The introduction of sulfa drugs in 1937, at the time I completed my residency in otolaryngology, seemed to point toward the end of surgery for much of suppurative diseases in this field. The senior specialists ominously predicted the early demise of our specialty because they believed that these drugs would control suppurative diseases and the general surgeons would annex all tumor surgery of the head and neck region.
In the light of this background, the younger otolaryngologists viewed with considerable interest Lempert's earliest publication of one-stage fenestration operation for improving hearing in clinical otosclerosis.After the usual initial objection to a new revolutionary surgical technique, there was gradual acceptance when favorable results were increasingly reported.
Interest in his endaural approach to surgery for otosclerosis as well as tympanomastoid disease became woldwide. He soon stablished a course in temporal-bone dissection and observation of surgery to teach this new concept to qualified otolaryngologists. Not everyone who applied was accepted. I had opportunity to participate in this course in December 1944.
Being eager to take full advantage of this new adventure in otology, I arrived at Lempert's combination office and hospital at 7:00 AM on the first day. After I had been ringing the doorbell for several minutes, someone finally answered. On establishing my identity and purpose, I was informed that Doctor Lempert never started to work at this pre-posterous hour. Thereafter, I managed to contain my early morning enthusiasm and did not arrive until 9:00 or 9:30.
It could be considered that the course consisted of two parts. One was observing surgery and dissecting temporal bones (including soft tissues) by the new endaural approach. The other was equally informative and interesting. It centered around the discussions and comments by Lempert at the midafternoon lunches at nearby restaurant.
In the dissections, the introduction of the use of the dental burr and loupe magnification permitted detailed study of the middle ear and the temporal bone for the first time in my pursuit of otology. Minutia of anatomy as well as pathological details usually not seem without magnification could be visualized. It was an exciting experience. Special mastoid curettes and other instruments designed by Lempert provided futher refinaments of technique not previously possible.
His entertaining and satirical comments at lunch and dinner revealed something of the basis for his motivation to explore and develop new and different concepts of temporal bone surgery. As he was of short physical stature and obviously of Jewish lineage, he frequently commented on the prejudice and harassment he endured at the hands of some medical fraternity members and others during medical school years. This no doubt created whitin him the urge to excel and to have the courage to deviate from the generally accepted ear-surgery techniques taught at that time.
In parlance of the present academic and sociological turmoil, he defied the "establishment" of otology in the 1930's by introducing innovations and techniques wich upset the elite of the specialty in that era. His Institute gradually became a worldwide mecca for otologists - both young and old.
It would be difficult to estimate the extent od the impetus which his pioneer work gave toward intensifying reseach activities in otophysiology and audiology. The need to have more specific knowledge of the reconstructed middle ear physiology became particular areas of investigation. Devising new approaches to differentiate middle ear from inner ear hearing impairments initiated studies wich are still broadening our otological horizons.
After Lempert rode the crest of eminende and professional recognition for many years, the revival of directed stapes surgery by others begam to attract the interest of a few otologists. Gradually this new technique eclipsed the older Lempert fenestration procedure. Having previously challenged the old and popularized new surgical ideas, he now assumed the role of the "establishment" and refuse to recognize the potential of directed stapes surgery.
Ironically, the new approach to stapes surgery was based on Lempert's tympanotomy incision wich he had evolved to expose and excise the tympanic plexus for relief of tinnitus. It was rather tragic that his closed mind on stapes surgery gradually detracted significantly from his stature in otology.
Nevertheless, those of us who had the good fortune to study under him will always be indebted to him for initiating the modern era of otology. Lempert's direct contribuitions and the stimulus wich these gave to clinical and research otologists stand as the gateway to continuing evolution of our present highly sucessful otological surgical techniques.