Over the past few weeks we have been reviewing the development of the field of Otology. Throughout time many have made contributions to the field, but study really took off after the development of the microscope in 1595. Since that time history finds more individuals investigating the structure and function of the auditory system. Moving into the 19th century there was an explosion of information.
Last week Hearing international conducted an overview of the century’s study of the system. There are, however, a few individuals who merit some special attention as their contributions were very significant. One such individual is Prosper Ménière (1799-1862), French physician, botanist and historian. Ménière is famous for his 1861 paper before the French Academy of Medicine in which he described a series of patients with episodic vertigo and hearing loss. At the time, most physicians, even Ménière , did not realize the importance of the famous syndrome that bears his name. It is, however, that Ménière ‘s disease still remains one of the mystery maladies of the auditory system.
Born in Angers, France in 1799, young Prosper was the third of four children born to a wealthy merchant. He enjoyed a high level education, entering Lycee in 1812. According to the Prosper Meniere Society (2015), Ménière ‘s medical career started in 1816 at age seventeen when he entered the prepatory school of medicine at the University of Angers where he was an excellent student. As was the custom of the time in England and France, there was an annual prize given to the most promising students, and young Prosper won the prize from his school in 1817, 1818 and 1819. At the end of his third year, Ménière departed to Paris to complete his medical studies ,becoming an extern in 1822, an intern in 1823, becoming a Gold Medalist in 1826 and, finally, in 1828 receiving his doctorate. Simultaneously he was appointed aide de clinique to the famous surgeon Dupuytren, at the Hotel-Dieu, one of the famous hospitals in Paris. Ménière was originally set to be an assistant professor in faculty, but political tensions disturbed his professorship and he was sent to control the spread of cholera. While Ménière received a legion of honor for his work, he never gained the academic professorship to which he aspired. Fate came to Ménière when one of the fathers of modern Otology, Jean Itard , died in 1838. Itard was the physician to the famous Paris School for the Deaf founded by Charles-Michel d’L’Epee in the 1760. Itard was responsible for the health of the students and faculty where sign language concepts found in the streets of Paris were taught to other deaf people as a form of education. The sign language teachings at the Paris school were one of the early methods of educating the deaf worldwide. Upon Itard’s death in 1838, Ménière secured the position of physician-in-chief at the Institute for deaf-mutes (The Paris School for the Deaf) and this began his focus upon diseases of the ear.
According to the Prosper Meniere Society, Ménière was an acute clinical observer and an able surgeon. He was certainly a hard worker with many and diverse interests. Bloh (2001) suggests that the sheer volume of his writings makes one wonder how he found time to see patients or conduct research. He wrote about the political turmoil of his country and his experiences both personally and clinically. In 1848, Prosper Ménière published a paper titled: Traite des maladies de lourelle (translated as Treating Ear Disease). According to Junior et al (2007), Ménière also wrote papers on hearing loss and muteness as well as developed some crude hearing evaluation methods. Ménière did not believe in the barbaric methods of otologists that would promise to cure deafness. He felt deafness was incurable and patients should be reeducated to learn to live with it. These feeling perpetuated writing the two other, lesser known texts; the first was De la guérison de la surdi-mutité, et de leducation dês sourds-muets (The healing of the deaf-mutism, and education of the deaf and dumb) in 1853 and, later in 1856 he wrote, Du marriage entre parents, consideré comme cause de la surdi-mutité (Of marriage between relatives, considered as a cause of deaf-mutism), one of the first publications on the connection of deafness and consanguineous marriage. Obviously, Ménière had learned a great deal about deafness and conducted research in the area of hearing during his time at the Paris School. His clinical experience and research with various audio-vestibular disorders at the Paris School is what assisted in the formulation of his famous paper presented in 1861 to the French Academy of Sciences.
The Famous Paper
Based upon his medical experience at the Paris School, Ménière described a series of patients with episodic vertigo and hearing loss to the French Academy of Medicine in 1861. He also mentioned the postmortem examination of a young girl who experienced vertigo after a hemorrhage into the inner ear. Prior to that time, vertigo was thought to be a cerebral symptom similar to epileptic seizures. Ménière pointed out that vertigo frequently had a benign course and that common treatments, such as bleeding, often did more harm than good. He was not attempting to define a disease or syndrome but rather to emphasize that vertigo could originate from damage to the inner ear. This paper, titled: On a particular kind of hearing loss resulting from lesions of the inner ear ultimately led to the recognition of the famous syndrome that bears his name. Though he had never succeeded in forcing the gates of the Academie de Medicine, he enjoyed a wide acquaintanceship and reputation among its members. The Prosper Meniere Society says of Ménière , “he passed a remarkable man of many facets and would have given us much more had he lived beyond age 63.”
Today the technical name for Ménière’s Disease is Endolymphatic Hydrops and still baffles otologists as its symptoms can be quite arbitrary and capricious. The specifics of the disorder can be accessed at Vestibular Disorder sites. The disease endowed with Prosper Ménière’s name now has more clinical descriptions and pathological discoveries but experts still aren’t sure what generates the symptoms of an acute attack of disorder.
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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.
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