EAR DRUM PERFORATION - ON THE HISTORY OF PARACENTESIS AND GROMMETS

As early as 1649, jean Riolan the Younger pierced an ear drum, after w hich the patient's hearing improved. This occurred as a result of an a ccidental ear drum injury while cleaning an ear canal with an ear-spoo n. In 17 th and 18 th centuries, several pioneers in medicine (Thomas Willis, Antonio Mario Valsalva, William Cheselden) conducted experimen ts in an effort to ascertain the function of the ear drum in hearing. At the end of the 18 th century, ear drum perforation, like perforatio n of a cataract, was indiscriminately performed by itinerent quacks an d ''physicians'' in England, France, and Germany. Ear drum perforation was performed in many places even for the healing of deaf and dumb. A stlee Cooper reported about success with ear drum perforation in 1800 and listed strict indications. He recommended the operation only in th e presence of obturation of the Eustachian tube. Because of the negati ve results of indiscriminate ear drum perforation, the operation soon acquired a bad reputation and was not performed for decades. It was on ly Herrmann Schwartze who reintroduced paracentesis into the daily pra ctice of otorhinolaryngology. He was director of the royal ENT clinic in Halle and published a trail-blazing treatise on the indications, va lue, and success of this operation. Since physicians had soon realized that spontaneous healing tendencies of the ear drum quickly lead to c losure of an artificial perforation, many physicians tried different t echniques to obtain a permanent opening. Gruber resected half of the e ar drum - unsuccessfully. Others put foreign bodies into the ear drum apertures, such as catgut, whalebone rods, and lead wires. In his text book of 1845, Martell Frank first described a grommet made of gold foi l. Politzer experimented with a hard rubber ring but later abandoned h is attempts because of lack of success. Voltolini manufactured an open hollow ring of gold foil or aluminium, which had to be fixed at the h andle of the malleur. Armstrong described a ''new'' therapy for chroni c secretory otitis media consisting of inserting a vinyl tube into the ear drum. While he was not the inventor of the grommet, he was the fi rst to reintroduce grommets in the middle of the 20 th century. Thermo paracentesis was performed as early as 1867 by Voltolini, who performe d this operation using a galvanic cautery device. After more than 100 years, the Japanese physician Saito reintroduced thermoparacentesis in to the therapy of tube ventilation disorders. Paracentesis, grommet in sertion, and thermoparacentesis are among the most successful treatmen ts currently available to the ENT specialist when used properly. They are treatments with a long history.