The Catheter

Valsalva’s De aure remained one of the standard treatises on the ear and the Valsalva maneuver gained popularity among physicians and surgeons for diagnosing sources of blockages in the ear. The maneuver, however, contained little therapeutic benefits for cases in which there weren’t blockages in the tube or associated parts of the ear; moreover, it could hardly detect causes for the majority of cases of deafness. In 1724, Valsalva’s method was modified by the use of a catheter. In order to relieve his deafness, Edmé-Gilles Guyot, a postmaster at Versailles, constructed an angular tube of pewter and put it through his mouth into the opening of the Eustachian tube. The instrument was then attached to a leather tube connected to two small pumps that forced fluid into the mouth of his Eustachian tube and essentially, “washed” out his deafness. Excited with the success of his instrument, Guyot presented his apparatus to the Académie Royale des Sciences des Paris.[1] However, the instrument received little attention or excitement, in part since anatomists did not think the entire tube could be reached via insertion, and partly since the technique was believed to be cumbersome for regular treatments.[2]

In 1741, unaware of Guyot’s instrument, Archibald Cleland (1700-1771), a Scottish military surgeon, published a paper with engravings of several instruments for surgery, including a catheter meant for Eustachian tube catheterization.[3] His instrument and purpose was significantly different than Guyot’s: Cleland used a flexible silver tube instead of a pewter one, “to admit of bending them, as occasion offers.”

Cleland’s Instruments

Additionally, Cleland recommended catheterization only upon occasion in which drainage of ear wax or removal of obstructions with a forceps, failed to remedy the patient from deafness:

If, upon Trial, [the Eustachian tube] should be found to be obstructed, the Passage is to be lubricated by throwing a little warm Water into it by a Syringe joined to a flexible silver Tube, which is introduced through the Nose into the oval Opening of the Duct at the posterior Opening of the Nares, towards the Arch of the Palate. The Pipes of the Syringe are made small, of Silver, to admit of bending them, as occasion offers; and, for the most part, resemble a small Catheters: They are mounted with a Sheep’s Ureter; the other End of which is fixed into an Ivory Pipe; which is fitted to a Syringe, whereby warm Water may be injected: or they will admit to blow into the Eustachian tube, and so force Air into the Barrel of the Ear, and dilate the Tube sufficiently for the Discharge of the excrrementitious Matter that may be lodged there.[4]

Cleland’s procedure also differed significantly from that of Guyot’s with the insertion of the catheter; Cleland favored insertion though the nasal cavity, which allowed better access to the Eustachian tube, whereas Guyot’s method relied on the catheter being inserted through the mouth. It’s important to note that Cleland did not view the procedure solely as a remedy for deafness, but rather as a means to “dilate the Tube” sufficiently for drainage, and attached a syringe as part of the procedure.

Cleland’s procedure was further described in detail by the surgeon Jonathan Wathen, although Wathen ceased to mention Cleland’s work or might have not been aware of it. In 1755, he wrote “[w]hatever obstructs the passage leading from the ear into the nose, called tuba Eustachiana, so as to hinder the ingress of air through it into the cavity of the tympanum, is, I believe, universally esteemed destructive to the sense of hearing.”[5] Like his predecessors, Wathen argued the Eustachian tube played an important avenue for maintaining air pressure through its “free communication with the atmosphere,” and he describes in detail how he first examined the tube and found catheterization as a valuable mode for treating deafness arising from blockages. One of his patient, thirty-five year old Richard Evans, was deaf in both ears thought there was no visible evidence of any disorder in the external ear. Acknowledging the cause to a cold that subsisted for several years, Evans could not find any treatment sufficient to relieve him. After his death from small-pox, Wathen took the opportunity to conduct an autopsy to examine the Eustachian tubes, and found “them both stuffed quite full of congealed mucus, which was observed by two gentlemen of the profession present. This was the only visible cause of his deafness, the other parts appearing in their natural state.”[6]

Wathen’s observations led him to “make trial” of the operation proposed by Guyot, but “having never practiced it, he wanted the recommendation of facts to support and enforce it; [Wathen] therefore rejected [the procedure] as impracticable.”[7] However, after observing a demonstration by the anatomist John Douglas (d.1743), who, following the work of French surgeon Jean-Louis Petit (1674-1750), inserted a probe through the mouth (as opposed to the nose), Wathen perceived the procedure in a different light. It is to Douglas, Wathen claims, that he “freely acknowlege [sic] myself indebted for the hint, by which I was inclined to make trial on the living, of an operation of so much importance to mankind.”[8] He refined his skills by practicing catheterization on dead subjects, and having done so, he “did the same on a person that was very deaf, and on whom all other means had proven ineffectual: no sooner had I withdrawn the probe, that he said, he could hear better.”[9] Using a silver catheter fixed to an ivory syringe full of liquor (mel rosarum in warm water), Wathen treated several patients with various symptoms and cases of deafness, describing the use of the procedure on six of his patients; he thus is among the first to publish case studies of Eustachian tube catheterization as a remedy for deafness.

Instance of Eustachian Tube Catheterization by Wathen
(volume 49 (1755-6) of Philosophical Transactions; Science Photo Library)

He also acknowledges the difficulty of diagnosing obstructions in the tube:

I have endeavoured to ascertain the symptoms that indicate an obstructed tube, but have not been able to do it with any degree of certainty; nor can I see the great utility of it, could it be done; for the only disorders of the ear, that at present admit of chirurgical helps, are those of the external meatus, ulcerated and swell’d tonsils, &c., all of which are generally visible; and when they are not the cause of deafness, little or nothing is ever attempted, the patient being left to shift for himself.[10]

He does, however, note that Eustachian tube catheterization provided “another probable chance” for the “unhappy sufferer,” being the only procedure that can treat “corroborating symptoms.” The operation, Wathen declares, “is not all dangerous, it neither has, nor will, I believe, be thought painful by those who desire to recover their hearing.” [11]


NOTES

[1] “Machines ou Inventions Approvees par l’Academie en M.DCCXX,” Histoires de l’Académie Royale des Sciences (1720), 114:

‘Une Machine à scier de M. Guyot. Quoi-qu’elle foit conftruite fur le même principe que cells qui font en usage, & que le Vent ou l’Eau font agir, elle a quell-que chose de particulier & d’ingenieux. Elle a fur cells qui font à Vent ou à Eau l’avantage de pouvoir être transportée. Il n’est besoin d’acune adresse pour la faire travailler, & les plus mal adroit peuvent par son moyen équarrer & scier parsaitement des Planches, & tout cela peut dédommager de la petre des foces cause par les srottements inévitables dans toute Machine.”

[2] Neil Weir, Otolaryngology: An Illustrated History (London: Butterworths, 1990), 45.

[3] Archibald Cleland, “A Description of Needles made for Operations on the Eyes, and of Some Instruments for the Ears,” Philosophical Transactions 41 (1741): 847-851.

[4] Cleland, “A Description of Needles,” 849.

[5] Jonathan Wathen, “A Method Proposed to Restore Hearing when Injured from an Obstruction of the Tuba Eustachiana,” Philosophical Transactions of the Royal Society, 49 (1756): 213-222; 213.

[6] Wathen, “A Method Proposed to Restore Hearing,” 215.

[7] Wathen, “A Method Proposed to Restore Hearing,” 215.

[8] Wathen, “A Method Proposed to Restore Hearing,” 216.

[9] Wathen, “A Method Proposed to Restore Hearing,” 216.

[10] Wathen, “A Method Proposed to Restore Hearing,” 220.

[11] Wathen, “A Method Proposed to Restore Hearing,” 220.

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