; this led to it falling from favour for many decades. Hermann Schwartze reintroduced myringotomy later in the nineteenth century. It had been realised earlier that the tympanic membrane heals spontaneously, and much experimentation took place in attempting to keep the perforation open. The first described grommet was made of gold foil. Other materials were tried, including Politzer's attempts with rubber. Armstrong's vinyl tube effectively reintroduced grommets into current practice last century. There have been many eponymous variants, but the underlying principle of creating a perforation and maintaining it with a ventilation tube has remained unchanged. Recent studies have cast doubt over the long-term benefits of grommet insertion; is this the end of the third era?

Autoinflation: historical highlights and clinical implications.

In 1563, Eustachius first described the tube that came to be named for him. In 1704, Valsalva described the maneuver that bears his name, and in 1836 Deleau became one of the first to advocate infusion of pure air through the eustachian tube using a catheter. Politzer devised his own method for actively inflating the middle ear without using a catheter in 1863. Most modern studies examining the use of autoinflation in the treatment of secretory otitis media have shown a beneficial effect, with effusion being cleared in 52 to 62% of ears up to nine months after the treatment. In two studies, no effect of autoinflation could be demonstrated, and in one publication the autoinflation group had deteriorated compared to the control group. In light of the fact that secretory otitis media is a benign and transient condition, that treatment with antibiotics or insertion of ventilation tubes is not without problems, and that the chance of improving the condition by autoinflation is approximately 50%, it is concluded that autoinflation should be considered first-line treatment, before antibiotic or surgical treatment is planned.

Causes of glue ear. An historical review of theories and evidence.

Over the past one hundred years medical views on the cause of glue ear have frequently changed. The medical literature was reviewed to see if these changes reflected advances in the level of scientific support for different causes. This revealed that only a few of the many proposed causes command any scientific support. An explanation for the changing pattern of views on the aetiology of glue ear was therefore sought by considering secular changes in medical knowledge and belief in general. This suggested that the views held on the cause of glue ear at any given time are influenced and largely determined by the prevailing knowledge and beliefs of medicine as a whole. This phenomenon is not peculiar to glue ear--though conditions about which there is considerable uncertainty are probably more susceptible to such influences.

Fashion, science and technical change: the history of the treatment of glue ear.

One reason for the current epidemic in the rate of surgery for glue ear in children is that a shift in treatment has taken place from non-surgical to surgical methods. An historical review of the treatment of this condition reveals the existence of previous 'surgical epidemics' and the importance of two particular factors-technical developments, such as the design of tympanostomy tubes and the introduction of antibacterial drugs; and the lure of panaceas such as ionizing radiation. In addition, it reveals how medical practice is, like most human behaviour, subject to fashion. Despite this, there is a constant desire by practitioners to be adjudged 'scientific' in their work, and definitions of science are equally susceptible to change over time.

Is glue ear a modern phenomenon? A historical review of the medical literature.

There are many anecdotal reports of the recent increase in the incidence of surgery for glue ear, a phenomenon that the medical literature has considered to be a reflection of both an increased prevalence of the underlying condition and its increased detection. However, there has been no attempt to assess these considerations by means of an historical study. This reveals that, contrary to contemporary belief, the condition for which surgery is carried out has been recognized as a commonly occurring problem from at least the early 19th century. This suggests that changes in the surgical rate are more likely to reflect an 'apparent' rather than a 'real' increase in the underlying morbidity rate.