Otology

Otology is the field of medicine dedicated to the study and treatment of the ear. In most cases, the original diagnosis of ear problems is performed by primary care physicians such as pediatricians, internists, and family practitioners.

In the United States, the infection of the middle ear known as otitis media accounts for half of all visits to pediatricians. With simple infections that respond to antibiotics and with minor injuries, no further care is needed. Referrals are made when conditions are more serious.

Otologists work closely with physicians in related fields. Audiologists and asotometrists, for instance, deal with the functional assessment of the auditory system. Oticians serve as hearing aid providers and offer aural rehabilitation. Originally, eye institutions were the only resource for patients that required additional ear care.

Once ophthalmologists took on this additional responsibility, they formed hospitals dedicated to treating conditions of the eyes and ears, later adding disorders of the nose and throat. Eventually, otorhinolaryngology became a separate field dedicated to the study and treatment of eyes, and the combination of ear, nose, and throat became a common specialty.

Although ear disorders have been identified since ancient times, little was understood about the anatomy of the ear or the causes of particular disorders. The Annamites of East India, for example, believed that a tiny animal lived in the ear, generating earwax and serving as a channel for sound. If the animal died, deafness occurred. Even physicians who did not depend on superstition were often in the dark about the causes of ear disorders because the ear is complex and not easily accessible. Treatment was often limited to removing wax and draining fluid that built up around the mastoid bone. Diagnoses were made on a trial-and-error basis. It was not until the rise of experimental science that physicians began to devise treatments based on realities of particular disorders of the ear.

The discovery of antibiotics, electronics, and microsurgery transformed the treatment of ear disorders. The existence of a wide range of antibiotics now generally prevents otitis media, the most common ear infection, from developing into acute mastoiditis, as was common in the past. However, many otologists believe that there is a tendency for primary care physicians to over-prescribe antibiotics for ear infections, making them resistant to particular antibiotics. Consequently, persistent infections may require the use of several antibiotics before the most effective one is identified. In the United States, the Healthy People 2010 initiative has identified reducing antibiotic courses for ear infections to 88 courses per 100 children under the age of five as a major goal.

Hearing aids in some form or another have been around since the late 16th century. William F. House, the father of neurotology, pioneered surgery techniques that made it possible to safely perform otological surgery. The surgical microscope has been used to develop techniques that allow surgeons to reconstruct the middle ear. One of the most significant medical advances of the 20th century was the discovery that cochlear implants could restore full or partial hearing to large numbers of deaf individuals.

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