innovations became the precursor of
endoscopes to access the sinuses and
modern treatment of air and food
thus create options for surgical inter-
passage diseases by otolaryngologists,
vention. David W. Kennedy, MD, popu-
thoracic surgeons, pulmonologists,
larized the technique in the United
and gastroenterologists.
States soon thereafter, and today
Other specialty accomplishments
external sinus surgery is rarely done
include preservation /conservation
unless there is a rare complication of
surgery of the larynx. Previously,
the endoscopic approach.
laryngeal cancer led surgeons to
Access to the skull base has evolved
remove the entire organ and the art
with innovative surgical techniques.
of verbal communication was lost. But
Today, otolaryngologists, together
in the late ’60s, Joseph Ogura, MD,
with colleagues in neurosurgery and
of St. Louis pioneered partial resec-
plastic surgery, give new hope to
tion surgery to prevent this drastic
patients with tumors in this complex
outcome, and today this procedure is
anatomical region.
the standard worldwide. Surgical lasers have also become
Strides in Otology
an important surgical development of the modern era. Otolaryngology
Surgeons began working in the
was in the forefront in the first use of
ear and mastoid in Europe in the
surgical lasers, thanks to the Boston
David W. Kennedy
and M. Stuart Strong. Their publication, Laser Surgery of the Vocal Cords:
Advancements in Nasal and Sinus Surgery
attempted. In the pre-antibiotic era, ear infections often progressed to mastoiditis and frequently to intra-
An Experimental Study With Carbon
COURTESY OF THE AMERICAN ACADEMY OF OTOLARYNGOLOGY–HEAD AND NECK SURGERY
mid-1800s—very crude operations usually done to relieve infection were
University team of Drs. Geza Jako
Dioxide Lasers on Dogs, detailed a
Nasal surgery certainly was the
cranial infection. Drainage was the
methodology to use a microscope and
purview of otolaryngologists from the
only treatment, and crude methods
laser attachment to visualize and treat
beginning of the specialty. It included
(by today’s standards) using hammer
lesions of the larynx transorally. This
reconstructive surgery, surgery for
and chisel were used to open the ear
was a major breakthrough because it
chronic infection, and surgery to
and mastoid.
magnified structures and provided a
remove tumors. In the era before
Major developments changed this
laser delivery system, making trans-
antibiotics, sinus infections—thanks
approach. First came the evolution
oral endoscopic surgery of the larynx
to their proximity to the brain—were
of more refined instruments. Otologic
possible. Jako and Strong opened the
potentially very lethal problems.
surgeons soon learned that the dental
airway to micro-minimally invasive
Intracranial infection secondary to
drill powered by electricity could
surgery so that patients didn’t have to
sinus pathology was potentially fatal.
be useful in opening the ear and
suffer invasive neck operations.
Methods to clear sinus pathology
mastoid. Next came the operating
More recently, the National Institute
evolved from the late 1800s through
microscope in the 1920s, which
of Deafness and Other Communication
the late 1970s, with most operations
otologists used to magnify the middle
Disorders was established as a result
taking an external approach. The
ear and the tiny ossicles behind the
of the urging and efforts of the otolar-
surgeon would make an incision
eardrum, thus allowing reconstruc-
yngology–head and neck surgery
somewhere on the patient’s face and
tion of the hearing system. This led to
community; it became a full institute
enter the sinuses by that route.
stapedectomy in 1956, an operation
at the National Institutes of Health
I n t he 1970 s, D r. Hei n z R.
that revolutionized the treatment
during the Reagan Administration,
Stammberger (an Honorary Fellow
of deafness. Otolaryngologists truly
bringing hope to millions of hearing-
of the ACS), an Austrian otolaryn-
became the first micro surgeons with
and speech-impaired patients.
gologist, revolutionized the use of
this evolution.
143