Historical development

Development of ENT medicine

ENT medicine as we know it today and as we apply it in our ENT practice in Frankfurt am Main looks back on a very long history. We would like to give you a brief insight into this history in the following article.

The second half of the 19th century saw an impressive and above all significant development: all kinds of new medical specialities emerged. In addition to ophthalmology and dermatology, the ENT medicine from general medicine and from then on developed into an independent field.

Laryngology - the medical speciality that deals with the larynx and its diseases - emerged in the medical clinics. Special laryngological consultations were introduced for the treatment of laryngeal tuberculosis, for example.

At the same time, more attention was also paid to the ears: ear specialists (known as otologists) were predominantly surgeons at the time. At that time, surgical treatment of ear problems was the only treatment for ear diseases that promised success. The surgeons worked in private clinics or in the surgical departments of large hospitals.

The trigger for the development of the ENT-The development of medical science lay in the remarkable emergence of new surgical procedures made possible by the introduction of anaesthesia. But the rapid growth in the population also played its part.

History of the development of general ENT medicine

This was because a large number of patients were sometimes treated in the hospitals, which gave doctors new experiences and more practice. Otology and laryngology were first developed in Paris, London and Vienna. It was not until the last third of the century that Berlin and other German university cities joined in.

Interesting facts about practical otology

Adam Politzer: The most famous otologist at the end of the 19th century

Adam Politzer (1835-1920) came from Hungary and worked in Vienna. Following his studies, he worked physiologically, morphologically and experimentally on the middle ear, the tympanic tensor muscle (Musculus tensor tympani) and the Eustachian tube (also known as the Eustachi tube). He visited the most important institutes of his time in Heidelberg, Paris, London and Würzburg. He had also made a name for himself at the time with his theoretical work.

Following his study trips, the Vienna faculty promoted him to lecturer in otology. A few years later, he became the first professor of this speciality and head of the University Ear Clinic.

In a short time, Politzer's clinic developed into the most important school for otology.

Adam Politzer's work on the treatment of functional disorders of the eustachian tube and on adhesive otitis (ear disease in which a thin, retracted eardrum is sucked into the middle ear cavity and adheres to the ossicles and other bones of the middle ear) was groundbreaking. He also worked on the origin and development of chronic suppurative inflammation of the middle ear with bone destruction (cholesteatoma). Politzer is also known as the discoverer of the Otosclerosis - a disease of the bone surrounding the inner ear - known as a separate clinical picture.

Politzer's students were well-known otologists such as Barany, Neumann and Alexander.

The development of nasal medicine

In the second half of the 19th century, rhinology - i.e. nasal medicine - took a back seat.

The surgeon Konrad Johann Martin Langenbeck had described bone growths and thickening of the nasal septum in 1842, but a systematic expansion of septal surgery could not take place until 1884, as new anaesthetics were only gradually discovered.

The first Nasal septum surgerys related to fractures (Asch, 1890). Gustav Kilian began in 1900 with the development of modern submucosal septal resection, i.e. the surgical treatment of a deviated nasal septum.

Gustav Kilian (left), Morell Mackenzie (right)

The first textbooks dealing with nasal medicine go back to Spencer Watson (1875) and Morell Mackenzie back. He wrote the classic work "Manual of Diseases of the Throat and Nose". Jansen and Killian developed their methods of frontal sinus surgery in 1884 and 1885.

A few years later, the American H. P. Caldwell (1893) and the Frenchman Henri Luc (1894) independently developed a special surgical method: radical surgery of the maxillary sinus after opening from the canine fossa of the facial skull (fossa canina).

Further discoveries in rhinology

1854 described Theodor Billroth nasal polyps, which he thought were oedematous growths. Virchow, on the other hand, believed in 1863 that they were myxomatous, i.e. mucus-forming formations. Edward Woaks from London, on the other hand, was of the opinion that nasal polyps were swollen mucous membranes that were mainly formed from the mucous membrane. Sieve bone comes. In addition to the adenoids, the palatine and pharyngeal tonsils (tonsils) also came into focus: the Würzburg anatomist Theodor Kölliker examined the Tonsils 1852 microscopically and macroscopically. The final description of the finer structure was carried out by Waldeyer in 1884.

The TonsillectomyThe complete surgical removal of the palatine tonsils was an operation that was viewed very critically by the old surgeons, as it was usually associated with high blood loss in the patient. This only changed when Morell Mackenzie developed an alternative method for tonsillectomy. He used a tonsillotome built by Phillip Physick, a special surgical instrument for removing the tonsils. Today it is known as the "flagpole".

In 1852, Kölliker surmised that tissue similar to that in the palatine tonsils could be present in the nasopharynx. In 1868, the Copenhagen physician Hans Wilhelm Meyer The doctor was able to give a precise description of the adenoids and recorded the symptoms of an enlarged adenoid very accurately. As a result, the disease could now be diagnosed by any doctor. He developed a method with which the adenoids could be removed with a ring knife (adenotomy). He also recognised the positive effects of adenoid surgery on nasal breathing and ventilation of the middle ear.

Rudolf Albert Kölliker (left), Wilhelm von Waldeyer-Hartz (right)

Laryngology: The beginnings of the medical speciality that deals with the throat and larynx

The breakthrough for the Laryngology came with the development of the laryngeal mirror through Manuel Garciaa Spanish singing teacher and professor at the Academy of Music who lives in London.

Manuel García (left), Nepomuk Czermak (right)

He had been studying the larynx and its functions for a long time. During a holiday in Paris, he came up with the idea of Vocal cords himself - with a special arrangement of mirrors. He obtained these from the Parisian instrument maker Charrière. Garcia demonstrated his new method in London in 1854.

Two years later, the Viennese neurologist Ludwig Türckto use laryngoscopy on his patients. Nepomuk Czermak, a physician and physiologist living in Budapest, borrowed the mirrors from him and used them to examine his patients. He also used artificial light.

Interesting facts about laryngeal diseases, their diagnosis and treatment

For many years, laryngology was limited purely to diagnostics, a possible determination of the prognosis and interventions within the larynx, from biopsies to the removal of polyps.

In 1732, Margagni wrote about laryngeal cancer for the first time in a dissection report. In 1798, the removal of a foreign body via the laryngofissure by Pelletan was named. With the introduction of the method of laryngoscopy, the clinical picture of laryngeal cancer became clearer. It was not until 1873 that the first surgical removal of the larynx (laryngeal total extirpation) was performed by Billroth.

Langenbeck succeeded in performing the first pharyngeal transverse resection. Themistocles Gluck and Soerensen created improved surgical methods that are still valid today. They brought about a turnaround: The primary mortality rate fell drastically from 80 per cent to less than 1 per cent.

Bernhard von Langenbeck (left), Themistocles Gluck (right)

Plastic reconstructive surgery in ENT medicine

The First World War, with its countless disfigured and severely injured victims, paved the way for a new branch of ENT medicine: plastic reconstructive surgery of the head and face with the Berlin doctor Jacques Joseph as a pioneer.

Jacques Joseph (left), historical nasal surgery around 1900 (right)

The knowledge and observations gained from the gruesome experiences in the field hospitals formed the basis for standardised surgical procedures, which are still the basis for certain trauma and tumour surgery procedures today.

Joseph is not only known for this, but also as the father of aesthetic head and neck surgery. He wrote a standard work on facial and nasal surgery. This went far beyond the actual core subject.

Breakthrough in ENT medicine: minimally invasive operations

The cold light endoscope was developed in the 1960s. This marked the birth of "keyhole surgery" - a revolution in medicine. The ENT-healthcare benefited from this in particular. Narrow and hidden target areas in the head and neck had previously made access routes extremely difficult.

With the help of cold light endoscopy, it was now possible to perform gentle, minimally invasive surgery on the paranasal sinuses and larynx.

Hearing and auditory processing are still complex topics

Despite modern science and the many new findings, hearing and auditory processing have only been partially understood to this day. Nevertheless, there was a great leap forward in the 1970s and 1980s: objective measurement methods for recording the function of auditory nerves and auditory cells were introduced.

This was accompanied by implantable hearing aids, which enabled deaf and deafened people to hear in society. Nevertheless, it seems that hearing aids are still a taboo subject in our society. Yet modern digital hearing aids, as they are now on the market, are very powerful, comfortable and even unobtrusive. Some of them can already be controlled and customised using an app.

Snoring and sleep apnoea should not be taboo subjects

Another topic in ENT medicine is snoring. Many patients are still reluctant to go to the doctor about it. They are embarrassed to talk about snoring at night, which can also have a negative impact on their relationship. Snoring can also have an impact on performance and the frequency of illness. Snoring in combination with breathing interruptions is particularly risky. Due to persistent Sleep apnoea cardiovascular diseases and other health problems in the long term.

In recent years, a lot has happened in the field of ENT medicine in terms of snoring therapy and Sleep apnoea concerns. A wide range of diagnostic and minimally invasive therapeutic measures can help patients.