[Tympanic membrane massage, origin and decline of a promising therapeutic concept]

BACKGROUND, APPLICATION OF STATIC PRESSURE AT THE TYMPANIC MEMBRANE: Cleland in London (1741) presumed that the pressure of a strong sound wave would push the tympanic membrane inward, thereby causing deafness. He recommended correcting this situation by applying suction to the auditory canal, and he demonstrated a small tube suitable for this purpose. Toynbee in London (about 1860) realized that, following a malfunction of the Eustachian tube, a negative pressure would develop in the middle ear and draw the tympanic membrane inward, thus causing hearing loss. This concept resulted in efforts to actively support the aeration of the middle ear via the Eustachian tube. In addition to these measures, Politzer in Vienna (1867) suggested blocking the external auditory canal tightly so that resorption of the air would produce negative pressure, counteracting the low pressure in the middle ear. Lucae in Berlin (1874) proposed the theory that the two small muscles in the drum would act as antagonists on the tympanic membrane and accommodate the ear for high and low-pitched sounds respectively. He tried to correct malpositions of the tympanic membrane due to a misbalance of the two muscles by applying static positive or negative pressure in the auditory canal. APPLICATION OF ALTERNATING PRESSURE AT THE TYMPANIC MEMBRANE: Siegle in Stuttgart (1864) put forward the idea that repeated strong movements driven by the pneumatic ear speculum that he had invented would be able to loosen adhesions in the middle ear. Lucae (1884) later devised an elastic probe to be placed on the short process of the malleus for massage of the ossicular chain. Delstanche in Brussels (1885) presented two instruments called "rarefacteur" and "masseur du tympan et des osselets" which in the auditory canal would produce negative pressure or alternating pressure respectively. The next step were suggestions and devices enabling the patient to treat himself for reduced mobility of the tympanic membrane or the ossicular chain, such as alternating pressure on the tragus, or tubes to conduct pressure from the mouth or a rubber bag to the ear. With the aim of speeding up the frequency of the pressure impulses, mechanic pumps were constructed, which were first driven by hand, later on by electric power. CRITICAL EVALUATION: At the turn of the century numerous attempts were made to evaluate the effectiveness of the pneumatic massage of the middle ear and to specify the indication for this kind of treatment. Although no convincing and predictable results could be demonstrated and even harmful effects had been observed in animal experiments, the massage of the tympanic membrane continued its triumphant march for half a century. The reason for this seems to be the suggestive and plausible therapeutic approach to a well known pathology of the middle ear. Since the middle of this century it has been regarded as obsolete and is no longer mentioned in text books. The history of this episode is presented in detail.