French Perspectives on Eustachian Tube Catheterization

Earlier I wrote about Sir Astley Cooper and his procedure of tympanic membrane perforation as a remedy for deafness. While in Britain there wasn’t tremendous grounds being made in aural surgery, the situation was quite different in France, as surgeons made more advancements in Eustachian tube catheterization as a remedy than their British counterparts.  By the early nineteenth century, the Institut Nationale des Sourds-Muets á Paris emerged as the frontrunner for newer and more experimental surgical methods for treating deafness.

The Institute’s surgeon, Jean-Marc Gaspard Itard (1774-1838) employed an image of deafness based on physiological defect—not of philosophical inquiry into language, as it was in the seventeenth and eighteenth centuries. Within this image, Itard searched for a cure that he hoped would “objectify the disease,” turning to postmortem examinations to draw conclusions about the root cause(s) of deafness. His research suggested that in several instances, congenital deafness arose from material causes that could be surgically removed; as thus, Itard applied his surgical skills towards the Eustachian tube, as a way for surgically treating deafness.

Jean Marc Gaspard Itard
Jean Marc Gaspard Itard

In Traité des Maladies de l’Oreille et de l’Audition (1821), Itard wrote of his fondness of Eustachian tube catheterization and recommended various processes for catheterization, including using solutions combined with salt, or gaseous vaporizations such as tobacco smoke, coffee fumes, or ether. Arguing that Eustachian tube connected the ear with the mouth, and thus hearing with speech, Itard insisted that any blockage in the Eustachian tube severely interrupted the communication process. His procedure was a modified version of Cooper’s tympanic membrane puncture: he injected the cavity of the tympanum through the membrane, in order to expel any obstructions through the Eustachian tube and out the nose. The procedure was first undertaken on twelve year old Christian Dietz, deaf from birth, was an immediate success, as Dietz’s hearing was almost fully restored and he recovered the use of speech.[1] However, the procedure failed to remedy the deafness in twelve other pupils.

Itard’s reputation as a physician offering specialized treatments for deafness flourished and he became identified with the newer approach towards deafness, one which relied on research and clinically-driven perspectives on the “disease” and a search for a cure. By the 1820s, the therapeutic application of catheterization, as outlined by Itard, gained tremendous ground in British aural surgery. Although the operation had been known for nearly a century, and despite Itard’s tremendous movements on the procedure, some practitioners considered Eustachian tube catheterization “as having demonstrated nothing, except the practicability of the injection of the Eustachian tube, and the little reliance which could be placed upon it as a means of cure.”

Opinions surrounding the procedure drastically transformed in 1825, when Nicolas Deleau (1797-1862), another surgeon appointed at the Paris Institute, undertook a series of experiments on Eustachian tube catheterization, in order to affirm that the deaf and dumb could be restored to hearing and speech. Like Itard, Deleau contended that tympanic membrane perforation could only go so far in restoring hearing; catheterization of the Eustachian tube combined with an injection of fluid, however, was not as effective as catheterization with air—which was much better tolerated by patients.  The modified technique for catheterization as well as his work with Claude-Honoré Trézel made Deleau famous, particularly his claims that the tympanum is useful, but not absolutely necessary for hearing.

As George Day (1815-1905), instructor at the New York Institution for the Deaf and Dumb, describes, Deleau’s publication “excited great interest at the time both in England and the continent,” to such a degree that even “newspapers eagerly seized hold off what so nearly approached the marvelous, and circulated the most exaggerated reports of [Deleau’s] magic power.”[2] The Académie des sciences favorably reported Deleau’s success in a report, noting that

Nothing remarkable occurred during the operation, which is very simple and by no means new. It consisted in the injection of liquids into the Eustachian tube, by means of a small flexible sound. The first few days after the development of hearing, was a season of continual delight to the child.[3]

Day also affirms that there was a palpable contradiction between the report presented to the Academy of Sciences and Deleau’s account, namely that the report described the operation in using the injection of liquids, whereas Deleau professed using the injection of air.Although Day does not elaborate on the contradiction—focusing rather, on whether the operation did indeed restore Trézel’s language and speech facilities—this is significance worth emphasizing. One of the reasons Deleau’s work caused great interest in the procedure was his use of douches d’air in conjunction with the catheter, which was claimed to be superior than Itard’s advocating fluids, and Deleau embarked his practice on this difference.

It appeared that Deleau’s publications, combined with favorable support from the Academy, led to “injections of air (douches d’air,)…finally to have taken the place of nearly all other remedies.”Nevertheless, not all aurists agreed with Deleau’s general claim about the effectiveness of Eustachian tube catheterization as a remedy for deafness. According to Day,

There were some, however, who, in the midst of this general enthusiasm [for ETC], had the boldness to doubt the reality or at least the extent of the wonderful cures alledged [sic] to have been performed. Themselves physicians and surgeons, and many of them distinguished for their knowledge of the anatomy and diseases of the ear, they were too well acquainted with the little success which had attended the efforts of others, and with the intrinsic difficulty of the subject, to believe that it had all at once been so entirely surmounted, that henceforth deafness would be as easy to cure as other diseases. In reply to the numerous cases of restoration to hearing which M. Deleau was constantly publishing, they affirmed that some of his operations were precisely such as had been repeatedly performed before him with not the least success; and that others were anatomically impossible. They complained that no information was given of the condition of the patients after the operation; and denied, in short, that any cures had really be effected. In answer to these objections, he seems to have relied in a great measure upon his apparent success in the case of a boy named Trézel.[4]

 The procedure also held other general problems for aurists. In addition to general difficulties with the method for employing the catheter—which often induced vomiting and nausea occasioned with the introduction of the probe into the mouth—it was difficult for aurists to examine the body as a vehicle for complex ideological structures, as deafness was not perceived as being part of the realm of the surgeon’s expertise. Where there was not obvious physical defect, it was difficult for the surgeon to treat the patient or even encourage the patient to undergo surgical procedures. The growing popularity of the procedure meant aurists employed the procedure in order to demonstrate to their patients their surgical skills, leading to an over-dependency on the procedure.

 In 1827, the Council of Administration of the Royal Institution for the Deaf and Dumb at Paris requested Itard to follow-up with Deleau’s claimsand submit a report on the advantages of various remedies offered for deafness. As Itard experimented with the utility of Eustachian tube catheterization, performing the operation on 120 cases, he remarked that the results were “just nothing, with regard to hearing, in the great majority of the mutes, and in the rest, temporary and of little advantage.”[5] Itard’s report concluded that despite a few cases of perfect recovery—which he deemed as isolated exceptions—congenital deafness could not be cured, thus opposing Deleau, who had long supported Itard’s technique.  Deleau rallied against Itard’s criticisms, ridiculing the latter in a chapter of Treatment for Catheterization of the Eustachian Tube, and insisting that the work of a physician was split between providing medical and surgical care for ears, as well as improving the speech of deaf-mutes (instead of teaching them sign language).

Across the Channel, catheterization as outlined by Deleau gained tremendous ground during the 1830s. Originally viewing the procedure as “having demonstrated nothing, except the practicability of the injection of the Eustachian tube, and the little reliance which could be placed upon it as a means of cure,” British aurists employed the procedure in order to demonstrate to their patients their qualifications as an aural surgeon, offering it alongside other remedies. However, in addition to general difficulties with the method for employing the catheter—which often induced vomiting and nausea occasioned with the introduction of the probe into the mouth—it was difficult for British aurists to examine the body as a vehicle for complex ideological structures as their French counterparts did, for in Britain, deafness was not perceived as being part of the realm of the surgeon’s expertise, but rather confined to the realm of sign language and educational instruction. The social and ideological image of deafness as a psychological defect meant that where there was not an obvious physical defect, it was challenging for an aurist to encourage the patient to undergo surgical procedures, and many offered a mixture of medical (herbal-based emetics or nostrums) and surgical remedies to relieve patients of their deafness.


 [1] On Itard’s post-mortem examinations: “He twice found the cavity of the tympanum filled with concretions of a chalky appearance, and in two other instances with fungous excrescences, in connection with the loss of the membrane of the tympanum and the little bones. A fifth subject presented a mass of gelatinous matter, which filled not only the cavity of the tympanum, but the semi-circular canals of the labyrinth. In another, who died after two years of malignant fever, the auditory nerve had little more consistence than mucus. Others have found the Eustachian tube in some cases filled, and in others completely obliterated. The partial or total imperforation of the meatus auditorius has been observed.” George Day, “On the late efforts in France and other parts of Europe to restore the deaf and dumb to hearing,” American Journal of Sciences and Arts 30 (1836): 301-323; 303.

[2] Day, “On the late efforts in France,” 316. Dietz died a few months after the operation, after being attacked with a disease “which baffled medical skill.”

[3] Day, “On the late efforts in France,” 317.

[4] Day, “On the late efforts in France,” 316.

[5] Deuzième rapport, lu, le 9 fèvrier, 1827, au Conscil d’Administration, etc., p.11, as quoted in Day, 323.

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