[Tympanic membrane massage, origin and decline of a promising therapeutic concept].
[Tympanic membrane massage, origin and decline of a promising therapeutic concept].
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[鼓膜按摩，一个有前途的治疗概念的起源和衰落]。
DOI：
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发表时间：
1996
期刊：
影响因子：
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通讯作者：
H. Feldmann
中科院分区：
文献类型：
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作者：
H. Feldmann
背景：在鼓膜上施加静压：Cleland在伦敦(1741年)假定强声波的压力会将鼓膜向内推，从而导致耳聋。他建议通过对耳道进行吸力来纠正这种情况，并展示了一种适合于此目的的小管子。伦敦的汤因比(大约1860年)意识到，咽鼓管出现故障后，中耳会产生负压，并将鼓膜向内拉，从而导致听力损失。这一概念导致了积极支持通过咽鼓管充气中耳的努力。除了这些措施，波利策在维也纳(1867年)建议严密地堵塞外耳道，这样空气的再吸收就会产生负压，抵消中耳的低压力。Lucae在柏林(1874年)提出的理论认为，鼓中的两块小肌肉将作为鼓膜上的拮抗者，分别适应耳朵的高音和低音。他试图通过在耳道内施加静态正负压力来纠正由于两块肌肉失衡而导致的鼓膜错位。交流压力在鼓膜上的应用：斯图加特的Siegle(1864年)提出了由他发明的气动耳镜驱动的反复强有力的运动能够松开中耳粘连的想法。Lucae(1884)后来设计了一种弹性探头，放置在锤骨的短突起上，用于听骨链的按摩。Delstanche在布鲁塞尔(1885年)提出了两种被称为“Rrefacteur”和“Masseur du Tympanet des osselets”的乐器，它们在耳道中会分别产生负压或交变压力。下一步是建议和装置，使患者能够治疗自己的鼓膜或听骨链活动能力降低，例如对耳屏或管子进行交替加压，以将压力从口腔或橡胶袋传导到耳朵。为了加快压力脉冲的频率，人们建造了机械泵，最初是用手驱动的，后来用电力驱动。关键评估：在世纪之交，人们多次尝试评估中耳气动按摩的有效性，并明确这种治疗的适应症。尽管在动物实验中没有令人信服和可预测的结果，甚至观察到了有害的影响，但鼓膜按摩仍延续了半个世纪的胜利行军。这样做的原因似乎是对一种众所周知的中耳病理的提示性和看似合理的治疗方法。自本世纪中叶以来，它一直被认为是过时的，不再在教科书中被提及。详细介绍了这一集的历史。
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.