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Mudry, Albert M.D., Ph.D.

doi: 10.1097/MAO.0b013e3181ec1ba5
Letter to the Editor

Department of Otolaryngology Stanford University Palo Alto, California,

To the Editor:

I read with a lot of interest "Cavitating otosclerosis: clinical, radiologic, and histopathologic correlations," written by Makarem et al. (1), with its brief historical introduction. I was astonished to find the statement that ankylosis of the stapes was first described in 1735 by Valsalva, thus 12 years after his death. This inaccuracy is regularly found in reference books or articles (2-5). In fact, Valsalva described it in 1704: "One day on the cadaver of a deaf person I found the cause of the deafness. This membrane [covering the oval window] was ossified in such a way that the base of the stapes and the periphery of the oval window formed a solid piece and the stapes had become immobile" (6).

Furthermore, Toynbee already described, in 1841, the case of an ankylosis of the stapes but without mentioning it as a common cause of deafness: "A remarkable pathological condition is presented in the firm anchylosis of the base of the stapes to the margin of the fenestra ovalis. This appears to be produced by an expansion of the base of the stapes, which projects into the cavity of the vestibule, so as to form within it an oval protuberance, which is smooth, and of an opaque white, and firmly adherent to the vestibular parietes. This anchylosis appears to depend upon a disease of the stapes, the walls of the vestibule being perfectly healthy […] I am unable to say whether this resulted from the process of absorption during life, or was produced by a mechanical lesion, previous or subsequent to death" (7). It is only in 1857 that Toynbee (8) clearly associated deafness with ankylosis of the stapes in the results of his pathologic studies, one of which was "The establishment of the existence as a disease, of membranous and osseous ankylosis of the stapes to the fenestra ovalis, one of the most common causes of deafness."

It is not in 1881, but already in 1867, that von Tröltsch (9) used the term sclerosis to describe this entity: "We know the least about that form which we describe as an interstitial process, as a dry catarrh-if I may use the term-as sclerosis of the mucous membrane of the middle ear. These names accord with a practical need of distinguishing certain forms of aural diseases which we must refer to morbid processes in the middle ear, from the ordinary form of aural catarrh […] This sclerosis is a pathological process, in which the mucous membrane becomes denser, more rigid and inelastic […] They finally lead to complete rigidity, calcareous or osseous degeneration of the membrane surrounding the stapes, ankylosis of the stapes […] We do not yet know certainly whether calcareous deposits, or other molecular changes constitute the basis of this condition." As for Valsalva, this inaccuracy of date also is regularly found in the otologic literature (2,10).

Effectively, in 1893, Politzer (11) clearly described the origin of the ankylosis of the stapes: "The affection arises from the capsule and that the bony new proliferation not only attacks the plates of the stapes but proliferates upon its outer surface." However, it is only in 1901 that Politzer (12) selected the term otosclerosis: "This affection has erroneously been called dry middle ear catarrh […] Since specialists have already adopted the termination sclerosis for the progressive form of deafness, the author considered it advisable to select the term otosclerosis. It may also be called capsulitis labyrinthi."

I hope that these few precisions will bring more light to the delightful history of the first descriptions of ankylosis of the stapes known today as otosclerosis.

Thank you for your attention to this letter.

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1. Makarem AO, Hoang TA, Lo WWM, Linthicum FH Jr, Fayad JN. Cavitating otosclerosis: clinical, radiologic, and histopathologic correlations. Otol Neurotol 2010;31:381-4.
2. Ludman H. Mawson's Diseases of the Ear. 5th ed. Chicago, IL: Year Book Medical, 1988:562.
3. Glasscock ME 3rd, Storper IS, Hanyes DS, Bohrer PS. Twenty-five years of experience with stapedectomy. Laryngoscope 1995;105:899-904.
4. De Souza C, Glasscock ME III. Otosclerosis and Stapedectomy. New York, NY: Thieme, 2004:ix.
5. Arnold W, Häusler R. Otosclerosis and Stapes Surgery. Basel, Switzerland: Karger, 2007:86.
6. Valsalva AM. De Aure Humana Tractatus. Bononiae, Italy: Pisarri, 1704, >Cap. II, X>:31.
7. Toynbee J. Pathological and surgical observations on the diseases of the ear. Med Chir Trans 1841;6:190-211.
8. Toynbee J. A Descriptive Catalogue of Preparations Illustrative of the Diseases of the Ear. London, UK: Churchill, 1857:ix.
9. Tröltsch A. Lehrbuch der Ohrenheilkunde. 3rd ed. Würzburg, Germany: Stahel, 1867:211-2.
10. Paparella MM, Shumrick DA. Otolaryngology. Vol. 2 Ear. Philadelphia, PA: Saunders, 1973:205.
11. Politzer A. Ueber primäre Erkrankung der knöchernen Labyrinthkapsel. Zeitschr Ohrenheil 1893;25:309-27.
12. Politzer A. Lehrbuch der Ohrenheilkunde. 4th ed. Stuttgart, Germany: Enke, 1901:263.
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