Background and Evolution of Endoscopic Sinus Surgery

Introduction According to Spiess,I anterior rhinoscopy was routinely used since 1868. From then on, there were numerous attempts to achieve and improve the view into the different meatis, clefts and cavities of the paranasal sinus system. Wertheim' builthis conchoscope,andZaufal,' ValentinI and others explored the Eustachian tube orifice with the help of a modified cystoscope. HirschmannandReichert' inspected the maxillary sinusendoscopically viaanalveolus. Inthatsame year, Hirschmann was able to endoscopically inspect fiveethmoidal sinuses after part of the middle turbinate had been resected. Inonecasewithchronic ethmoidalempyema, hewas able toidentifytheunderlying focusandclearitendoscopically. There was continuous technical improvement. Some authors managed to insert an endoscope through a trocar which was inserted into the maxillary sinus via the inferior nasal meatus. Despite numerous attempts, however, technical problems prevailed, prohibiting a widespread use of the technique. Zamiko in 1925 gives his impression on nasal endoscopy: "It impresses me more as an interesting toy than as a necessary diagnostic tool. I knowof no results achieved by its use that couldnot have been achievedbyother, simpler methods." Zollnerstated in 1942 that: "Althoughendoscopy wasinvented inGermany..., the nasalendoscopehasnotbeen accepted by a widecircleof our specialty." After the Second WorldWar, maxillarysinusendoscopygained the supportof individuals in a number of countries, although it still did not achievewide-spreadacceptance. Aslateas1956,Liischerwrote: "A cystoscope-like antroscope can be introduced through the inferior nasal meatus that permits direct visualization of the maxillary sinus. Insomecases thismaymakea contribution." During this time period (1951-56) Hopkins made fundamental improvements in the optics of endoscopy. Although initially the maxillarysinus and the orificeof the Eustachian tube were the focus of diagnostic interest, endoscopy was soon extended to the other paranasal sinuses. At the beginning of my academic career my teacher, Prof. G. Hofer, advised me to study the normal as well as the pathological function of the upper airways. I conducted several experiments on: the influence of various hormones,