Abstract:
A device and method to protect a user&#39;s ear from changes in external atmospheric pressure and to treat middle ear disease by actively controlling (increasing, decreasing, oscillating or preserving unchanged) air pressure in the user&#39;s outer ear cavity. Preferably pressure is controlled using an earplug that fits tightly into the outer ear cavity with minimal air leakage. An axial channel through the earplug connects a pressure source which controls pressure to the outer ear cavity. Optionally the device also includes a conveyor and oscillator to supply controlled pressure oscillations to the outer ear cavity. A method to treat middle ear disease in a patient by transmitting vibrations to the patient&#39;s middle ear. Vibrations are transmitted by bone conduction or by pressure oscillations in the outer ear cavity. Vibrations reduce swelling and pain in the middle ear. The scope of the present invention includes use of the device for preventing pressure differential across the eardrum between the middle ear and the outer ear cavity and for the treatment of middle ear disease.

Description:
FIELD AND BACKGROUND OF THE INVENTION  
         [0001]    The present invention relates to a device and method to protect a user&#39;s ear from changes in external atmospheric pressure and to treat middle ear disease and more particularly a device and method to actively control (increase, decrease, oscillate or preserve unchanged) air pressure in the user&#39;s outer ear cavity and transmit vibrations to the user&#39;s middle ear.  
           [0002]    The ear (FIG. 1) contains two cavities, an outer ear cavity  10  and a middle ear  12 . An eardrum  14  separates the two cavities. If there is a difference in pressure between these two cavities there will be a stress on eardrum  14 . This stress can cause pain, tissue damage or hearing loss.  
           [0003]    Outer ear cavity  10  is in direct contact with an external atmosphere (not shown) while the only contact between middle ear  12  and the external atmosphere is through an Eustachian tube  16 . Eustachian tube  16  is a narrow tube between middle ear  12  and a nasopharynx (not shown). Under normal conditions Eustachian tube  16  opens in response to yawning or swallowing. This preserves pressure equilibrium between middle ear  12  and the nasopharynx. The nasopharynx is in pressure equilibrium with the external atmosphere. Therefore, under normal conditions, middle ear  12  and outer ear cavity  10  are both in pressure equilibrium with the external atmosphere. Therefore the two cavities are in mutual pressure equilibrium and there is no stress on eardrum  14 .  
           [0004]    The pressure in outer ear cavity  10  immediately equilibrates to pressure changes in the external atmosphere. On the other hand, pressure changes in middle ear  12  require slow venting of air through narrow Eustachian tube  16 . Therefore, sudden pressure changes in the external atmosphere may cause temporary pressure differential between outer ear cavity  10  and middle ear  12 . This pressure differential stresses eardrum  14  and may result in pain (acute Barotrauma).  
           [0005]    Barotrauma is often experienced by airplane passengers during landing and take off. For example, when an airliner ascends, the external pressure (cabin pressure) and the pressure in outer ear cavity  10  are immediately reduced. On the other hand, the reduction of pressure in middle ear  12  occurs much more slowly. This results in temporary over-pressure in middle ear  12 . Until the excess pressure in middle ear  12  is fully vented, eardrum  14  will be stressed outward causing pain.  
           [0006]    Eustachian tube  16  may become blocked in children or in adults with respiratory infections. This makes the equilibrating process between middle ear  10  and the external atmosphere exceedingly slow. On a long air journey, an air passenger with blocked Eustachian tube  16  may experience extreme and continuing pain due to pressure differential between outer ear cavity  10  and middle ear  12 . Furthermore, this pressure differential can lead to chronic pain, hearing loss and tissue damage.  
           [0007]    Mobley et al. (U.S. Pat. No. 5,467,784) developed a device that is intended to help airline passengers limit pressure differential between middle ear  12  and outer ear cavity  10 . The Mobley et al. device is a passive earplug that shields outer ear cavity  10  from sudden pressure changes in the external atmosphere. The Mobley et al. device must be inserted into outer ear cavity  10  before any pressure change in the external atmosphere and must remain in outer ear cavity  10  continuously until pressure in middle ear  12  equilibrates with the pressure in the external atmosphere. If the Mobley et al. device is not inserted before pressure changes in the external atmosphere (take off) or if the Mobley et al. device falls out or is removed early then the Mobley et al. device gives no further benefit. Therefore the Mobley et al. device will fail for travelers who, at the beginning of their trip, were not aware of blockages that may exist in their Eustachian tube  16 . The Mobley et al. device will also fail for travelers who prematurely remove the device. Furthermore, the Mobley et al. device can not be adjusted and retains pressure for a preset period that may not be appropriate for all users. Thus, for a passenger with blocked Eustachian tube  16 , the preset pressure retention period of the Mobley et al. device may be too short. When the pressure retention period of the Mobley et al. device is too short, then the Mobley et al. device will not prevent Barotrauma. On the other hand the preset pressure retention period of the Mobley et al. device may be too long for passengers with clear Eustachian tube  16 . When the pressure retention time of the Mobley et al. device is too long, then pressure in middle ear  12  will change faster in response to changes in external atmospheric pressure than pressure in outer ear cavity  10  causing (inverse) Barotrauma.  
           [0008]    Another disadvantage of the Mobley et al. device is that it prevents pressure oscillations from reaching outer ear cavity  10 . This reduces the hearing of the user of the Mobley et al. device. Reduced hearing causes inconvenience to the user who wishes to listen to music or join a conversation. Reduced hearing can also be a safety hazard because the user fails to receive important information such as announcements over an airplane&#39;s intercom. Furthermore, controlled low frequency pressure oscillations passed by eardrum  14  to middle ear  12  can be used therapeutically to reduce congestion of Eustachian tube  16  and swelling of tissue in middle ear  12 .  
           [0009]    Proetz (Proetz, A. W. “Allergy in middle and internal ear.” Ann Otol. 40: 67, 1931) developed a treatment for chronic blockage of Eustachian tube  16  by actively producing pressure oscillations (short-term overpressure) in the nasopharynx. Pressure in the nasopharynx affects middle ear  12  through Eustachian tube  16 . Recently, Arick et al. (U.S. Pat. No. 5,419,762), Stangerup (U.S. Pat. No. 5,431,636) and Donaldson et al. (U.S. Pat. No. 5,950,631) developed devices to treat chronic ear diseases by controlling pressure in the nasopharynx. Controlling pressure in the nasopharynx can not alleviate Barotrauma in victims of blocked Eustachian tube  16  because the pressure from the nasopharynx can not traverse blocked Eustachian tube  16  to reach middle ear  12  fast enough to prevent pain or damage.  
           [0010]    Liquid in middle ear  12  is common cause of reduced hearing in children. Liquid is drawn into middle ear  12  from surrounding tissue when there is negative pressure in middle ear  12 . Negative pressure in middle ear  12  occurs when a child with partially blocked Eustachian tube  16  clears his nose by sucking. The Proetz methodology is not well suited for treating negative pressure in middle ear  12  of small children because applying pressure oscillations to the nasopharynx requires highly coordinated motor activity on the part of the user (stretching the neck and swallowing or blowing while holding the breath). It is desirable that there be a device to apply therapeutic pressure oscillations to middle ear  12  without requiring highly coordinated motor activity of the user.  
           [0011]    Thus, there is a widely recognized need to prevent acute Barotrauma and associated long-term ear damage in people experiencing rapid external pressure changes. Barotrauma is particularly serious for people with blocked Eustachian tube  16 . Barotrauma in a person with blocked Eustachian tube  16  will last longer than Barotrauma in a person with clear Eustachian tube  16 . Furthermore, in a person with blocked Eustachian tube  16 , Barotrauma will be have more serious complications and long term side effects than Barotrauma in a person whose Eustachian tube  16  is clear. Therefore, it is highly desirable to have a method to reverse pressure differentials between middle ear  12  and outer ear cavity  10  after the onset of Barotrauma (when a victim becomes aware of the Barotrauma due to perceived pain). It is further desirable that the method to reverse pressure differences between outer ear cavity  10  and middle ear  12  be effective also in the presence of blockage of Eustachian tube  16 . It is further desirable that the method allows adjustable rate equilibration of pressure between outer ear cavity  10  and the external atmosphere and it is further desirable that there be further provided a procedure for conveying pressure oscillations and vibrations to the user&#39;s ear.  
         SUMMARY OF THE INVENTION  
         [0012]    According to the present invention there is provided a device for active control of air pressure in an outer ear cavity of a user&#39;s ear including: (a) a pressure source; and (b) an applicator to apply air pressure from the pressure source to the outer ear cavity.  
           [0013]    According to the present invention there is provided a device for active control of air pressure in both outer ear cavities of two of a user&#39;s ears including: (a) a pressure source; and (b) an applicator to apply air pressure from the pressure source to the outer ear cavities.  
           [0014]    According to the present invention there is provided an active method to prevent barotrauma in at least one of two ears of a user including the steps of: (a) providing a source of controlled pressure; and (b) applying the controlled pressure to an outer ear cavity of the at least one ear.  
           [0015]    According to the present invention there is provided a method to treat ear disease in an ear of a patient including the steps of: (a) providing a source of controlled pressure; and (b) applying the controlled pressure to the patient&#39;s outer ear cavity.  
           [0016]    According to the present invention there is provided a method to treat ear disease in an ear of a patient comprising the steps of: (a) providing a source of vibrations; and (b) transmitting the vibrations to tissue surrounding a middle ear cavity of the ear.  
           [0017]    As understood herein, the terms pressure and air pressure include both positive gauge pressure and negative gauge pressure (suction).  
           [0018]    According to further features in preferred embodiments of the invention described below, the device may also include a pressure conveyor. The conveyor serves to transmit pressure oscillations to outer ear cavity  10  of the user via the applicator. The pressure oscillations may be of an audible frequency or of an inaudible frequency. Audible oscillations include sounds from the external atmosphere, music or the contents of a sound channel (for example the audio program of an aircraft). Low frequency (inaudible) pressure oscillations have therapeutic value for users suffering from swelling or blockage in middle ear cavity  12  or Eustachian tube  16 .  
           [0019]    Unlike the Mobley et al. device, the present invention is active. Therefore, the present invention can be used to equilibrate pressure differentials between the outer ear cavity and middle ear after the onset of Barotrauma. The present invention can be adjusted during use allowing users with blocked Eustachian tube to choose a longer pressure equilibration time in the outer ear cavity and allowing users with clear Eustachian tube to choose a shorter equilibration time.  
           [0020]    Unlike devices based on the Proetz methodology, the present invention controls pressure in the outer ear cavity and therefore prevents acute Barotrauma even in the presence of blocked Eustachian tube. Therefore the present invention functions in the situations described above where prior art devices fail.  
           [0021]    Preferably, the user&#39;s outer ear cavity is insulated from pressure in the external atmosphere by means of an earplug. A channel is bored axially through the earplug and connected to a flexible tube. The flexible tube connects the outer ear cavity through the channel in the earplug to a pressure source (a source of increased or decreased pressure). The flexible tube also acts as a pressure buffer and preserves the pressure in the outer ear cavity when the pressure source is not active even in the presence of small leaks around the earplug. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0022]    The invention is herein described, by way of example only, with reference to the accompanying drawings, wherein:  
         [0023]    [0023]FIG. 1 is a schematic view of an ear;  
         [0024]    [0024]FIG. 2 a  is an axial cross section (taken through lines B-B of FIG. 2 b ) of a ribbed earplug of a preferred embodiment of the present invention;  
         [0025]    [0025]FIG. 2 b  is a transverse cross section (taken through lines A-A of FIG. 2 a ) of a ribbed earplug of a preferred embodiment of the present invention;  
         [0026]    [0026]FIG. 3 shows a preferred embodiment of the present invention with an independent ribbed earplug for each ear. Pressure is controlled using a removable pipette squeeze ball and flexible tubing;  
         [0027]    [0027]FIG. 4 shows an alternative preferred embodiment of the present invention including two alternative embodiments of a conveyor which transmits pressure oscillations to outer ear cavity  10 , and tapered earplugs held to the ear by a flexible assembly similar to a medical stethoscope. Pressure is supplied by a standard disposable medical syringe. A valve directs controlled pressure to each ear independently;  
         [0028]    [0028]FIG. 5 a  is an axial cross section (taken through lines E-E of FIG. 5 b ) of an alternative embodiment of a conveyor which transmits pressure oscillations;  
         [0029]    [0029]FIG. 5 b  is a transverse cross section (taken through lines D-D of FIG. 5 a ) of an alternative embodiment of a conveyor which transmits pressure oscillations;  
         [0030]    [0030]FIG. 6 is a transverse cross section taken through the center of an alternate preferred embodiment of a pressure oscillation source assembly;  
         [0031]    [0031]FIG. 7 a  is a transverse cross section (taken through lines F-F of FIG. 7 b ) of an alternate preferred embodiment of a pressure oscillation source assembly;  
         [0032]    [0032]FIG. 7 b  is an axial cross section (taken through lines G-G of FIG. 7 a ) of an alternate preferred embodiment of a pressure oscillation source assembly;  
         [0033]    [0033]FIG. 8 a  is a further alternate embodiment of a pressure source assembly;  
         [0034]    [0034]FIG. 8 b  is a transverse cross section taken through the center of a 4-port 2-way valve used in the preferred embodiment of FIG. 8 a  configured for descent;  
         [0035]    [0035]FIG. 8 c  is a transverse cross section taken through the center of a 4-port 2-way valve used in the preferred embodiment of FIG. 8 a  configured for ascent;  
         [0036]    [0036]FIG. 9 is an illustration of the application of vibrations to the mastoid bone. 
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0037]    The present invention is of a pressure controlling device. Specifically the pressure controlling device of the present invention serves for protecting a user&#39;s ear from changes in external atmospheric pressure and for treating middle ear disease by actively controlling (increasing, decreasing, oscillating or preserving unchanged) air pressure in the user&#39;s outer ear cavity.  
         [0038]    The principles and operation of a pressure controlling device according to the present invention may be better understood with reference to the drawings and the accompanying description.  
         [0039]    A preferred embodiment of the present invention is shown in FIGS. 2 a,    2   b  and  3 . FIGS. 2 a  and  2   b  respectively show detailed axial and transverse cross sections of an earplug  18 . Earplug  18  has a solid cylindrical body  19  and ribs  20 . Earplug  18  is a common sound attenuating earplug with the following modifications: an axial channel  22  is bored through earplug body  19 . A conical fitting  24  with an internal thread  25   a  is inserted into channel  22 . One end of a tubing adapter  26  screws into conical fitting  24  by means of an external thread  27   a.  The other end of tubing adapter  26  connects by means of a barbed tube fitting  28   a  to a flexible tube  30   a.    
         [0040]    When earplug  18  is inserted into outer ear cavity  10 , outer ear cavity  10  is insulated from pressure in the external atmosphere by ribs  20  while flexible tube  30   a  and channel  22  provide a path for control of pressure within outer ear cavity  10 .  
         [0041]    [0041]FIG. 3 shows an entire preferred embodiment  29   a  of the present invention. Flexible plastic tube  30   a  connects ribbed earplug  18  to an on-off valve  31  that can be opened and closed. Ribbed earplug  18  has a cylindrical body  19  and ribs  20 . On-off valve  31  is connected by means of a standard plastic tubing quick connect friction fitting  32   a  to a pressure source  33   a  which, in embodiment  29   a  is a standard pipette squeeze ball.  
         [0042]    When the user (e.g., a passenger in an ascending airplane) feels discomfort due to overpressure in middle ear  12 , the user inserts earplug  18  into outer ear cavity  10  and uses friction quick connector  32   a  to attach pressure source  33   a  to on-off valve  31 . The user then opens on-off valve  31  and squeezes pressure source  33   a.  This increases the pressure in outer ear cavity  10  relieving the pressure differential between middle ear  12  and outer ear cavity  10 . The user may then close on-off valve  31  and remove pressure source  33   a  (leaving earplug  18  in outer ear cavity  10 ) until the user feels a need for further equilibration. With on-off valve  31  closed, a large volume of air in flexible tube  30   a  acts as a buffer retaining the pressure inside outer ear cavity  10  even in the presence of small leaks around earplug  18 .  
         [0043]    When the user (e.g. a passenger in a descending airplane) feels discomfort due to under-pressure in middle ear  12 , the user inserts earplug  18  into outer ear cavity  10 . Then the user squeezes pressure source  33   a  collapsing pressure source  33   a  and emptying pressure source  33   a  of air. The user then attaches collapsed pressure source  33   a  to on-off valve  31  using friction quick connector  32   a.  Finally, the user opens on-off valve  31  and releases pressure source  33   a  allowing pressure source  33   a  to resume its natural (inflated) shape producing a vacuum. This reduces the pressure in outer ear cavity  10  relieving the pressure differential between middle ear  12  and the outer ear cavity  10 . The user may then close on-off valve  31  and remove pressure source  33   a  (leaving earplug  18  in outer ear cavity  10 ) until the user feels a need for further equilibration. With on-off valve  31  closed, a large volume of air in flexible tube  30   a  acts as a buffer retaining the pressure inside outer ear cavity  10  even in the presence of small leaks around earplug  18 .  
         [0044]    An alternative preferred embodiment of the present invention, which is referred to herein as system  29   b,  is shown in FIG. 4. Tapered earplugs  35  are sealed over outer ear cavities  10  of both of the user&#39;s ears using a frame  36  (similar to a doctor&#39;s stethoscope or to audio earphones). Each earplug  35  contains an axial channel (not shown) which is connected to four-way valve  38  by means of flexible tubing  30   b.  Pressure source  33   b  is connected to four-way valve  38 . Four-way valve  38  allows the user to close off tube  30   b  or to connect tube  30   b  to pressure source  33   b  or to the external atmosphere. Four-way valve  38  allows separate control of the pressure in outer cavity  10  of each ear. Pressure source  33   b  in this alternate embodiment is a standard disposable medical syringe which connects to four-way valve  38  by means of a standard threaded hypodermic quick connect  32   b.  Pressure in outer ear cavity  10  can by increased by using pressure source  33   b  to inject air into flexible tubing  30   b.  Pressure in outer ear cavity  10  can by decreased by using pressure source  33   b  to extract air from flexible tubing  30   b.    
         [0045]    Flexible tubing  30   b  includes a safety pressure release  41 . Safety release  41  in this embodiment is a thinning of the walls of flexible tubing  30   b.  In the event of dangerously high pressures within tubing  30   b,  thinned safety release  41  bulges to release pressure. In the event of dangerously low pressures within tubing  30   b,  thinned safety release  41  collapses to prevent sudden release of pressure from outer ear cavity  10 . Alternatively safety release  41  may be a pressure release valve.  
         [0046]    Flexible tube  30   b  further includes a constriction  42  which prevents large volumes of air from quickly entering or leaving the channel of earplug  35 . Thus the air in the hollow of flexible tubing  30   b  between earplug  35  and constriction  42  acts as a buffer protecting outer ear cavity  10  from sudden pressure changes. Alternatively, the channel of earplug  35  could itself be narrow and serve as a constriction; the small volume of air inside of outer ear cavity  10  serving as a pressure buffer.  
         [0047]    Flexible tubing  30   b  also includes a conveyor  44   a  which in this embodiment is a standard tubing Y-connect. In this preferred embodiment, conveyor  44   a  is to be connected to a pressure oscillation source assembly  56   a.  Pressure oscillation source assembly  56   a  includes a miniature loudspeaker  48   a  (similar to the miniature earphone speakers included with portable cassette players) which is connected by a wire  45   a  which passes through stopper  50  to a standard audio earphone plug  46   a.  Loudspeaker  48   a  is inserted through conveyer  44   a  into the hollow of tubing  30   b  and stopper  50  is inserted into the opening of conveyor  44   a  preventing pressure leakage to the external atmosphere. Plug  46   a  can be inserted into an aircraft sound system plug or a portable tape player to allow the user to listen to music or plug  45   a  can be attached to a microphone (not shown) to allow the user to better to hear sounds in the external atmosphere.  
         [0048]    System  29   b  further includes an alternative preferred embodiment of a conveyor  44   b.  Conveyor  44   b  is a diaphragm assembly communicating pressure oscillations to the cavity of flexible tube  30   b  through a barbed tubing connector  28   b.  Diaphragm assembly conveyor  44   b  includes a rigid cylindrical box  60   a  which has an open end covered by a flexible diaphragm  62 . As shown, diaphragm assembly conveyor  44   b  transmits pressure oscillations from the external atmosphere via the internal cavity of tube  30   b  to outer ear cavity  10  improving the ability of the user to hear sounds in the external atmosphere. Diaphragm assembly conveyor  44   b  also includes an external thread  27   b  to connect diaphragm assembly conveyor  44   b  to a pressure oscillation source.  
         [0049]    Diaphragm assembly conveyor  44   b  and barbed tube connectors  28   b  are shown in more detail in axial cross section in FIG. 5 a  and in transverse cross section in FIG. 5 b.  Diaphragm assembly conveyor  44   b  includes rigid cylindrical box  60   a,  which has an open end covered by flexible diaphragm  62 . In this preferred embodiment diaphragm assembly conveyor  44   b  has an external thread  27   b  to connect diaphragm assembly conveyor  44   b  to a pressure oscillation source. Also shown in FIG. 5 b  is a transverse cross section through the center of a connector  66 , which connects diaphragm assembly conveyor  44   b  to a pressure oscillation source. Connector  66  is a rigid cylindrical box  60   b  open at one end with an internal thread  25   b  which screws connector  66  (like a jar cover) to diaphragm assembly conveyor  44   b.  A barbed tube fitting  28   c  serves to join connector  66  to a pressure oscillation source.  
         [0050]    A transverse cross section through the center of an alternative preferred embodiment of a pressure oscillation source assembly, which is referred herein as assembly  56   b  is shown in FIG. 6. Assembly  56   b  contains a rigid cylindrical box  60   c  in which is mounted a standard audio speaker  48   b  connected to an oscillating electric current by means of wire  45   b  and audio earphone plug  46   b.  Pressure oscillations of loudspeaker  48   b  are transmitted via barbed tubing connector  28   d  and flexible tubing  30   c  to a conveyor (for example  44   a  or  44   b ). An oscillating electric current may be applied to earphone plug  46   b  from any audio device, for example a tape deck (not shown) or the sound system of an aircraft (not shown).  
         [0051]    Low frequency pressure oscillations (low frequency sounds or sub-audio low frequency vibrations) have a therapeutic effect reducing swelling and pain in middle ear  12  and Eustachian tube  16 . Thus, therapeutic treatment of middle ear disease (swelling in middle ear  12  or blocking of Eustachian tube  16 ) is achieved by placing pressure regulation device  29   b  over the ears of a patient and supplying low frequency pressure oscillations. Such pressure oscillations are supplied by oscillation source assembly  56   b  which is connected by means of audio plug  46   b  to a tape player (not shown) playing a custom audio tape of low frequency signals (not shown).  
         [0052]    Another alternate embodiment of a pressure oscillation source referred to herein as assembly  56   c  is shown in FIGS. 7 a  and  7   b.  Assembly  56   c  includes an electromagnet  74 , which pulls down a press  82  which is mounted on an actuator arm  86  connected to a hinge  84 . When electric current is applied to magnet  74 , press  82  squeezes flexible tubing  30   d  reducing the internal volume of tubing  30   d.  When the ends of tubing  30   d  are sealed, decreasing the volume of tube  30   d  increases internal pressure. For example, assembly  56   c  may be installed along tubing  30   b  that is included in the applicator apparatus of FIG. 4. Applying an oscillating current to magnet  74  creates pressure oscillations inside tube  30   d  which are translated to outer ear cavity  10 . Assembly  56   c  can produce very low frequency pressure oscillation similar to pressure oscillations produced by muscular activity in the Proetz methodology. Thus, assembly  56   c  in combination with applicator assembly  29   b  applies therapeutic pressure oscillations to outer ear cavity  10  alleviating swelling of middle ear  12  and blockage of Eustachian tube  16 .  
         [0053]    [0053]FIG. 8 a  shows an alternative embodiment of a pressure source assembly herein referred to as pressure source assembly  88 . Squeezing pressure source  33   c , which is a squeeze ball in this preferred embodiment, pushes air through a one-way valve  90   a  into a flexible tube  30   e.  Releasing pressure source  33   c  from its collapsed state allows source  33   c  to inflate drawing air through a one-way valve  90   b  from a flexible tube  30   f.    
         [0054]    Flexible tubes  30   e  and  30   f  are further connected to two ports of a four-port two-way valve  92 . Four-port two-way valve  92  is further connected to an applicator (not shown) via a barbed tube fitting  28   e  and to an external atmosphere (not shown) via an exit port  98 . A transverse cross section of four-port two-way valve  92  is shown in FIG. 8 b  and FIG. 8 c.  Four-port two-way valve  92  includes a cylindrical body  60   c  and a rotating inner chamber  94 . Rotating inner chamber  94  contains two channels  96   a  and  96   b.    
         [0055]    Four-port two-way valve  92  has two configurations (ways): The first configuration herein referred to as descent is shown in FIG. 8 b.  In the descent configuration, channel  96   a  connects flexible tube  30   e  to the applicator via barbed tube fitting  28   e.  Simultaneously, in the descent configuration, channel  96   b  connects flexible tube  30   f  to the external atmosphere via exit port  98 . Thus when four-port two-way valve  92  is in the descent configuration, alternately squeezing and releasing pressure source  33   c  draws air through exit port  98  and pumps the air into the applicator, increasing pressure on the outer ear cavity. The second configuration herein referred to as ascent is shown in FIG. 8 c.  In the ascent configuration, channel  96   a  connects flexible tube  30   e  to the external atmosphere exit port  98 . Simultaneously, in the ascent configuration, channel  96   b  connects flexible tube  30   f  to the applicator via barbed tube fitting  28   e.  Thus when four-port two-way valve  92  is in the ascent configuration, alternately squeezing and releasing pressure source  33   c  vents air through exit port  98  and draws the air out of the applicator decreasing pressure on outer ear cavity.  
         [0056]    In FIG. 9 a commercially available muscle relaxation vibrator  105  is shown being applied to the mastoid bone  110  of a patient. Vibrations relieve middle ear disease due to Eustachian blockage because vibrations reduce swelling in middle ear tissue by inducing blood flow. Vibrations also break up blockages in Eustachian tube  16  and reduce pain through competitive nerve stimulation.  
         [0057]    It will be appreciated that the above descriptions are intended only to serve as examples, and that many other embodiments are possible within the spirit and the scope of the present invention.