Through generations people dream of having these moments, which have been exemplified by Camelot and the Knights of the Round Table; by The Three Musketeers, and in our days by the Jedis who fought and defeated the Evil Empire.

These moments may last for a period of time, but in the hearts and spirit of the participants they last forever, and while those privileged individuals who have lived them may at some time part, wherever they might be, a bond remains, that will last a lifetime.

I have been privileged to have lived these moments at Home, at School, and then at the Department of Otolaryngology in Minneapolis Minnesota, where I did my ENT training. We were and we are a group that can make magic happen and I want to believe that I have also done my part and that part of the shining glare provides from my own magic wand.

I want to dedicate this book to our group and to add a special thanks to three master jedis, who in their own character and style have contributed to strengthen my “Otologic force within”—

In 1967, Michael M Paparella became Professor and Chairman of the Department of Otolaryngology at the University of Minnesota and was looking for the right person to establish an auditory biochemistry laboratory and develop the graduate program for residents in otolaryngology. His longtime friend, Dr David Lim did one more of the many good things he has done for Otolaryngology when he recommended that Michael should incorporate Steve Juhn to the Minnesota team. Steve accepted and since that time, he has devoted himself to research and teaching at the University of Minnesota.

It is not easy to summarize Steve's vast contributions in both middle and inner ear research. He has authored more than 230 publications and 10 book chapters. He has been a pioneer in the study of biochemical events taking place in the pathogenesis of otitis media, in middle and inner ear interaction as well as in inner ear physiology and physiopathology.

While his scientific merits are vast and internationally known and recognized, Steve's additional activities have resulted in great achievements in other aspects that are as much if not more transcendent than the above mentioned. In 1988, he helped establish the faculty and student exchange program between the University of Minnesota and the Karolinska Institute in Sweden. The idea for this program stemmed from a conversation between Dr Juhn and former Minnesota Governor, Wendell Anderson in the streets of Stockholm during a casual encounter, while both were just walking around in the evening (both were in Stockholm for totally different activities) and Steve recognized the Governor and started talking to him. In addition to the scientific exchange, this resulted in close ties and friendships with the Swedish otolaryngologists that persist until today. Moreover, in 1993, Steve also participated in the development of the Biomedical Research Center at the Korea Institute of Science and Technology (KIST) in Seoul, Korea, where he served as the first director.

He has published two nonscience books in Korean entitled, “Dreaming Traveler” in 1996 and “Mississippi Minnesota-Dream and Hope of a Sojourner” in 2007. These books contain essays and poems crystallizing his thoughts and wisdom from daily life, and are not only entertaining with quiet humors, but also full of educational and heartwarming true stories. Behind his many accomplishments is the unfailing, dedicated support of his wife, Jane. They have three sons, Peter, Martin and Paul and four grandchildren.

Steve has made an outstanding impact as a teacher in the full sense of the word. In addition of orienting and helping through the years, all the residents of the Department in their laboratory rotations; under his direct supervision, 28 otolaryngology residents finished research projects, some with masters, others with doctoral degrees. He also supervised and helped 25 international research fellows and had many students doing research in his laboratory. Many of his former fellows became professors, chairs and leaders in their fields.

Above all, his sincere Christian concern for other people, his optimistic attitude towards life and his wisdom made a positive influence to many students and colleagues alike and contributed to change their lives for the better. Without Steve, the Department would have never reached the levels of excellence that it achieved since pure science is not enough. Wisdom, love, sense of humor and friendship are essential ingredients for success and Steve was one of the main sources of these magic ingredients for our Department.

Describing his sites of training and positions has been easy, however, summarizing Michael's scientific and academic achievements would be quite complex and would require a book. To put it in brief, Michael is a world legend in Otolaryngology and it would be simpler to summarize Michael Jackson's musical achievements. Michael has been awarded practically all the honors that can be awarded to a specialist, has won all the Grants that somebody would like to have and belongs and has belonged to all the Otolaryngology Societies, Specialty Committees, Boards, Editorial Boards, etc. that are worth belonging to. His papers are in hundreds and so are his chapters and books, including the classic textbook of our specialty—“Otolaryngology” with its three editions. His contributions to the field include major concepts in otitis media pathogenesis and treatment, including silent otitis media, sensorineural hearing loss and otitis media, labyrinthitis ossificans pathogenesis, the concepts of POM, SOM, COM, ROM, design of PE tubes (Paparella PE tubes), surgical procedures such as flexible approach, IBM, sac surgery, and many others that are known by everybody in our field.

However, while his scientific achievements are self evident and respected all over the world, there are important aspects about him that have to be mentioned because they are not that known, since, believe it or not, Michael is a shy man when it comes to describing his deeds.

Michael has two sons from his first marriage (his wife died), Mark and Steve, and one adopted daughter (Lisa). Michael is above all a great father, friend and leader and a wonderful human being. From the very beginning he organized a Department oriented to research and to the study of pathology and pathogenesis. In the process he brought together people from all areas and created an environment of creativity and friendship that gradually developed into a group full of spirit and mystique on its way to glory. In addition, he opened his Department and lab to the world and his Department became a United Nations, not of pompous Professors with impressive language, but instead of natural and spontaneous friendly people. In this environment we all learned from each other and received inputs from people of different cultures and backgrounds, at the same time that we were enjoying life and having fun.

The origin of this book goes back to my first year of residency in Otolaryngology. Although many good texts were available, I felt that I needed a book that went back to basics in clear and understandable language, and that would provide me with the essential concepts from which to start. It seemed to me that a complicated organ such as the ear could be made, at least at that stage, a little simpler (not simple). Over time I thought of different aspects that I felt to be important and useful for this purpose, and I asked different contributors to do the same. Accordingly, we have tried to create a book that emphasizes the basics, rather than one that shows our methods. In this same spirit, this book has different authors who have different approaches for the same aims and purposes.

In the same context, this atlas is only intended to complement other texts on the subject. Because this is primarily a conceptual atlas, we have made no attempt to provide detailed discussions of evaluations and indications; such discussions are provided by the works cited in the list of selected references. Because of the extent of these subjects, the works available number in the thousands; we apologize and request the understanding of those authors whose important publications are not cited. This is not because we want to ignore their contributions and pretend to make them our own, but because of lack of space. We are aware that this edition will need improvements. It is our hope that these will come from your criticisms and suggestions.

This book has a number of thoughts and general philosophies that I believe are useful. I do not expect you to agree with them, but to be exposed to them and think. Some of them will make sense, some will not. I hope that some of the latter will make sense to you in time.

Otologic surgery, like medicine and life itself, is a never-ending learning process. Moreover, otology in particular, is a very humbling specialty because unwanted results and recurrences do happen. Those otologists who do not have them, most probably have their patients consulting somebody else. You are never too good to learn from everybody else. Seeking advice is not a sign of weakness but of maturity. Learn to use your senses; observe and listen to other surgeons and specialists, the operating team, your patients, and others. Learn positively from those who want to help you and from those who want to harm or use you. Learn to learn from everything you do and everybody around you.

A few words on the edition of a previous atlas in 1989 by WB Saunders Company in Philadelphia. The medical illustrator was Gwenn Afton. At the time she was finishing an MS program in Medical Illustration at the Medical College of Georgia. She needed a thesis and the Atlas was just what she needed. Fortunately for her and me, she was just what I needed. I had the privilege of writing the temporal bone dissection manual that she illustrated as her master's thesis. In spite of her being by far the youngest member of the team, her professionalism, dedication, interest, and talents were those that I would have expected from an experienced and famed medical illustrator. I worked directly with her on each and every drawing (in all chapters) in the atlas. Her efforts gave fruit, since these drawings gained her the national USA medical illustration award that same year. We have been asked to lend many of the illustrations (only those designed by Gwenn and me) to Michael Paparella for the otology volume of his text and I have used these drawings in different publications. In 1995, I contacted Saunders Company regarding a new edition of the atlas, but at the time they were already involved in other books, and gave me back the original drawings and pictures as well as a release letter. I had told my friend and former fellow Chris de Souza about my intentions of writing a new Atlas and last year he not only came up full of ideas and enthusiasm, as he usually does, but he brought along the interest and expertise of Jaypee Brothers Medical Publishers as well. In addition, they informed me that the publication was going to be in English, Spanish and Chinese. This seemed to me like a good idea and I accepted, with the understanding that the drawings and pictures remain my property and the drawings of the different chapters would remain as property of the authors. At that point I contacted the different contributors and I must say with positive emotion, that they responded positively. Due to the complexity of putting everything together properly, I convinced Celeste Valencia to be our coordinator and general organizer and Dr Gloria Ribalta (with whom I have worked for over 15 years at our ENT Department in Clínica las Condes) to be a co-editor, particularly of the video section. Their work, the contributions of my friends and my modifications to the original book resulted in this new edition of this atlas which I hope you like as much as I do. The opinions in this preface, as well as the selection of the dedication, key concepts, motto and surgical comments in the atlas, are my own, and do not necessarily represent the opinions and choices of the contributors to this atlas.

The ear is a part of the body that is oriented toward two fundamental functions: hearing and balance. In order to fulfill these purposes, it is formed by a structural system that is functionally synergic and harmonic; in which every component is oriented toward the overall function of the ear, which in turn is an integral part of the body. Surgeons must become familiar with these concepts. That is to say, with anatomy and function, and their harmonic and precise operations oriented to its purpose.

We must consider that surgery is not performed in an isolated organ, but in one that interrelates anatomically and functionally with other organs and systems, some of which are of the same embryologic origin. Moreover, this occurs in a person who has unique general conditions and lives in an environment which has an important influence in his/her behavior, function and adaptation. When the aggression factors prevail over the defense system of the body, this harmonic function is disturbed.

The aggression factors of disease might be the same, however, they can manifest in different ways. The structures involved might be the same; however, the individuals that are affected are not the same and may react in different manners. A procedure that is good for somebody might be harmful to another. People and environments are unique and have variations.

This Atlas has a special emphasis in structure, function, pathogenesis and research. This is because of my firm conviction that in order to select, modify or develop a rational therapy, it is essential to have an understanding of the anatomy, function and pathology of the organs involved as well as of the mechanisms of disease. This is what leads to progress and innovation, and also allows for the most important concept of timing.

Under this philosophy, the techniques described in this book are more oriented toward a way of thinking than toward a dogma of doing. Moreover, because our knowledge and ability to define particular states and stages of otologic disease are partial, we hardly can be dogmatic in its treatment. Therefore, this Atlas advocates an open-minded approach that tailors the treatment to each patient rather than fitting patients into rigid treatments.

In addition, it is expected that this atlas will provide information that would contribute to a gradual acquisition of a three- dimensional functional image of the ear. This process implies hours of practice and study until this three-dimensional image is internalized and becomes natural. In reality, this learning process is similar to other activities.

Just as a violinist, an athlete, a golfer or a chess player requires a certain number of hours before internalizing their movements toward maximal efficiency; the same occurs with a surgical act in which every movement is regulated by neuronal circuits that provide anticipation. That is why it is essential to have dedication, passion, and hours and hours of hard work. It is not possible to achieve excellence from 8 to 12 and from 2 to 6 based on good public relations.

The ideal approach towards disease for years has been prevention and early detection. With the current scientific advances, particularly in genetics and molecular biology, we are approaching a personalized predictive medicine that will eventually turn into regenerative and not only of tissues but of full organs. Response to medications and potential allergies or toxicities will be predicted, and therapies will be improved. Moreover, this regenerative medicine is starting to include tissues such as the central nervous system, tissues that nobody would have ever dreamed that could be regenerated.

As suggested in the initial paragraphs, as early as 1894, Santiago Ramón y Cajal described the concept of neural plasticity. He suggested that as a difference with telephone cables, with proper stimulation the central nervous system would develop an increase in dendritic and axonal connections in some of the stimulated neuronal circuits. These concepts have re-emerged in otology especially for sensorineural hearing loss, and we find ourselves working hard in early detection and stimulation. Little did Ramón y Cajal and our own selves just a few years ago, imagine that regeneration of the cells themselves could be possible. We are in the doorsteps of a wonderful new approach to otology, and in particular to sensorineural hearing loss, in which cochlear implants, hearing aids and bone anchored hearing devices are only part of it. Hair cells can be regenerated by different means; nervous tissue can be exposed and responds to neurotrophic factors, hearing aids and implants are making gigantic progress and advances in digital systems and chip technology are completely revolutionizing signal processing. This is truly a great moment, and we are facing a new world of different and stimulating approaches. Based on these firm beliefs is that I have asked the different authors to touch upon these subjects along this surgical atlas since in the not too distant future we will be approaching some of these therapies surgically.

Dr Goycoolea has put together the finest quality of authors and the finest quality studying material. All the well-respected names have agreed to contribute to this book because of their respect and admiration for Dr Goycoolea.

The material presented in this book is not abstract theory but a living text that provides excellent insight into disorders ranging from the simple to the complex.

This text provides excellent material that can be applied directly into clinical practice.

I have trained under Dr Goycoolea at the University of Minnesota where he conducted excellent research on the round window membrane among many things. I still continue to learn from him and my patients are the better for it.

I am proud to be associated with Dr Goycoolea and his magical wonderful text.

I thank the numerous authors of this text for so graciously and unselfishly sharing their knowledge and experience so that all who read this text can benefit from it.