
The story of Samuel Rosen and surgery of the stapes bone (2016) - bookofjoe
http://hekint.org/2017/01/30/a-one-millimeter-push-revolutionizes-ear-surgery-the-story-of-samuel-rosen-and-surgery-of-the-stapes-bone/
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lopmotr
I don't understand the story. In the 1800s, surgeons corrected the problem by
moving the stapes. Then in 1952, Rosen again corrected the problem by moving
the stapes, but this time, the effect seemed to be permanent (or not?). What
was different about Rosen's technique from the 100-year prior one? Was the old
one simply forgotten because fenestration worked well enough instead?

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Declanomous
To understand what is going on, you need to understand the anatomy of the ear.
Normally the eardrum vibrates, which moves the little bones in the ear, which
transfer the vibrations to the cochlea, which sends sound to the brain.

The issue at hand is that the small bones (the staples in this case) can
basically get gunked up with bone stuff, which prevents transferring
vibrations from the ear drum to the cochlea.

Early on they used staples mobilization to knock the bone crud off. The
problem is sometimes mobilizing the staples caused the fluid to leak out of
the inner ear. This fluid is used for balance, so this would cause vertigo.

The next step was completely bypassing the staples and the ear drum by
drilling a hole in the back of the head that lead directly to the cochlea. Not
only is this not as effective at hearing as a fully-functioning ear, but
people feel strongly about having extra holes in their head, to the extent
that extra holes in your head are used as an example of something that is
extremely undesirable in a common figure of speech.

This guy comes along and decides he should maybe test patients to see if they
have bone crud on their staples before he drills holes in their heads, so as
to make sure that they are actually treating the right problem. This involves
pushing on the staples a bit to see if they are frozen.

While preparing to drill a hole in the head of one patient, he determines that
he indeed has bone crud on his staples. He decides to see what happens if he
pushes a bit harder. He breaks the staple free, thus eliminating the need to
drill a hole in his patients skull.

His patient is really excited about getting his hearing back without
increasing the number of holes in his head. He is so excited, he asks the
doctor to push gently on the other side.

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lopmotr
I gathered all that from the article, but how is "has bone crud on his staples
(sic) [...] He breaks the staple free" different from "Early on they used
staples mobilization to knock the bone crud off"? Was the new version done in
a way that didn't risk leaking the fluid? And wouldn't it still get stuck
again after some time, requiring more operations, just like before?

~~~
Declanomous
The difference is he basically figured out that sometimes you should knock the
bone crud off, and sometimes you should drill a hole in the skull.

According to other sources he did a bunch of research on novel ways to access
the inside of the ear, so that may have played a part.

But no, it doesn't really go that deep into what make the operation unique.

~~~
lopmotr
I Googled around a bit and it seems like around 1900, a bunch of influential
surgeons recommended that nobody should even consider stapes mobilization
again, partly because the risk of infection, which could be fatal, was so
great. So people collectively forgot about it until Rosen re-discovered it
after antibiotics and safer surgery was available. But Rosen's technique seems
to be different - moving the base of the stapes, rather than the small end
connected to the incus bone.

