today, accounted for much childhood deafness and
frequently led to the complication of MASTOIDITIS, a
bacterial infection in the porous mastoid bone
behind the ear that in turn often spread to the
brain, causing MENINGITISor ENCEPHALITIS. Even TON-
SILLITISfrequently resulted in abscesses in children
and adults alike; tonsillectomy, in the absence of
adequate ANESTHESIA, was not an option.
These infections had grim outlooks, leading to
desperate treatments such as lancing (cutting open
the ABSCESSor infection) and application of chemi-
cal disinfectants (for example, iodine and carbolic
acid), which were the standard of treatment for
external wounds. The highly toxic nature of these
approaches became a calculated risk in the fight
for life. Lancing an abscess opened a direct chan-
nel into the bloodstream for the BACTERIA, virtually
guaranteeing rapid death due to SEPTICEMIA(“blood
poisoning” or septic shock). The alternative, how-
ever, was suffocation from the swelling that closed
off the throat. DIPHTHERIAand PERTUSSIS(whooping
COUGH), bacterial infections of the throat,
remained the leading causes of childhood death
until the 1950s. Today antibiotics, surgery, and
routine childhood vaccinations have relegated
these diseases, for the most part, to entries in text-
books and encyclopedias.
Breakthrough Research and Treatment AdvancesSome the most profound breakthroughs in oto-
laryngology have been in the area of hearing loss.
Digital technology brings the computer to the ear,
allowing tiny and fully programmable hearing aids
that fit far enough within the auditory canal to be
undetectable. Computerized adjustments accom-
modate individual variations in tonal loss, helping
people screen out the kinds of noise interference
that have made the traditional HEARING AIDa less
than ideal solution. The COCHLEAR IMPLANT, which
debuted in the 1980s, makes hearing possible for
thousands of people with sensorineural hearing
loss for whom hearing aids do not work. Hair-thin
wires reside within the inner ear, receiving input
from outside the ear and conveying it directly to
the hair cells within the cochlea in much the same
way nerves do. External components collect and,
using digital technology, interpret sound signals.
Other advances mark improvements in treat-
ments for ear infections, sinus infections, seasonal
allergies, and operations on structures of the oro-
facial structures. Infants born with cleft deformi-
ties today will grow up with little evidence of this
once disfiguring CONGENITAL ANOMALY, as advances
in anesthesia and surgical techniques now permit
surgeons to perform corrective procedures early in
childhood and often in a single operation. Endo-
scopic surgery reduces risk for numerous opera-
tions on the nose, middle and inner ear, and
throat. New understandings of immune function
and allergy response have led to new treatment
approaches for chronic SINUSITISand ALLERGIC RHINI-
TIS. Current research continues to explore age-
related changes in hearing, seeking approaches to
head off hearing loss.6 The Ear, Nose, Mouth and Throat