No abstract

The ability of the human nose to warm and humidify the respiratory air is important to maintaining the internal environment of the lungs, since ambient air is conditioned to nearly alveolar conditions (body temperature and fully saturated with water vapour) upon reaching the nasopharynx. Because of very short time of the inspiratory phase duration, as well as expiratory phase, only the rich vascularization of the nasal mucosa and specific organization of the submucosal vessels are not able to assure such effective physiological activity. Therefore the type of airflow during the respiration is essential to understanding the functional possibilities of the nasal mucosa. Most studies have investigated the airflow only in steady-flow conditions, where the laminar flow was observed. Anatomically accurate physical models of real nasal cavities and particle image velocimetry allow evaluation of the entire flow field in the nasal cavity. In these investigations a partially turbulent flow was observed even at low air velocities in most part of the nasal cavity. From a physiological perspective, a turbulent flow would seem sensible, since it enhances contact between air and the mucosal layer. By doing so, the nasal physiological functions - humidification, cleaning and warming are optimized.

The paper is a review of primary and secondary historical and scientific literature concerning the surgical treatment of the middle ear diseases. The development of mastoid surgery can be traced through the past 4 centuries. Once used as a means of evacuating a postauricular abscess, it has evolved to become a method for gaining entry into the middle ear to control acute and chronic ear diseases, or for treatment of otogenic complications. Earlier works led the way to the postauricular "Wilde incision", which gave rise to Schwartze mastoidectomy. Oscar Wilde's ultimate demise from an otogenic meningitis appears all the more ironic when one considers the role his father, Sir William Wilde, played as one of the founding fathers of modern otology. The death of baron von Berger after mastoidectomy performed for treatment of tinnitus and hypacusis, stopped the further development of surgical procedures for about hundred years. The Joseph Toynbee's "Diseases of the ear" was the first work about ear diseases on a pathologic anatomical base, and fundamental for otology of the German speaking countries in the nineteenth and early twentieth centuries. Otology was emerging as a specific specialty. Von Tröltsch was the first surgeon, who proposed the antral opening through the external ear canal. When Schwartze and his assistant, Eysell, published their paper: "On the Artificial Opening of the Mastoid Air Cells," a century or so had passed since the few previous attempts to remove the tegmen of the mastoid had been reported. One of the greatest otologists of the 19th century was Adam Politzer, His influence on the 50 years of otology has never been equaled. It is in his honor that the International Society of Otology bears his name.

Joseph Tonbee's life's work may be summarized in the words of William Wilde: "The labours and investigations of Mr. Toynbee have affected more for aural pathology than those of all his predecessors either in England or on the continent". Some idea of the extent of his researches is given by the fact that he dissected some 2.000 ears. These preparations formed the Toynbee Collection in the Museum of the Royal College of Surgeons of England. He wrote the results of his researches in a catalogue that includes the description of 1,659 human ears. This catalogue forms the basis of modern otology for all time. This purely pathological catalogue was completed in 1860 with the publication of a more clinical book, "The Diseases of the Ear: their Nature, Diagnosis and Treatment". Toynbee appears to have been the first to describe the pathological changes in otosclerosis. In his book "Diseases of the Ear" he described the condition clearly, recognizing "anchylosis of the stapes to the fenestra ovalis" in 136 temporal bones. He also aligned the subjective, visual and ausculatory tests for Eustacchian tubal patency which we use today. Adam Politzer wrote: "Toynbee was the first who realized in otology that therapeutic progress depends on the knowledge of anatomy". But Toynbee was also active on other fields. Politzer, in his lecture in Vienna in 1914 said: "Toynbee was as outstanding a savant as he was a philanthropist. In addition to his scientific activity, he considered it a sacred task to dedicate his spare time to the improvement of living and health conditions of the poorer classes." Tragic enough, Toynbee's zeal for clinical experimentation went too far. Seeking to help his patients by devising a treatment to allay their tinnitus, he conceived the idea of introducing a mixture of chloroform and prussic acid into the tympanic cavity by means of Valsalva maneuver. When he made the first trial on July 7, 1866, with himself as a subject, he was found dead on the couch in his consulting room.

The case history of the German emperor Frederick III, who died of laryngeal cancer in 1888, is briefly reported. In spite of fact, that the German laryngologists the patient's pathologic changes diagnosed as laryngeal cancer in early stage, the ultimate diagnosis was made too late for surgery to have any effect. This delay was due to the differences in opinions between the attending laryngologists; particularly between that of the English prominent laryngologist Morell Mackenzie and the Germans, prof. Gerhardt and prof. Bergmann. The roles of the British Queen Victoria as well as her daughter, the wife of Prince Frederick, the princess Victoria, in decisions about the treatment of the disease, are discussed. The behavior and the personality of Sir Morell Mackenzie played also a very important role in the course of the disease. Some medical facts and symptoms render it probable that syphilis was the underlying reason for the development of cancer. Crown Prince Frederick was a pipe smoker for at least 30 years before he died at the age of 57 years, so it may be possible, that the Emperor's laryngeal cancer was induced by tobacco. There are some suggestions, that the premature death of the King of Prussia and German Emperor Frederick III could be a critical turning point in European's history.