Using an Ear Trumpet

The other day I was conversing with my friend about what kind of hairstyles I planned to wear for my wedding. I remarked I would probably wear my hair down for the reception, since it will likely coordinate with my outfit. My friend told me I was silly–I should wear my hair up, in some fancy elaborate nest of curls and rhinestones, and show off my cheekbones. Without thinking, I instantly replied:

“No! My hearing aids would make my ears stick out in the photographs!”

Now, mind you, I’m not shy or ashamed about my wearing or showing my hearing aids. The Bridezilla in me was mortified about ears sticking out in photos more so than hearing aids being shown in photos–I feel it’s important for me to clarify that–and more so, liked the aesthetic of long, flowing hair against the most elaborate and colorful outfit.

Later on that day I started thinking about what I said. Save for a few early-teen photos, there’s hardly any photos of me with my ears showing. Then I remembered coming across this photo– Continue reading Using an Ear Trumpet

A Bead and a Thwack

Surgeon John Abernethy (1764-1831), in his Lectures on Operative Surgery (reprinted in The Lancet vol.8 (1827), 449):

Now I remember, not a very great many years ago, that there were paragraphs put into the newspapers, about a child having got something into its ear, which could not be got out. The poor child was in great agony, and it was said that this foreign body produced irritation in the child’s brain, and I don’t know what all. As the British public are very much alive to humanity, there were, morning after morning, in the papers, paragraphs exhorting the friends of this family not to be afraid, for the body would come out. To these paragraphs, I confess to you, I added one myself, and it was the following effect:–A child got a bead from its mother’s necklace; it was a large bead, and in playing with it, it put into its ear. In trying to get it out, she only poked it further down. In others attempting the same thing, they only made bad worse in the same manner. A surgeon was sent for, but this large bead had got so far down into the tube of the ear, that the surgeon said at first he did not believe it was there; being assured that it was, he put down a probe, and felt that there was something in it. The child was a good-natured child, and the surgeon said to it, Now I wish you would just lie down upon that ear; put your head upon this cushion, it’s a large soft cushion belonging to a fashionable sofa. The child did so. He took up another cushion, and put it upon the opposite ear. Now, said he, I will strike the opposite one, and tell me if it hurts you. The child said, No, it does not hurt me at all. He therefore kept thumping the cushion that was laying on the child’s head for eight or ten times, and then he said, Now let me look at your ear. He looked at it, and then said, Now I see it plainly enough. On repeating the operation, the bead came out. And now I really believe that that’s the best way of getting those things out.

 

A Brief History of the Eustachian Tube

The Eustachian tube is a passageway that lies between the middle ear and the pharynx, the upper part of the mouth located just below the top of the nose. One of the primary functions of the tube is to equalize ear pressure between the middle ear and the atmosphere; most of the time the tube is closed, but it can open to let in a small amount of air to prevent damage to the ear. Early mentions of the tube dates back to Alcmaeon of Sparta around 500B.C., who constructed a basis for understanding medicine via dissection, and thought the tube enabled goats to breathe through their ears as well as noses.[1] Other Greek philosophers, including Aristotle and Celsus, also vaguely referred to the tube’s existence, but did not elaborate on its function or purpose.

The Eustachian Tube
(from University of Maryland Medical Center)

The surge of Italian anatomists during the Renaissance period and their emphasis on dissection brought forth new understandings of the body and its parts. Andreas Vesalius (1514-1564), Professor of Anatomy of Padua, provided detailed descriptions of two of the tiny bones in the middle ear (the malleus and incus), but although he was aware of the existence of the Eustachian tube, he does not comment on its role in hearing. His contemporary, Bartholomeus Eustachius (1510-1574) who held the Chair of Anatomy at Rome, published the first detailed anatomical description of the tube in his 1562 Epistola de auditus organis (Examination of the Organ of Hearing), possibly the first treatise on the ear:

It originates at the anterior course of the base of the skull, and takes an anterior course toward the pterygoid process of the sphenoid bone. It consists of two parts: the first solidly connected with the temporal bone, close to the tympanic cavity; the second soft, partly ligamentous, partly cartilaginous, directed towards the nasopharyx. Cross sections of the tube are not perfectly round and the inner part is twice as wide as the outer.[2]

Bartholomeus Eustachius

Comparing the tube to a quill pen, Eustachius provided precise descriptions of its structure and position in the face, but he made no mention of its function:

Comparing to a Quill pen
(Wellcome Library Images)

Nor did he publish an engraving of the tube as part of the external auditory system in his 1651 Tabuli Anatomiceu, which also contained detailed figures of the ear ossicles and the tympanum membrane in man and dog.[3] It is likely that Eustachius held the long-standing belief that the Eustachian tube functioned as (another) avenue for breathing, since he postulated that other parts of the ear, especially the ossicles and tympanum, were involved in the mechanism of sound transduction. Not until 1683, with the work of French anatomist Guichard Joseph DuVerney (1648-1730) was this belief corrected. In Traité de l’organe de l’ouie, DuVerney described the Eustachian tube as a means for renewing air within the tympanum and for equalizing air pressure, believing that the tube was always open and it was the eardrum that maintained the flow of air.

Anatomy of the Human ear (1686); Steven Blankaart & Guichard Joseph Duverney
(Wellcome Library Images)

Descriptions of the Eustachian tube contained more than just anatomy: they highlighted the physiological and therapeutic importance of diagnosing and treating ear diseases confined to the Eustachian tube or tympanum. Antoine Maria Valsalva (1666-1732) is historically credited for giving the tube its eponymous name in honor of Eustachius, whose work set the foundation for understanding the anatomy and physiology of the ear. Valsalva, a pupil of the famed physician Marcello Malpighi (1628-1694), was appointed Professor of Anatomy at the University of Bologna in 1705, where his main interests were on anatomy and the function of the middle and internal ear.

Antonio Maria Valsalva. Line engraving by R. Ceracchi.
(Wellcome Library Images)

In 1705, Valsalva published De aure humana tractatus, which followed years of intense observations, animal experiments, and numerous dissections; the treatise included enhanced descriptions of the physiology and pathology of the ear, even demonstrating communication between the mastoid cells and the tympanic cavity. Valsalva also outlined the function of the Eustachian tube and its diagnostic use; the tube, he claimed, worked alongside the pharyngeal muscles of the ear. Believing that Eustachian tube blockages were among the main causes of deafness, in De aure, Valsalva also outlined his “Valsalvian maneuver,” a method consisting of the forced expiration of air through the Eustachian tube with the mouth and nostrils closed, thus resulting in increased pressure to the tympanic membrane. The procedure dates back to Arab physicians in the 11th century and was used as a remedy for cleansing the middle ear from pus, and hence, unblocking the ear and restoring hearing.[4]


NOTES

[1] Charles D. Bluestone, Eustachian Tube: Structure, Function, and Role in Otitis Media, Vol.2 (PMPH-USA, 2005), 4.

[2] Translated & quoted in Bluestone, Eustachian Tube, 5.

[3] Most of Eustachius’ works were not published during his lifetime or simply lost. His copper plates of anatomical engravings were discovered early in the eighteenth century and presented by Pope Clement XI to his physician Lanncisi (1655-1720), who then published the plates in 1712. Unlike Vesalius, Eustachius’ plates represented dead, not living anatomy.

[4] Steven H. Yale, “Antonio Maria Valsalva (1666-1723), Clinical Medical & Research 3: 35-38. The Valsalva maneuver remains a staple in modern medicine, having been adapted as a diagnostic procedure in modern cardiology for assessing heart murmurs and heart failure.