What the Temporal Bone has Always Known History, Evidence, and the Quiet Correction of Received Wisdom in Otologic Surgery

Abstract

Much of what has been taught and practised in chronic otitis media surgery over the past century was not evidence-based. It was consensus-based — a set of received positions transmitted from teacher to trainee with the authority of tradition rather than data. The dry ear prerequisite. The mandatory mastoidectomy. The uncritical preference for one canal wall strategy over another. Each has been challenged by evidence, and each has proved more fragile than its proponents believed. This article argues that this pattern is intrinsic to the history of temporal bone surgery, which has always been conducted at the intersection of what surgeons believed and what the bone eventually demonstrated. The figures who built modern otologic surgery were, at their best, willing to follow the evidence wherever it led — including away from their own most influential work. That disposition is what the current generation of otologic surgeons most needs, and what the history of this discipline most clearly models.