I was particularly interested in reading this book having recently reviewed The Journal of Laryngology & Otology Archives on this very subject. Mine was a snapshot effort, this is surely the standard work on this topic now. Most of us love to read of the history and evolution of surgical practice, being especially amused by the false, often illogical trails our predecessors followed. This book actually stands alone as a good review of current thinking on otosclerosis and is very readable. It is illustrated on every page, with universally well-reproduced images, in colour or monochrome. The style is very much that of Weir and Mudry in Otorhinolaryngology: An Illustrated History, so familiar to us all.
The author practices in his birthplace, Utrecht, and has 1400 stapedectomies to his name! I also noted that we both have memories of Ann Arbor, Michigan. John W House writes the Foreword; he recounts how his eminent father was told not to diagnose otosclerosis, as it condemned the patient to progressive deafness. The author describes much of the practice that followed as absurd and, in so many cases, highly dangerous.
The book opens with the early history of course. I had never heard of Giovanni Ingrassia but now learn that he was the first to notice the existence of the stapes in a cadaver. His divergent squint in his portrait is never explained. Valsalva in Bologna seems to have first described stapes fixation, Toynbee noted ankylosis in many a temporal bone, but to Politzer goes the credit for the first description of an otosclerosis focus.
Early conservative treatment involved pneumatic oto-massage of the drum to ‘exercise the ossicles’. Lucae was even more sporting; he devised a gadget to allow repeated percussion of the malleus, to mobilise the stapes. Balance finally went on to open the lateral semicircular canal, accidentally of course, but with benefit. Politzer led the sceptics, and surgery was abandoned for two decades so that medical treatment was the norm … and what treatment! This ranged from irradiation of the parathyroid glands (as late as the 1920s), to the administration of sex hormones from both genders, cortisone, and of course fluoride and bisphosphonates. The latter two are reviewed in a very updated and excellent sub-chapter.
Things got even dafter, with advice such as avoidance of the seashore, lest the noise of the surf worsen tinnitus. Irradiation of the temporal bone and thyroid simultaneously seemed like a good idea and, if the pituitary gland happened to be in the field, so much the better.
The third chapter is entitled ‘Treatment of otosclerosis and pregnancy’, but goes far beyond that and makes for very disturbing reading into eugenics. It was not just in Nazi Germany, but also in the USA that otosclerosis was seen as a ‘hereditary disease eligible for eugenical sterilization’ (sic). Many a pregnancy was terminated to avoid worsening of mother's hearing.
The book continues on more traditional lines to describe the evolution of stapedectomy, stapedotomy, prostheses and lasers. Probably the single greatest advance in evaluating all this is that we now have audiometry! It is so worth seeing the first ever Teflon® prosthesis. I always thought it was the famous strut, but it is far more elegant; it is a replica stapes with a hole in the ‘head’ to encase the long process of the incus. I would love to try one, but nowadays we are all small fenestra I guess.
I enjoyed this book immensely and will reread it from time to time, if only to remind me how deluded we may yet be in our current practice. Now I must go and decompress that sac this afternoon.
