Historical Reviews
By the beginning of the 20th century Politzer, and others, had established the basic principles of surgery for cholesteatoma. Remove all diseased tissues, exteriorise the cholesteatoma and create a good meatoplasty. The object was to reduce the risk of intracranial and other complications but, of course, there was no talk about routinely closing the perforation or trying to improve the hearing.

In the hands of the majority of surgeons these patients exchanged a smelly, discharging, deaf and unsafe ear for a smelly, discharging, deaf but relatively safe ear. Cheap at the price, I suppose, and if the operation was well done, with a good meatoplasty, the patient may even have got an intermittently dry ear. And the patients who got the very best of surgeons with the very best of luck even got permanently dry ears. But unless the luck was exceptional, the hearing always remained impaired.

During the 1950s Wullstein and Zollner turned their attention to trying to improve the hearing in chronic middle ear disease. Wullstein coined the term tympanoplasty and indeed together they had quite a measure of success in hearing improvement.

Initially only tympanic membranes were being repaired but later surgeons began also to make an effort at reconstructing an ossicular chain and by the late fifties ear surgeons were bubbling with optimism and enthusiasm. But nonetheless, cases of cholesteatoma were usually left with an open cavity with all the potential problems that this entailed at that time and all the limitations for hearing improvement.

And then in the words of the poet Yeats, all changed, changed utterly, a terrible beauty was born. Claus Jansen published his work on closed cavity surgery for cholesteatoma. At the same time, and unknown to each other, surgeons elsewhere had been working along the same lines. Bill House, Jim Sheehy and David Austin in the USA and Gordon Smyth in Ireland had similar ideas. It is difficult now, over 40 years later, to convey the excitement in the world of otology at that time. With the preservation of normal anatomy, we believed that the hearing could be restored, routinely, in every case. Everything seemed to be possible.

However there was a lot of opposition to closed cavity surgery, some rational and some irrational. There were those who were predicting a harvest of delayed intracranial complications and the world of otology was split into two camps…canal wall up and canal wall down. It wasn’t long before this became a very emotive issue and clashes were not uncommon at major meetings. I have previously likened the situation to Lilliput in the story of Gulliver’s Travels, where the big enders and the little enders were prepared to kill each other over the way to eat a boiled egg. Well, otologists were prepared to kill a reputation over the way to deal with cholesteatoma.

But the closed cavity did seem to offer a better chance of improving the hearing and it became almost wimpish not to be doing closed cavity cholesteatoma surgery. Almost all the young surgeons wanted to learn how to do it.

So it was in an atmosphere of great excitement that courses in closed cavity surgery began to be held. And the most popular were those run by the originators of these closed cavity procedures. They were held in various centres but most were at Gummersbach. The faculty varied a little from course to course but usually consisted of David Austin, Geza Jako, Claus Jansen, Jean Marquet, Jacob Sade, Gordon Smyth and Stuart Strong.

These courses were in big demand, were frequently oversubscribed and were a great success. Now, what really impressed me about them, as an onlooker, was how much the faculty got out of them, and learned from them. I was working with Gordon Smyth in those early days and he would always come back from the courses fired with enthusiasm.

The faculty would make their presentations at the courses and then there were panel discussions where they were forced to defend what they had just said. At the end of the day, there were the discussions in the bar when tongues were loosened. They were often critical of other peoples methods: their audiometry, their selection of cases and collection of results and yes, doubt was even cast on their honesty. But in the process they sharpened each other, learned a lot, became even more enthusiastic and got great fun. Learning and developing in otology was an exciting experience which they got at the courses. But those running them thought that these processes ought to be brought together in the form of regular pure otology meetings.

In the sixties and early seventies, there were very few pure otology meetings. There was a need for regular, comprehensive, international otology gatherings and it was to fulfil this need and out of these courses that the Politzer Society was born.

And from the first meeting in Davos in 1978, this Society hasn’t looked back. I have resisted the temptation of giving you the list of theplaces for our subsequent 23 meetings but it is available on the Politzer Society Website. The world has changed a lot in the last 25 years and we have gone from very few to too many otology meetings. Consequently, about 6 years ago the Politzer Board decided to hold a major Politzer meeting only every 2 years and this has worked well. There have been other Politzer affiliated meetings and smaller meetings with Politzer Society support but the idea of a major event only every two years has been a great success.

Politzer knew the importance of talking with the experts and he made a point of working with them in their clinics. And there is nothing to beat this. You and I may have difficulty in finding the time or money to visit the experts but here, this week, in Amsterdam we have a large collection of them. The programme allows you to meet and to talk with them. In addition you can create your own opportunities. There are few experts who do not enjoy talking about what they do so feel free to seize the opportunity. This has always been an important feature of this Society.

Let me conclude by commenting on three things. First let me comment on the ethos of this society. The officers tend to have a low profile and their position brings them little or no glory. In keeping with this I am not listing names. But this has resulted in dedicated officers who work hard for the society and for otology. Although I wouldn’t dream of naming them I assure you that we owe them a great debt of gratitude.

Secondly, there is the European Academy of Otology and Neurotology. Some people feared that the formation of the Academy might result in a weakening of the Politzer Society. Happily that fear has been unfounded. There is considerable overlap among the active members of both groups but the main purposes of the two are quite separate. There has been happy co-operation between the two to their mutual benefit, extending even to this meeting.

Finally, Rinze Tange and his team have been very diligent and have produced an wonderful programme. I expect this meeting to be excellent and on behalf of all, of you I say a big thank you to all of them. I hope you will have a great time over the next few days. Thank you.

Alan Kerr
With the advent of the surgical microscope and a better understanding of the principals of sound transmission during the middle of the 20th century, Middle ear surgery advanced considerably if not dramatically . This led to impressive surgical advances -not dared or even dreamt of before - especially as regards treating "Chronic Ear Diseases" in general and Cholesteatoma in particular. The therapeutic approach which evolved was that "one may and should remove any "diseased tissue" and thereafter repair any anatomical defect which resulted from the pathological process.

Most of the techniques evolved in respect of chronic ear surgery - emanated from several German Universities - and many flocked there from all over the globe to learn the new way of thinking and new techniques. This was the beginning of the Tympanoplastic era which intuitively regarded any chronic middle ear process as a sort of an infected "tumor" - its removal required some reconstruction which often ended with an open radical mastoid cavity.

Soon thereafter a new goal was set namely to remove all pathological tissues and at the same time preserve an almost completely anatomical reconstructed Middle Ear System with an intact posterior wall - avoiding thereby an open mastoid cavity. At the same time this method also tried to preserve or reconstruct a functional ossicular chain - all this together was termed Posterior Tympanotomy or Canal Up Tympanoplasty. The old concept of treating such ears especially in the presence of Cholesteatoma leaving an exteriorized radical mastoid cavity was considered to be obsolete.This kind of surgery i.e Posterior Tympanotomy evolved spontaneously in various centers in the world but was especially advocated by Claus Jansen from Gummersbach and Jim Shyhee from Los Angeles. Attention was focused on removing "disease" from the Middle Ear and repairing the damage.

In summary the goal being a reconstructed basically normal anatomical ear - with an intact posterior wall and an unexposed mastoid.The process which led to the various pathological situations requiring surgery i.e - retraction pockets - cholesteatoma - ossicular lesions and espe cially Middle Ear aeration Pathology etc. was often put at the footsteps of early childhood Otitis Media leading secondarily to "Eustachian Tube disease"- or narrowing of the Eustachian Tube and sclerosing of the mastoid.

Inspite of the fact that Claus Jansen's clinic was not related to a university - Claus Jansen was successful in organizing and pioneering yearly courses of surgery of the temporal bone during the beginning of almost every July of the sixties and the seventies. The aim was to teach and exercise Posterior Tympanotomies - having the goal to eradicate, cure and reconstruct chronic ears if possible in one step. The courses were held in Claus Jansen's clinic and a nearby hotel whose basement was fitted as a dissecting theater and lecture room. Many otologists flocked to these courses to learn the new techniques - and this endeavor can certainly be viewed as a stepping stone in the history of microscopic middle ear surgery.

The course was obviously led by Claus Jansen who was helped by a group of permanent instructors who together with him formed the teaching faculty.The surgical courses were accompanied by lectures given by a permanent faculty which attended the courses yearly - composed of (alphabetically) : David Austin (USA) Jako Geza (USA) Jean Marquet (Belgium),Jacob Sade'(Israel), Gordon Smyth (Ireland) Stuart Strong (USA). and of course Claus Jansen.

Apart from the permanent faculty - guest lecturers were also invited among whom were Peter Alberty (Canada) Herman Diamant (Sweden) and Ron Hinchkliff (Great Britain).The courses were very well organized - and lasted from early in the morning to the early evening . The evenings were mostly dedicated to discussions on a glass or two of Irish whisky. The discussions included many theoretical facets of the problems which faced the Otological surgeon and which were questionable. While during the day an orthodox discipline was taught, the evenings were characterized by un-orthodox questions and doubts. Questions were put forward whether the new wonderful surgical feats will withstand the test of time - and whether eradication of "disease" was the final optimal answer to such a complicated and vast and dynamic problem - may not the Cholesteatoma return and if it does - how often? Data was presented concerning many basic problems which were related to the processes we dealt with such as details of bone destruction-what caused it? when?what is the best way to repair them - what causes cholesteatoma - the relation to infection - middle ear aeration and especially what are the long term success after cholesteatoma surgery - which by itself was the most problematic question.

The basic philosophy of cholesteatoma was equated biologically to a sort of a tumor-"if you take it out completely you have cured the disease"- was this a true axiom? how about retraction of the Tympanic membrane recurring? Indeed with time these concepts were found to be somewhat naive because of the often dynamic and ongoing nature of retraction pockets and cholesteatoma. As the debates became more and more involved some of us came forward with the notion that we should meet more often periodically - not just for the sake of surgical exercise - but mainly to bring forwards our data and results of our surgical follow ups for discussion. It was this need i.e to analyze every possible detail and theoretical concepts which may lead us to exercise an optimal medical and surgical treatment of our patients - which formed the impetus and the idea for the formation of the Politzer Society. Most involved in promoting the idea of forming such an academic forum were Gordon Smyth, David Austin and Jacob Sade' who felt that the discussions are fruitful and important - in order to have a clearer notion of what we are doing surgically and what can we achieve realistically. Our premise was that when we leave the operating room with what seems to us a very satisfactory result - does not yet by necessity reflect what the ear will look like in the time to come. We understood that what we "have or see" at present may be of temporary value or temporary "truth" like most "scientific truths" generally are. We saw our conversations, discussions, clarifications and self searching as indispensable guides and adjuvant to our surgery.

This was the ideological background - for the creation of the Politzer Society. At the beginning we conceived our society to be a relatively small study group possibly 20 or 30 participants - we did not imagine that more will be interested in the subject.

When we all got together at one of the international meetings - (this time it was in Dallas Texas) we promulgated and agreed upon the bylaws . However reality is often different and surprising - our next academic Otological meeting was not a small intimate one - rather a relatively large international meeting in Iowa City were all of the Politzer founders also met and discussed questions regarding mainly Cholesteatomatous ears - culminating in a panel whose title was "Tel me about your failures"- details of which can be found in the Proceedings of the meeting published by Aesculapius -USA 1977 (page 410).

Following this meeting the first International Politzer Society meeting was organized and launched by Clause Jansen in Davos. Thus in practice the conceived relative small "clarifying" discussion symposia with on going progress reports made place to large international ongoing Otological congresses which continued in this new format since then every year.This was only natural considering the progress of Otology and the lack of any other meeting grounds dedicated soly to Otology and especially to the middle ear.


Jacob Sade'
Ramat Hasharon

In 1971 the ENT-Department of the Gummersbach City Hospital put up International Symposium on middle ear surgery in the Theodor Heuss Academy.

Gummersbach City is located near Cologne on the River Rhine. The cosy Hotel Heedt nearby provided first class accommodation. The basic permanent group of lecturers, called "The Gummersbach Group" involved in a temporal bone course included as a part of the symposium. Zeiss provided the group up to date microscopes for all participants. It was at this time that the ear surgeons worldwide were looking for a color TV-system to be mounted onto the Zeiss microscope. Phillips presented the first qualified camera to test in Gummersbach. The closed circuit color TV was appreciated very much. Surgery of the chronically infected ear using the Posterior Tympanotomy technique with tympanoplasty and other techniques were translated live from the operating theater to the audience in excellent quality. The symposium "Middle Ear Surgery" was excellently moderated by S.M. Strong.

Well known guest lecturers completed the Gummersbach Group and made the symposium a great success.

The succeeding symposia attracted an increasing number of participants and introduced the problem of accommodating the participants at local hotels.

"The Group" decided to found the Politzer Society in order to follow the aims of the scientific program in a sufficiently sized organization. The following names represent the members of the group who founded the Politzer Society:

D.F. Austin, USA, C. Jako1 USA, C.W. Jansen, Germany, J. Marquet, Belgium, Jacob Sade, Israel, G.D.L. Smyth, North Ireland, S.M. Strong, USA. Elected as the first president, Claus Jansen was chosen to be chairmen of the First Politzer Meeting in Davos: "Tympanoplasty, Art and Science, Review of 25 years" Guests of Honor: M. Arslan, Italy, E.H. Majer, Austria, George E. Shambaugh jr., USA, H.L. Wullstein, Germany.

The aim of the conference was to serve as a forum for ear, nose and throat surgeons particularly interested in chronic middle ear disease and its surgical treatment including tympanoplasty. The program committee voted for the title, realizing that after many years microsurgery of chronic middle ear disease and in spite of great progress, a host of problems remain. The complicated correlation between chronic middle ear surgery as a more destructive procedure and tympanoplasty as a reconstructive microsurgery technique is representative of a discussion which is still going on.

The conference intended to give up-to-date reviews by means of plenary sessions and various panel discussions. New ideas were presented in the same way as well as in the free paper sessions and movies.

The first international conference in Davos was a great successful event for the Politzer Society. The audience represented a significant number of interested ear surgeons from many countries. Scientific discussions of a highly qualified standard were greatly appreciated by the guests as \&ell as by the participants; The first step into the future of the Politzer Society was made with relative ease and seems to hold great promise for the future.

I should like to express my deep regret for the loss of our friends and colleagues J. Marquet and G.D.L. Smyth who thought their inspiration and much hard work made such a vital contribution to the success of the Politzer Society. Their names will no doubt live on to inspiration to future operations.
Claus Jansen

REMARKS ON THE CONCEPTION, BIRTH AND HISTORY OF THE POLITZER SOCIETY
By Jacob Sade

With the advent of the surgical microscope and a better understanding of the principals of sound transmission during the middle of the 20th century, Middle ear surgery advanced considerably if not dramatically . This  led  to impressive  surgical advances -not dared or even dreamt of before - especially as regards treating "Chronic Ear Diseases" in general and Cholesteatoma in particular. The therapeutic approach which evolved was that "one may and should remove any "diseased tissue" and thereafter repair any  anatomical defect which resulted from the pathological process. 
Most of the techniques evolved in respect of chronic ear surgery - emanated from several German Universities - and many flocked there from all over the globe to learn the new way of thinking and new techniques. This was the beginning of the Tympanoplastic era which intuitively regarded any chronic middle ear process as a sort of an infected "tumor" - its removal required some reconstruction which often ended with an open radical mastoid cavity.
Soon thereafter a new goal was set namely to remove all pathological tissues and at the same time preserve an almost completely  anatomical reconstructed  Middle Ear System with an intact posterior wall - avoiding thereby an open mastoid cavity. At the same time this method also tried to preserve or reconstruct  a functional ossicular chain - all this together was termed Posterior Tympanotomy or Canal Up Tympanoplasty. The old concept of treating such ears especially in the presence of Cholesteatoma leaving an exteriorized  radical mastoid cavity was considered to be obsolete.This kind of surgery  i.e Posterior Tympanotomy evolved spontaneously in various centers in the world but was especially advocated by Claus Jansen from Gummersbach  and Jim Shyhee from Los Angeles.  Attention was focused on removing "disease" from the Middle Ear and repairing the damage.
In summary the goal being a reconstructed basically normal anatomical ear - with an intact posterior wall and an unexposed mastoid.The  process which led to the various pathological situations requiring surgery i.e - retraction pockets - cholesteatoma - ossicular lesions and especially Middle Ear aeration Pathology etc. was often put at the footsteps of early childhood Otitis Media leading secondarily to "Eustachian Tube disease"- or narrowing of the Eustachian Tube and sclerosing of the mastoid. 
Inspite of the fact that Claus Jansen's clinic was not related to a university - Claus Jansen was successful in organizing and pioneering yearly courses of surgery of the temporal bone during the beginning of almost every July of the sixties and the seventies. The aim was  to teach and exercise Posterior Tympanotomies - having the goal to eradicate, cure and reconstruct chronic ears if possible in one step. The courses were held in Claus Jansen's clinic and a nearby hotel whose basement was fitted as a dissecting theater and lecture room. Many otologists flocked to these courses to learn the new techniques - and this endeavor can certainly be viewed as a stepping stone in the history of microscopic middle ear surgery.
The course was obviously led by Claus Jansen who was helped by a group of permanent   instructors who together with him  formed the teaching faculty.The surgical courses were accompanied by lectures given by a  permanent faculty which attended the courses yearly - composed of (alphabetically) : David Austin (USA) JakoGeza (USA) Jean Marquet (Belgium),Jacob  Sade'(Israel), Gordon Smyth (Ireland) Stuart Strong (USA). and of course Claus Jansen.
Apart from the permanent faculty - guest lecturers were also invited among whom were Peter Alberty (Canada) Herman Diamant (Sweden) and Ron Hinchkliff (Great Britain).The courses were very well organized - and lasted from early in the morning to the early evening . The evenings  were mostly dedicated to discussions on a glass or two of Irish  whisky. The discussions included many theoretical facets of the problems which faced the Otological surgeon and which were questionable. While during the day an orthodox discipline was taught, the evenings were characterized by un-orthodox questions and doubts.  Questions were put forward   whether the new wonderful surgical feats will withstand the test of time - and whether eradication of "disease" was the final optimal answer to such a complicated and vast and dynamic problem - may not the Cholesteatoma return and if it does - how often?  Data was presented concerning many basic problems which were related to the processes we dealt with such as details of bone destruction-what caused it? when?what is the best  way to repair them - what causes cholesteatoma - the relation to infection - middle ear aeration and especially what are the long term success  after cholesteatoma surgery - which by itself was the most problematic question.
The basic philosophy  of cholesteatoma was equated biologically to a sort of a tumor-"if you take it out completely you have cured the disease"- was this a true axiom? how about retraction of the Tympanic membrane recurring? Indeed with time these concepts were found to be somewhat naive because of the often dynamic and ongoing nature of retraction pockets and cholesteatoma. As the debates became more and more involved some of us came forward with the notion that we should meet more often periodically - not just for the sake of surgical exercise - but mainly to bring forwards our data and results of our surgical follow ups  for discussion. It was this need i.e to analyze every possible detail and theoretical concepts which may lead us to exercise an optimal medical and surgical treatment of our patients - which formed the impetus and the idea for the formation of the Politzer Society. Most involved in promoting the  idea of forming such an academic forum were Gordon Smyth, David Austin and Jacob Sade' who felt that the discussions are fruitful and important - in order to have a clearer notion of what we are doing surgically and what can we achieve realistically. Our premise was that when we leave the operating room with what seems to us a very satisfactory result - does not yet by necessity reflect what the ear will look like in the time to come. We understood that what we "have or see " at present may be of temporary value or temporary "truth" like most "scientific truths" generally are. We saw our conversations, discussions, clarifications and self searching as indispensable guides and adjuvant to our surgery.
This was the ideological background - for the creation of the Politzer Society. At the beginning we conceived our society to be a relatively small study group possibly 20 or 30  participants - we did not imagine that more will be interested in the subject.
When we all got together at one of the international meetings - (this time it was in Dallas Texas) we promulgated and agreed upon the bylaws .
However reality is often different and surprising - our next academic Otological meeting was not a small intimate one - rather a relatively large international meeting in Iowa City were all of the Politzer founders also met and discussed questions regarding mainly Cholesteatomatous ears - culminating in a panel whose title was "Tel me about your failures"- details of which can be found in the Proceedings of the meeting published by  Aesculapius -USA  1977 (page 410).

Following this meeting the first International Politzer Society meeting was organized and launched by Clause Jansen in Davos.  Thus in practice the conceived relative small " clarifying"discussion symposia with on going  progress reports made place to large international ongoing Otological congresses which continued in this new format since then every year.This was only natural considering the progress of Otology and the lack of any other meeting grounds dedicated soly to Otology and especially to the middle ear.


Jacob Sade'
Ramat Hasharon

Claus Jansen

Gordon Smyth