Neurotology and I

A long period of time has elapsed since my last blog. I ask my readers to apologize me. I had the idea that in my old age I would have less work to do and plenty of leisure time. It is not so. It seems that I have more and more things to do. But I cannot complain, because I love my work.

One of my Neurotology professors, Dr. Wallace Rubin, has died recently. He was a very good friend and we visited each other many, many times. We have been together in New Orleans, where he lived, but also in Chicago, Los Angeles, New York, Palm Beach, Cancún, Bad Kissingen and, of course, in São Paulo. Maybe it is because of him that I am now reminiscing about my adventures in Neurotology. For my readers that are not physicians or audiologists, this is the interface between Otology and Neurology. We deal with the labyrinth. We mainly treat vertigo, disequilibrium and unsteadiness.

Dr. Claus-Frenz Claussen, Dr. Wallace Rubin and I

My first Professor of Neurotology was Dr. José Santiago Riesco MacClure, a physician from Chile that created two Neurotology clinics in the United States: one in Saint Louis, MO, where I was, and the second in Chicago, IL. As a consequence, he had many disciples.

Riesco once told me that when Dr. Alfonso Asenjo, an eminent neurosurgeon, founded his Institute of Neurosurgery in Santiago, Chile, in 1939, he and his colleague Dr. César Fernandez were invited to become the neurotologists of the institute. At that time Riesco and Fernandez shared an Otolaryngology clinic in Santiago.

None of them knew anything about Neurotology, so they got some books and studied them very hard. They were called to the Institute to see patients and wrote their reports.

One day Riesco finished his office earlier than usual and decided to go to the Institute’s clinical discussion, that he seldom attended. The meeting had already started and nobody saw him entering the room. As they were discussing a patient, one of the physicians inquired: “What does the neurotological report say?” Another doctor read the report: “They say that the patient has a cerebellar tumor.” Said the first physician: “Then the patient must have a frontal lobe tumor.” And everybody laughed.

Riesco left the room as quietly as he had arrived and called his coworker: “Fernandez, we are the clowns of the Institute.”

They left their books aside and began to follow the patients, observe the operations to see the precise location of the lesions and gradually acquired the knowledge that they had not succeeded in getting from books.

In Saint Louis he gave us a series of lectures based on his own experience. To this day I believe that these are the only lectures worth while listening; I have no interest in hearing a lecturer who limits himself to quote papers or books, cause I can read them myself. And we got together to see patients and to perform electronystagmography, that was, at that time, a new way of recording eye movements. I already told you, in an older blog, that he was the man who taught me to think. For that was what we did, analyzing the data from each patient to reach a diagnostic conclusion.

Before I went to Saint Louis both Riesco and Fernandez spent sometime in the research department of the Central Institute for the Deaf. For many years this department was conducted by Dr. Rafael Lorente de Nó. When this eminent neurophysiologist moved to the NIH laboratories in Bethesda, MD, he was replaced by the equally eminent Dr. Hallowell Davis, the father of electrical response audiometry. Riesco went back to his clinical practice in Santiago, where he stayed, except for his years as Visiting Professor in Saint Louis and in Chicago. Fernandez, on his way back to Chile, decided to make a brief stop in Mexico City, to work with another important neurophysiologist, Prof. Arturo Rosenblueth. The brief sojourn extended to two years and then he received an invitation from Dr. John R. Lindsay to join the Department of Otolaryngology of the University of Chicago. So it happened that Fernandez never went back to Chile, except to visit his relatives. He was an extraordinary researcher, with enormous contributions to the field of Neurotology. And he was also a good friend. It is interesting to add that he spoke English with a marked Spanish accent. And I have a distinct feeling that he could no longer speak  Spanish; he only spoke English, even to Riesco.

During my days in Saint Louis I spent two afternoons a week in Dr. Theodore Walsh’s private office. Dr. Walsh was the head of the Department of Otolaryngology. One day we were seeing a patient with Menière’s disease and I told him that it was very rare in Brazil. “No,” he said, “when these patients find out that you can treat them and that you care about them, they will look for you. I predict that you will have many patients with Menière’s disease.” I think it is quite unnecessary to confirm that his prediction came through.

Along the many medical meetings that I attended I met many people who added knowledge to the discipline of Neurotology, like Profs. George François Greiner, from Strasbourg, Leonard Barend Willem Jongkees, from Amsterdam, Peter C. R. Pfaltz, from Basel, Brian F. McCabe, from Iowa City, Kenneth H. Brookler, from New York City, and many others.
 

Our Neurotology book, organized by Francisco Zuma e Maia, Sergio Carmona and I

Another important neurotologist in my life was Nils Henriksson, who worked in the University of Lund, in Sweden. He was a disciple of Jongkees and also worked with Cesar Fernandes in Chicago. I visited him in Lund and he also came to São Paulo to visit me.

Claus-Frenz Claussen was also an important neurotologist who, in 1974, founded the Neurootological and Equilibriometric Society (NES) in Bad Kissing, a small German town. One of the cofounders of NES was Prof. Juan Manuel Tato, from Buenos Aires. I was introduced to him in my father’s house when I was 14 years old; he and my father were good friends.

In one of the NES meetings I received a special homage and was saluted by Wallace Rubin.

Dr. Sergio Carmona and I in Baltimore, Maryland

The later portion of the 20th century and the present times brought many important changes to Neurotology. There were many new contributions to Neurotology, brought by researchers like Michael Halmagyi and Ian Courthoys, from Sidney, David Newman-Toker and David Zee, from Baltimore, Jorge Kattah, from Peoria, Michael Strupp and Thomas Brandt, from Germany, Herman Kingma, from Holland, and many others. It must be mentioned that Halmagyi, Courthois, Newman-Toker and Zee are neurologists, and Kattah is a neuro-ophtalmologist, demonstrating how interdisciplinary is our medical specialty. And I am grateful to my friends Francisco Zuma e Maia, from Porto Alegre, Sergio Carmona, from Rosario (Argentina) and Renato Cal, from Belém, who help me in the pursuit of the new Neurotology. We live in an age of changes, and Neurotology is also definitely experiencing a phase of intense progress.