Schuknecht’s Crusade Against Myths in Otology

Like Joseph Toynbee, Harold Schuknecht believed that the only way to develop rational treatments for inner ear diseases was to understand the pathology of these diseases. Schuknecht used his human temporal bone studies to “refute the conceptual validity of several popular otologic therapies.” Probably the most controversial of these was the treatment of Ménière’s disease with endolymphatic shunt surgery. Schuknecht argued the concept that the endolymph sac can be drained to relieve endolymphatic hydrops is a pedantic notion at best. He studied numerous human temporal bone specimens of patients who had had shunts placed in the endolymphatic sac, and in every case the shunt devices were ensheathed in fibrous tissue. He debunked many other controversial treatments in otolaryngology. He argued that most cases of sudden deafness and acute vertigo (vestibular neuritis) were due to viral infections of the inner ear and eighth nerve, and that vascular treatments were inappropriate.