Abstract
I wish to thank and compliment Drs Bluestone and Swarts 1 for their recent article on the pathogenesis of otitis media as a consequence of human evolution. With all due respect to molecular biology, genetics, and inflammatory mediators, there are human illnesses that are primarily anatomic. Often the evolutionary changes resulting in the anatomy of anatomically modern Homo sapiens (a.m. H sapiens) provide useful insight into the pathogenesis and then potentially the surgical correction. As Dr Bluestone points out, the upper respiratory tract evolved dynamically over the past 250,000 years primarily to facilitate speech. 2 Part of this change required a shortening of the face typically called the splanchnocranium. The anthropologists describe this change as klinorhynchy, defined as the rotation of the splanchnocranium under the neurocranium. As a result, the length of the nose from front to back was dramatically shortened. As described by Dr Bluestone, this compromised the space available for the eustachian tube and predisposed it to obstruction with resultant otitis media. Perhaps the same occurred with the paranasal sinus ostia. Perhaps the eustachian tube is the most posterior ostium and unique in its length.
Dr Stupak 3 recently used similar thinking to examine the evolution of a.m. H sapiens external nose. There is much that the head and neck surgeon has to learn by the study of evolution and collaboration with colleagues in anthropology.