History of Audiology – BC to the Renaissance

Ebers Papyrus (1550 BC)

As originally used, the term “audiology” concerns itself with hearing assessment.  The more “modern” aspects grew from the collaborative efforts of physics, physiology, experimental psychology, and otology.  There seems, however, to have been a continuous thread that represented a logical sequence even as early as 1550 BC, long before our “pioneers” in modern-day audiology were a gleam in their parents’ eyes.

To my knowledge, the best reference for the discipline that has now become “audiology,” is “A History of Audiology: A Comprehensive Report and Bibliography From the Earliest Beginnings to the Present” translated by Harald Feldmann from “Die geschichtliche Entwicklung der Hörprüfungsmethoden, kurze Darstellung und bibliographie von den Anfången bis zur Ggenwart.”  This work appeared in Germany in 1960 in zwanglose Abhandlungen aus dem Gebrief der Hals-Nasen-Ohren-Heilkunde, H. Leicher, R. Mittrermaier, and G. Theissing, eds.  Georg Thieme Verlag, Stuttgart, 1960.  The intent of this, and subsequent blogs, is to provide some of this history that seems to have been ignored and/or forgotten.

While it might seem logical to consider the origins of audiology with the advent of electronic hearing assessment in 1919 (electronic audiometer in Germany), it must be recognized that such advancements were merely the technical realizations of older notions.

Note:  Although the author of this blog would like to claim credit for researching this information, what is written here is a compilation of the significant works of others and comes from an English translation of the referenced work in 1970 in Translations of the Beltone Institute for Hearing Research {{1}}[[1]] Feldmann, H.  A history of audiology: a comprehensive report and bibliography from the earliest beginnings to the present.  Translations of the Beltone Institute for Hearing Research.  No. 22, January, 1970, 111 pages.[[1]]

How Old is Old?

Ebers Papyrus (1550 BC)

Hippocrates of Cos (460-370 BC)

One might just as well ask how old is paper?  There is evidence that hearing disorders and therapeutic attempts date at least to 1550 BC {{2}}[[2]] Politzer, A.  Über subjective Gehörsempfindungen.  Wien. Med, Wschr. 1965. Zit. Nach Politzer, Lehrbuch der Ohrenheilkunde, 1. Aufl. 1978-228.[[2]] taken from the famous papyrus Ebers, but most likely even this was based upon older writings then in existence.  It dealt with the management of hearing loss.  Hippocrates (460-377 BC), about a thousand years later reported, for the first time, on clinical findings related to hearing disorders and attempted to account for their causes.  He related these primarily to weather changes, the direction of prevailing winds, but also to tinnitus.  And, although he had reported also on a case of hearing loss from skull trauma, differential diagnosis and the various forms of hearing disorder were unknown.

Aulus Cornelius Celsus (50-25 BC)

About 500 years later, Celsus provided a clear etiological differentiation of hearing disorders and offered treatment measures, some of which are still in use today – primarily related to occlusions of the ear canal by cerumen, foreign bodies, ulcerations, atresia, etc.  But, other treatments, without etiological differentiation, for what we now identify as otitis media used a procedure later described by Valsalva “until some foam-like fluid emerges from the ear.”

From BC to AD

The New Testament (Mark 7, 31; Matthew 11, 5) described various forms of treatment for deaf persons and are most likely during the time of Celsus.  And, perhaps one of the most famous historically relates to the Roman Emperor Hadrian (76-138 AD).  The use of his cupped hand behind his ear when listening to discussions was well-known throughout Rome.  This use of the cupped hand by the hearing impaired led Galen (130-200 AD) to recognize the functional significance of the pinna as an auditory funnel.  But, Galen also speculatively differentiated between peripheral, auditory nerve, and central hearing disorders, but offered no differential diagnostic signs or symptoms.  In fact, the inner ear was not even known to exist.

Claudius Galenus; Claude Galien; Galen (129-217 AD)

From the time of Galen until the end of the Middle Ages, directions related more to expanding the existing therapeutic treatments, which included acoustic stimulation, than to differential diagnosis.  As an example, Archigenes, a famous Roman physician during the time of the emperor Trajanus (98-117 AD) used loud sound presented into the ear via a “tuba” to stimulate the auditory system.  Alexander of Tralles (525-605 AD), another physician, reported on both treatment and acoustic stimulation procedures apparently widely in vogue at the time, describing them as drugs (herbs, emetica, etc.), and following arteriotomies, blowing a trumpet directly into the auditory canal.  Others used large bells and other special instruments devised for stimulating the ear in hopes of improving hearing.

Middle Ages

Other “interesting” approaches were used with the hearing impaired, such as a rehabilitation program in which the ears were supposed to be aroused by a soft voice (Lanfranchi – died approximately 1301?).  Arnaldus de Villanova (1235-1312?) made his patients sneeze while they closed off their nostrils.  Nicolai Nicole (1357-1430) recommended suction upon the eardrum using a small tube made of silver or gold and tightly fitted into the ear canal for that purpose.

Hearing Loss Types

The relationship between hearing loss and age seems to have been identified early because it was mentioned in the Talmud (a vast collection of Jewish laws and traditions, 3^rd to 5^th century).  The same holds true for acoustic trauma in a quote from John Riolanus (1580-1657) in which he relates that those living close to the falls of the Nile in Egypt are commonly hard of hearing, and ultimately become completely deaf.

So, essentially, from the time of Hippocrates until the end of the Middle Ages (a span of about 2000 years), no real progress concerning the functional diagnosis of hearing disorders was made.  That would not occur until the time of the Renaissance (16^th century).

A future blog will describe and reference early hearing measurement tools and equipment – The Renaissance Period of Hearing Assessment.