During the last quarter of a century Urbanschitsch, Politzer, Lucae, Delstanche, Hegener, and many others have introduced and upheld massage in the treatment of diseases of the ear.

Ear massage consists partly of "external ear massage" in the form of neck effleurage and other movable pressure on the external parts of the ear, partly of "internal ear massage" in the form of vibrations or frictions upon the drum or in the Eustachian tubes.* Massage of the pharynx and nose, for catarrh, is often associated with treatment of the ear, since catarrh of these parts is apt to spread to the tube or middle ear.

* As early as 1883 Eitelberg wrote a series of articles in the Wiener Med. Presse on massage in diseases of the ear, and in Bum's "Mechanotherapy" there is a long treatise as to the mechanical treatment of these diseases. The greater part of this treatment, however, cannot be said to be massage; neither the static pressure exercised by means of "tampons" or drainage tubes, nor the dilatation by means of a sponge or laminaria tent, or the insertion of a sound belong to massage. As I wish rather to show the reader what may help to give him a complete survey of the use he may make of massage and gymnastics in the various departments of his practice, and not to deal with every mechanical detail which may arise in the performance of this treatment, I have not thought it necessary to deal with other means than those which exert movable pressure by means of the hand or an instrument.

The most effectual part of massage of the inner ear is that which aims at applying vibrations through the external ear passage to the tympanic membrane and to the chain of small bones in the middle ear.

We have two different types of instrument: -

(1) Lucae's vibrating sound, and

(2) Delstanche's pneumatic vibrator, the so-called "rarefier." Both instruments have undergone various modifications, both by the inventors themselves and by others, during the years which have passed since they were first invented; for full details I refer to the special works.* In Sweden instruments are most used which are constructed after Delstanche's pattern, and aim, by means of rapid alternate condensation and rarefaction of the air in the external auditory meatus, at administering vibrations to the tympanum.

Lucae's first vibrating sound consisted of a hollow metal handle containing a spring and of a sound connected with it, ending in a little cup-shaped terminal and running in a tube. After having injected into the ear a 10 per cent. solution of cocaine and covered the sound with cotton-wool, the terminal is placed by means of a speculum on the tympanic membrane just above the short process of the malleus. At first vibrations are administered with the hand.

Nowadays vibrations are usually given with an electro-pneumatic apparatus. A glass cylinder may be inserted filled with lukewarm water. According to Lucas this hydro-pneumatic apparatus is the most satisfactory and transmits to the sound a large number (2,000 to 4,000) vibrations a minute.

The first of Delstanche's apparatus for pneumo-massage of the ear, the so-called "rarefier," consists of a little syringe worked by hand, with a spring placed in front of the piston in a cylinder, which pushes the piston back as soon as the finger (thumb) ceases to push it forward. The syringe is combined with a small rubber tube. This may end either in an oval bored ear-plug which hermetically closes the external ear passage, or in a little terminal tube placed in the side of Siegle's speculum. In the last case one has the advantage of being able to regulate and notice the effect upon the tympanum during the air massage, as well as to examine the mobility of the drum and malleus. Lucae also inserts here his glass tube filled with warm water between the tube closed by a thin clastic rubber membrane and the ear, and considers the hydro-pneumatic massage thereby produced more effectual. In order alternately to rarefy and condense the air in the external ear passage by means of quick small vibrations definitely limited as to their excursions, a motor has been constructed for this apparatus, driven by electricity (Breitung, Noebel, Warnecke, Cordes, etc.). These are also to be had worked by hand or by a sewing machine.

* In particular to Louis Blau's "Bericht liber die neueren Leistungen in der Ohren-heilkunde" : Leipzig, 1902.

Jankau has introduced what he calls "double massage" by carrying two tubes from an air pump (rubber bulb), one to the outer ear passage, the other to a catheter introduced into the Eustachian tube, by means of which the drum and chain of small bones can be treated by vibrations at the same time both from within and from without.

Other instruments and apparatus for the same purpose have also recently been constructed, which need not be further referred to here.

The Eustachian tubes are massaged by Ernst Urbanschitsch and others by means of a thin sound or bougie which is inserted through the catheter 3 cm. at the most, i.e., not quite as far as the internal opening of the tube, and which is set in quick piston-like motion with small excursions either by the hand or by means of an electromagnet. This is useful in stenosis and in chronic catarrh of the tube, and also to counteract subjective sensations of sound by stimulating the auditory nerve and so producing changes in it.