He Yongzhao(1913-1984), Professor of Otolaryngology, Former Director of the Department of Otolaryngology, Renji Hospital

Introduction

Dr. He Yongzhao was a pioneering figure in the development of otology in China, celebrated as a master in the field for his groundbreaking achievements in microsurgery and audiology research. His career as an otological giant is a testament to a physician’s relentless pursuit of knowledge and innovation. With immense passion and extraordinary skill, he established new frontiers in China’s otological medicine and propelled the advancement of the otology department at Renji Hospital. His dedication spanned medical education, clinical practice, and scientific research—every breakthrough rooted in his profound love for medicine. His medical journey embodied a spirit of lifelong dedication, as he remained at the forefront of research until his very last days, constantly pursuing and striving for progress.

The Path to Medicine

In the 1910s, He Yongzhao’s hometown of Yuyao, Zhejiang, was a picturesque water town in the Jiangnan region, defined by its serene canals and ancient stone bridges. It was a place where time seemed to move slowly, steeped in a quiet, historic charm.

Born in 1913, He belonged to the first generation of Chinese citizens born after the fall of the Qing Dynasty, growing up in a nation grappling with the clash between old traditions and new ideals. At the time, modern medical education was a rare privilege, accessible only to the most outstanding students. Driven by a passion for medicine and a thirst for knowledge, He Yongzhao earned a place at the prestigious St. John’s University Medical College in Shanghai.

In 1940, he graduated with a medical doctorate. On his graduation day, his gaze was resolute, already focused on the future patients whose suffering he would relieve through his skills.

Initially, He Yongzhao did not specialize in otology. He joined Shanghai Tongren Hospital, a leading medical institution at the time, and began his career in the Department of Ophthalmology and Otolaryngology (ENT). There, he specialized in iridencleisis, a surgical procedure for treating anterior staphyloma that is now obsolete. During the procedure, patients were given local anesthesia. Using delicate ophthalmic instruments, He meticulously incised adhesions in the anterior chamber and embedded the iris into the corneal incision. This created new adhesions that stabilized the iris and reduced the chamber’s volume, alleviating the symptoms of staphyloma. He also employed trichloroacetic acid cauterization and, when necessary, pressure bandages, achieving remarkable success even in advanced cases.

Tongren Hospital provided He with a broad platform to practice, exposing him to a wide range of complex ENT diseases and allowing him to hone his skills through relentless clinical experience.

After years of practice and reflection, He Yongzhao shifted his focus to otolaryngology. In 1946, he traveled to the United States for advanced studies, earning a master’s degree in otolaryngology from the University of Pennsylvania and becoming a member of the American Academy of Otolaryngology.

Following his graduation, he specialized in otology and the fenestration operation at the Lempert Institute of Otology in New York, laying the groundwork for his future achievements. The institute, founded by the pioneering German-born otologist Julius Lempert, was renowned for its innovations in inner ear surgery. Lempert had revolutionized the treatment of otosclerosis—a middle ear disease causing progressive hearing loss—with his fenestration operation in the 1940s. By creating an opening in the semicircular canal to bypass the immobilized stapes bone, the procedure restored sound conduction and improved hearing for countless patients.

He Yongzhao chose the Lempert Institute to master these cutting-edge techniques, driven by a singular goal: to bring the world’s best otological practices back to China.

Leading the Way at Renji Hospital

In 1950, He Yongzhao returned to China, equipped with advanced medical knowledge and a fervent dedication to his homeland. Beginning in 1952, he served as a Professor at Shanghai Second Medical College, Director of the Otolaryngology Teaching and Research Group, and Head of the Otology Research Laboratory.

In the 1950s, keeping pace with global advancements, He pioneered the use of surgical microscopes in China for microsurgical procedures, including fenestration operations, tympanoplasty, and stapedectomy. Tympanoplasty, a state-of-the-art technique in the early 1950s, involved the repair and reconstruction of damaged middle ear structures—particularly perforated eardrums and injured ossicular chains caused by infection or trauma. By restoring the middle ear’s anatomy and function, this procedure could improve or even restore hearing, proving vital for the treatment of chronic otitis media.

Stapedectomy, introduced in 1956, addressed otosclerosis by removing the fixed stapes bone and implanting a prosthesis to restore sound conduction. While traditional stapedectomy involved the complete removal of the bone, the newer stapedotomy used minimally invasive methods, reducing risks and accelerating recovery. These procedures significantly improved hearing for patients with otosclerosis.

The exploration of these contemporary techniques propelled China’s otology forward. In 1957, following departmental adjustments, He Yongzhao joined Renji Hospital as Director of Otology, establishing a dedicated inpatient ward that same year.

From 1958, he deepened his focus on otolaryngology, launching innovative surgical procedures and research initiatives. That year, he explored the use of procaine penicillin for the localized treatment of chronic maxillary sinusitis, conducting a systematic study of dozens of cases. Chronic maxillary sinusitis, characterized by persistent nasal congestion, discharge, headaches, and facial pain, often proved resistant to conventional treatments like oral antibiotics or surgery. By injecting procaine penicillin directly into the maxillary sinus, He increased the drug concentration at the infection site, enhancing its efficacy while minimizing systemic side effects. This approach enriched Renji Hospital’s therapeutic options and provided valuable clinical insights.

As a pioneer of fenestration and microsurgery in China, He shifted his focus in the 1960s to promoting tympanoplasty. He published his findings in the Chinese Journal of Otolaryngology and trained physicians nationwide, making tympanoplasty a widely accepted treatment for otitis media and restoring hearing to countless patients.

Five years later, he collaborated with Professors Pan Genchang and Huangfu Musan to conduct a systematic study on the indications for tympanoplasty. Their research provided scientific validation for its clinical application and guided otologists across the country. To better suit the needs of his patients, He modified Types III and IV tympanoplasty:

Type III: Used when the malleus and incus are absent; the eardrum is grafted directly onto the stapes head to conduct sound.

Type IV: Applied when the stapes remains mobile but other ossicles are severely damaged; the eardrum is grafted over the stapes footplate or the oval window.

His innovations significantly improved outcomes for complex cases, enhancing patients’ quality of life. Subsequently, he researched hearing rehabilitation for patients with otitis media, emphasizing that restoring hearing was as crucial as treating the disease itself—a profound contribution to society.

Pioneering New Trends

The following decade brought significant challenges due to the political climate of the era, forcing many of He’s clinical and research projects to a halt. Yet, he never ceased his efforts.

As work resumed in 1977, he published a pivotal article in Medical Equipment reviewing China’s otological microsurgery techniques and innovations. Through this review and outlook, he aimed to steer China’s otological field back on course. He acknowledged both the progress that had been made and the growing gap with global advancements after a decade of stagnation.

Early Chinese otological surgery had been hampered by limited tools; the use of hammers and chisels caused cranial vibrations, increasing patient pain and risking damage to the facial nerve. The introduction of surgical microscopes enabled the precise removal of lesions and more effective hearing restoration. He emphasized the critical role of medical equipment engineers in improving these instruments, highlighting the demonstration microscopes from the Shanghai Syringe Factory and the precision tools from the Shanghai Surgical Instrument Factory, which boosted surgical success rates. Despite this progress, he urged domestic manufacturers to prioritize developing high-precision tools like otological drills to meet urgent clinical needs.

In 1979, he conducted a systematic review of the progress in tympanoplasty since 1949, seeking a “new anchor” for the field after its decade-long stagnation and advocating for further refinements. Though in his seventies, he devoted extensive time to the clinical and mechanistic study of ear diseases. To help China catch up internationally, he researched the latest advances in otitis media with effusion, analyzing global literature to propose new treatment strategies.

From the 1980s, He focused on the clinical and basic research linking brainstem auditory evoked potentials (BAEP) to hearing. BAEP measures the electrical activity in the brainstem in response to sound stimulation, providing an objective assessment of the auditory pathway’s function from the cochlea to the brainstem. He and his collaborators established normal BAEP values and defined their clinical significance, solidifying his authority in the field of audiology.

To validate the clinical use of BAEP, he conducted chronic experiments on drug-induced ototoxicity in guinea pigs. These studies, which exposed guinea pigs to ototoxic drugs while monitoring hearing changes through auditory tests and histological examinations, provided critical insights into the mechanisms of ototoxicity, risk assessment, and preventive strategies. This work laid the groundwork for the early diagnosis of drug-induced hearing loss.

He also pioneered the use of BAEP and electrocochleography (ECochG)—which directly measures the cochlea’s electrical responses via ear canal electrodes—for diagnosing cerebellopontine angle lesions. Together, these tests improved diagnostic accuracy for lesions affecting the auditory nerve, enabling more targeted treatments.

Even in his final year, He remained a prolific scholar. In 1984, he participated in research on the protective effects of thyroxine against kanamycin-induced ototoxicity, marking a milestone in otological pharmacology. That same year, he studied cochlear spiral ligament reinforcement surgery—a complex procedure involving the implantation of rigid materials to repair damaged ligaments and restore cochlear function in cases of deformity or trauma. He also refined techniques for displaying succinate dehydrogenase activity in the cochlea, which enhanced the study of cochlear metabolism and pathology.

He Yongzhao passed away in 1984, a profound loss to China’s fields of otological microsurgery and audiology research. His life, dedicated to the triad of medical education, clinical practice, and research, was instrumental in advancing China’s otology and nurturing generations of medical talent. His legacy endures not only in his published research and teaching philosophy but also in his deep compassion for patients, inspiring otologists, patients, and scientists alike to pioneer new frontiers in ear care.

Editor: Chen Qing @ ShanghaiDoctor.cn, 

Note: Chinese Sources from “The Path of Benevolent Medicine” which was published in 2024. It records 90 important medical figures in the history of Renji Hospital. Yewen Renyi (ShanghaiDoctor.cn) team was one of the major writers of the book and is authorized by Renji hospital to create English version on the website of ShanghaiDoctor.cn