Book Review

Pediatric Otology and Neurotology

N Engl J Med 1998; 339:1087October 8, 1998

Article

Pediatric Otology and Neurotology
Edited by Anil K. Lalwani and Kenneth M. Grundfast. 728 pp., illustrated. Philadelphia, Lippincott–Raven, 1998. $149. ISBN: 0-397-51466-2

Fields such as pediatrics and internal medicine long ago became comfortably distinct from each other on the basis of both the age of the patient treated and the uniqueness of diseases suffered by the respective populations. The field of otology, in contrast, has approached these distinctions ambivalently. This textbook is proof that information about disorders of the ear in children is worthy of compilation.

Historically, much of otology did focus on children. Before the availability of antibiotics, acute mastoiditis was an extremely common disease. It accounted for approximately one third of all hospital admissions on a children's ward. Children underwent rapid operations in the postauricular area, and the mastoid was cleaned with a curette with the hope of facilitating drainage and resolution of the infection before it spread further. Adult otology was still a backwater specialty, not because of a lack of good intentions but because of technical problems.

With the arrival of antibiotics, the incidence of acute mastoiditis dropped and the future of the entire specialty of otolaryngology took on an anachronistic pallor. Fortunately, the Germans introduced the use of a brightly illuminated microscope to the management of diseases of the ear; thus was the technique of microsurgery born. A renaissance, primarily with respect to adult ear conditions, exploded, because diseased ears could be reconstructed surgically. Otosclerosis could be corrected by stapedectomy. Tympanoplasty became highly successful. Mastoid surgery became more precise. The inner ear became a new challenge, and acoustic tumors could be approached in concert with neurosurgery. Cochlear implantation was born. The adult ear had never had so many opportunities for improvement.

Problems of the child's ear, in contrast, became synonymous with otitis media. Efforts were focused on antibiotic treatment and surgical insertion of ventilation tubes. During the past decade, a critical mass of varied and relevant information pertinent to the ear of the child has been gained; Pediatric Otology and Neurotology catalogues this information well.

This book is comprehensive; the information between its covers is long overdue. The title indicates that the field has stepped beyond the external and middle ear to the inner ear. The editors have selected credible authors. The reviews are thorough and readable. The bibliographies are extensive. The editors have been wise to unite several disciplines, such as otology, pediatric otolaryngology, audiology, genetics, and education of the deaf. The book is contemporary. There are excellent sections related to the exciting field of molecular genetics. An entire chapter is devoted to human immunodeficiency virus infection. The book is reasonably well illustrated; the individual authors have provided high-quality illustrations, although there is a lack of consistency to the style. The book takes on challenging topics, such as fluctuating and mixed hearing loss, the management of the atelectatic tympanic membrane, and the type of mastoidectomy to use in cholesteatoma surgery. The chapter on posterior fossa tumors is unique and lends credibility to the word “neurotology” in the title of the book.

The book does have certain characteristics with which a reader might have difficulty. There is a fair amount of overlap among chapters. Although such overlap might be an advantage for the reader looking only at one chapter, the redundancy is unnecessary for those reading multiple chapters. The chapter on education of the deaf emphasizes oral communication without providing a substantial counterbalance with regard to sign language. The chapter on speech and language is categorized as basic science, which seems odd for a clinical activity. Information on the enlarged vestibular aqueduct syndrome, which is becoming quite important in the realm of pediatric otology, is difficult to find in this book. Finally, the editors encouraged some of the authors to include two case reports, presumably to provide the perspective of personal experience. However, several of the authors did not include numerical tallies from their own experience or from the literature, which leaves the reader wondering how common or how rare their topics might actually be.

Good fences make good neighbors. This textbook stacks many solid stones as a way of defining the area that should be farmed in the field of pediatric otology. Yet the authors are careful to leave openings in the fence to permit the passage of ideas and to help establish common ground with their colleagues in adult otology.

Roland D. Eavey, M.D.
Massachusetts Eye and Ear Infirmary, Boston, MA 02114