[History of the ear speculum. Images from the history of otorhinolaryngology, highlighted by instruments from the collection of the German Medical History Museum in Ingolstadt]

Abstract

BACKGROUND. Inspection of or interventions in the external ear canal and the nostrils pose similar technical problems. This is the reason why early instruments devised for otoscopy and rhinoscopy were based on an identical principle. They were shaped like a pair of tongs, comparable to nasal specula of today. A similar type of instrument had been developed earlier by barber surgeons for inspecting narrow wound cavities. TONG-SHAPED SPECULA. The first description and illustration of an aural and nasal speculum was provided by Guy de Chauliac in Montpellier, France in 1363. Sophisticated models were presented by Fabricius Hildanus in Germany in 1646 and J.J. Perret in Paris in 1772, who offered them in his illustrated catalogue of surgical instruments at fixed prices. W. Kramer (1836) in Berlin improved this tong-shaped instrument and devised the ear speculum named after him that was generally favored during the first half of the 19th century. Further variations of this type were presented by Lincke and Schmalz (1846) in Germany. FUNNEL-SHAPED SPECULA. Ignaz Gruber in Vienna in 1838 devised the first tunnel-shaped ear specula made of metal. They had a simple conical shape, were not divided into separate jaws, and could not be spread. Gruber himself did not publish his invention, but he demonstrated his ear specula to W. R. Wilde from Dublin, who had paid a visit to his office in Vienna. Wilde reported on this in 1844, and subsequently systematically refined Gruber's specula. A. v. Tröltsch from Würzburg (Germany) had seen these instruments at Wilde's office and it was Wilde himself and v. Tröltsch who helped this type of ear speculum to gain acceptance on an international scale. A different type of bottle-shaped ear speculum was first used by Schmalz (1846) and Erhard (1859) in Germany, but it was only developed into a commercially available instrument by Josef Gruber in Vienna in 1870. The ear specula most in use today were first presented by A. Hartmann in Berlin in 1881. SUPPLEMENTARY INVENTIONS. An important supplementary invention was the pneumatic ear speculum by E. Siegle in Stuttgart (Germany) in 1864. It permitted not only inspecting the tympanic membrane but also examining its compliance and response to variations in air pressure in the ear canal. The importance of this instrument was recognized at once and has remained undisputed to this day. J. Bruton, an English military surgeon, presented his otoscope in 1862. It was the first device to incorporate interchangeable ear specula, illumination by a perforated mirror, and a magnifying lens into one handy instrument. It is the precursor of the modern diagnostic sets comprised of a battery-handle, various specula, and accessories for otoscopy, rhinoscopy, and ophthalmoscopy which started to come into use in the late twenties of this century. This historical development of the ear specula is described and illustrated in detail.