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Myringotomy and ventilating tubes in the 19th century

Eustachian tube obstruction was recognized as a cause of deafness in the 18th Century, and the operation of myringotomy popularized by Astley Cooper was widely undertaken in the early part of the 19th Century for hearing loss from this cause, and unfortunately, for hearing loss from many other causes. The procedure fell into disrepute because of postoperative infection and because of the tympanic membrane's property of rapid healing, which meant that relief was only evanescent. Tonsillectomy for hearing loss was introduced in the early 19th Century and had considerable vogue, but it, too, failed to be as effective as its early proponents, particularly Yearsley, expected. Direct assault upon the eustachian tube by air and fluid pushed up through catheters was practiced throughout the 19th Century. Myringotomy was re‐introduced extensively in the 1860's and determined efforts were made to remove secretions from the middle ear by means of medication introduced both through the eustachian tube and the ear canal. Efforts were also made to make permanent openings in the tympanic membrane, or at least to delay closure of the opening. They included turning tympanic membrane flaps and resecting large portions of the membrane including on some occasions the malleus, and on others the annulus. None of these techniques were successful. Attempts were made throughout the century to keep open the hole in the membrane by means of foreign body, initially catgut strings, and then a variety of wire and tube, ultimately leading to the development of a hollow grooved hard rubber eyelet with thread attached which is similar in appearance to the ventilating tubes in use today. A variety of metal prostheses were also used. Ultimately the high failure rate coupled with a high infection rate led to the abandonment of these methods of therapy, and a return to the nasopharynx, for the newly discovered adenoids were being removed in greater quantities and the technique of politzerization were providing an acceptable alternative to some of the previously used methods of eustachian tube medication.