A Treatise on Otosclerosis and its Treatment

Review by L Flood
Middlesborough, UK

This is a large format (A4) book that successfully combines superb coverage of the history of our understanding of otosclerosis and its management with recent advances and future prospects. It takes a clever author to mix so many images of some formidably severe and formal characters from the nineteenth century or earlier, with the current triumphs of the radiologist or geneticist.

There is much humour to be found in this book, as we read of some bizarre theories and therapies associated with the condition of otosclerosis. Indeed, the term itself is controversial, with many of our continental colleagues calling it otospongiosis (not unreasonably), but certainly not in this text. For every topic, there is much coverage of the earliest researchers, who were looking at the underlying pathology and evolving surgical management.

Countless memorable illustrations include that of Tullio blowing a whistle into the ear of an unfortunate rabbit (in order to induce his eponymous phenomenon), or an ear trumpet wielded by what I think is an officer of Horse Artillery (who is wearing the Légion d’Honneur and may well have had noise-induced deafness, I would bet).

There is a particularly novel and well updated coverage of the influence on otosclerosis of ageing, pregnancy, genetics, hearing aids and medical treatment. Chapter 7 is disturbing, in covering ‘Alternative Treatments’, largely, thank goodness now obsolete. These include such measures to avoid the disease as ‘judicious clothing’ and avoidance of living by the seashore. Indian traditional treatments, drainage of cerebrospinal fluid and replacement with air, diathermy, or even ionising radiation have all been employed, and are covered in detail.

A chapter on ‘Well Known Persons and Otosclerosis’ presented a few surprises. Beethoven we would expect, but I did not know his temporal bones had been harvested, only to disappear before proper analysis. Frankie Valli of Jersey Boys fame is among the sufferers, as was Howard Hughes. Buzz Aldrin at least only developed it after his moon landing, unlike Alan Shephard who was allowed to fly after a sac drainage procedure for Ménière’s disease!

A brief final chapter, ‘Future Perspectives of Otosclerosis’, is particularly thought-provoking. It is possible that the prevalence will decrease with the fluoridation of drinking water, vaccination strategies, low-dose contraception and the influence of globalisation on our genetic make-up. The challenge then will be to develop the competence of earlier surgeons, even with the help of robots.

Although there is no index, the opening table of contents is very detailed. The references run to over 50 pages and then a list of the author’s personal publications takes up another dozen.

Overall, this book is a very entertaining read, where the emphasis is as much on the history of our concept of otosclerosis as it is on current management. It is recommended for the established otologist especially, and certainly belongs in the departmental library, if trainees are to understand ‘how we got to where we are’.

Amazon Link: A Treatise on Otosclerosis and its Treatment
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