Another major player in the development of 19th century otology was the Hungarian otologist, Adam Politzer (1835-1920). Born to a wealthy Jewish family in 1835 in Alberti about 35 miles southeast of Budapest, young Adam was schooled by the founders of the Modern Medical School of Vienna where special interest was taken in his development by two influential people, Johann Ritter von Oppolzer (1808–1871) an Austrian physician, and the famous German physiologist and comparative anatomist, Carl Ludwig (1816–1895).
After obtaining his medical degree in 1859 he began working in Carl Ludwig’s laboratory at the University of Vienna on many projects, but was specifically interested in those that related to the auditory mechanism. While working in Ludwig’s laboratory, Politzer proved that the tensor tympani muscle was innervated by the Trigeminal Nerve (CN V) and that the stapedius muscle was innervated by the Facial Nerve (CN VII).
He developed his famous Polizeration technique while working with Ludwig, a procedure that involves inflating the middle ear by blowing air up the nose during the act of swallowing. Variations of Politzer’s famous technique are often performed today to reopen the Eustachian tube and/or equalize pressure in the sinuses.
The Travel to Other Laboratories in Europe
After some time in Ludwig’s laboratory, Politzer left Vienna to study with other famous auditory anatomists and physiologists of his time, with the goal of increasing his practical training and learning more about the function of the Eustachian tube and its innervation. At Wurzburg in northern Bavaria, he worked with Anton Friedrich Freiherr von Troeltsch (1829–1890) who popularized the use of head mirrors for observation of the ear canal and tympanic membrane as well as physiologist Heinrich Müller who, at the time was establishing his research into the ocular system and demonstrating that the heart was stimulated by electricity.
While in Wurzburg, Politzer also spent time studying microscopic anatomy of the labyrinth with Albert von Kölliker (1817–1905), a comparative anatomist with innovative methods of staining specimens for use in microscopic research. During this time he also visited Hermann von Helmholtz (1821–1894) in Heidelberg, Germany who was studying the new conservation of energy theory.
Subsequently Politzer went on to Paris to conduct clinic with Prosper Meniere at the Paris School; work on blind experiments with the “father of physiology” Claude Bernard (1813–1878) and with renowned physicist Karl Rudolf König (1832–1901). Toward the end of his travels, he went on to London where he conducted ear surgery with Joseph Toynbee (1815–1866).
Politzer’s interest during his travels turned to the study of the mobility of the ossicular chain after sound stimulation. These experiences with contemporary colleagues provided the foundation for his important work in otology: compiling and improving theories, especially in eardrum and ossicular movement.
If you have been following the Giants in Otology blogs you will recall that these anatomists, otologists, physiologists and surgeons with whom Politzer studied were the most knowledgeable medical scientists and physiologists of 19th century Europe.
The Appointment and Publications
With the support and influence of mentor Johann Oppolzer, Politzer, still under age 30, was appointed as the very first Professor of Otology at the University of Vienna in 1861. Armed with a unique background, he was prolific in his further study and publications, including his Atlas of Otoscopy in 1865, the first of its kind when published, which was expanded and re-published in 1896. The atlas was an outgrowth of his study in Ludwig’s lab based upon his lighted vision of the tympanic membrane.
Politzer’s seminal book on Otology, Textbook of Diseases of the Ear, was originally published in two volumes, first in 1878 and again in 1882. Subsequent editions were edited four times as a single volume with the last version published in 1908.
The observation that ossicles vibrate to sound stimuli was made by Politzer. The instrument for measuring hearing in Politzer’s time was the pocket watch but differences in tone and intensity of the watches of his time did not allow the “watch tick test” to be standardized.. Recognizing this, Politzer constructed the “acoumeter”in 1913. This instrument made a noise like a watch tick and could be heard at known distances by normal subjects. It also had a feature that allowed the practitioner to compare air and bone conduction and was certainly a forerunner of the audiometer.
As a professor, Politzer lectured with equal fluency in German, French, Italian, and English which resulted in obtaining students from all over Europe and the United States. One of his students Robert Barany, was awarded the Nobel Prize in 1914 for clarifying the physiology and pathology of human vestibular apparatus.
The Pathology of Otosclerosis
Ankylosis or the abnormal stiffening and immobility of the stapes was first described by Valsalva in 1704. Toynbee observed fixation of the stapes to the margins of the oval window and found similar cases in 136 of 1,000 temporal bone dissections in 1841. The histologic features of otosclerosis were demonstrated by Politzer, who had identified the problem as an otic capsule disorder characterized by abnormal new bone formation.
For years, Politzer had studied the movement of the tympanic membrane and the auditory ossicles, starting during his travels and intensifying between 1862 and 1893. Mudry (2006) presents that Politizer’s initial concept of the disease was a dry catarrh of the middle ear, the fixation of the stapes became progressively associated with a specific ossification in and around the footplate.
Politzer presented his first results in December 1893, published in German in a journal he founded, the Zeitschrift für Ohrenheilkunde (Journal of Otology). His description of the primary disease of the bony labyrinthine capsule was supported by 16 anatomopathologic temporal bone dissections. This report was translated into English and published a few months later in the Archives of Otology, the English counterpart of the Zeitschrift. He completed his research by concluding in 1901 that otosclerosis had become an independent disease and should have the right to its own chapter in otologic books.
His biographer, Mudry (2006), states that Adam Politzer is certainly the greatest otologist of the 19th century and probably one of the greatest of all time. His influence on the 50 years of otology has never been equaled.
Junior, J.; Hermann, D., Americao, R., Filho, I., Stamm, A. Pifnatari, S., (2007). A brief history of Otorhinolaryngology: Otology, Rhinology and laryngology. Revisita Brasileira de Otorrinolaringologia. Vol 73(5). Retrieved October 19, 2015.
Mudry, A. (2006). Adam Politzer (1835-1920) and the description of otosclerosis. Otology Neurotology, 27(2). pp 276-281. Retrieved November 16, 2015.
Pappas, D. (1996). Otology through the ages. Otolaryngology Head Neck Surgery. 114(2). pp. 173-176. Retrieved November 4, 2015.
Snell. R. (1986). Clinical anatomy for Medical Students. Boston: Little, Brown & CO Retrieved November 16, 2015.
Top Colleges on line (2015). University of Vienna. Retrieved November 16, 2015.
Politzer, A. (1887). Textbook of the Diseases of the Ear. Politzer Society. Retrieved November 17, 2015.