Otosclerosis and the History of Stapes Surgery

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Abstract presented at the meeting British Society for the History of ENT

Held December 6th 2012

In the Toynbee McKenzie Room, at the Royal Society of Medicine, London
Otosclerosis and the History of Stapes Surgery

Authors : Mamoona Khalid-Raja. John Oates

Queens Hospital, Burton Hospitals NHS Trust. Burton-On-Trent.
Ludwig van Beethoven (1770-1827) was considered to have mixed hearing loss attributed to otosclerosis. Beethoven first admitted his deafness at the age of thirty-one when writing to a friend complaining of progressive worsening of his hearing. His deafness drove him to social isolation and his last public performance was at the age of forty-four.

Toynbee (1857) first described ‘osseous anchylosis of the stapes to the fenestra ovalis’ as a common cause of deafness. Politzer in 1893 went on to describe in detail bony ankylosis and named it otosclerosis.

The first ever stapes surgery was attempted by Kessel in 1876. He tried to mobilise the stapes by applying pressure to its head in various directions and then if fixed, removed it. Similar work was conducted in France and USA. The results were variable and stapes surgery came into disrepute.

The revival of stapes surgery occurred in the 1950s by work conducted by Homgren, Sourdille and Lempert. This was aided by the development of improved anaesthesia, lighting, microscopes, antiseptic techniques and antibiotics.

Julius Lempert M.D. was a Russian immigrant who developed the single stage fenestration operation. Samuel J.Kopetsky was a prominent, influential physician who attempted to steal Lempert’s credit but was fortunately unsuccessful.

In 1952 Rosen accidentally mobilised the stapes and found a significant, immediate hearing improvement. In 1958 John Shea revived the stapedectomy operation (Rarely seen video clip of his work will be shown) and over the following forty years developed his technique using a vein graft, various prosthesis, microdrill and then laser. It is these principles which are applied to modern stapes surgery.

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