The story of Samuel Rosen and surgery of the stapes bone (2016) | Hacker News Reader

The story of Samuel Rosen and surgery of the stapes bone (2016)

hekint.org

12 pointsbookofjoe6 comments

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?

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.

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?

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.

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.

Figured out that you could try an old technique that was already known to have superior results when it works before performing a newer type of operation? Seems quite a weak discovery if it's a discovery a all. Maybe the author didn't understand what was significant about his work so accidentally missed that.

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