Abstract:
A method is disclosed for clearing effusion from an ear. The method may include applying liquid to an ear canal, which is proximal to a perforated tympanic membrane, which is proximal to a middle ear containing effusion, applying an ear device to seal and pressurize the liquid inside the ear canal, the ear device regulating the amount of pressure inside the ear canal, and inducing a Eustachian tube, which is distal to the middle ear, to open, which causes the fluid to displace the effusion into the Eustachian tube.

Description:
[0001]    This application claims the benefit of U.S. Provisional Application No. 61/140,805, filed Dec. 24, 2008, the entirety of which is incorporated by reference herein for all purposes. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The invention generally relates to methods and devices for treatment of the ear, which may be supplemental to a tympanocentesis procedure. 
       BACKGROUND OF THE INVENTION 
       [0003]    Middle ear infections are common in young children. Suffering may be alleviated by puncturing the tympanic membrane to evacuate the fluid, a treatment known as tympanocentesis. The patient may undergo general anesthesia prior to a tympanocentesis procedure, but this is not preferred due to cost and health concerns. As a preferable alternative, the tympanic membrane can be locally anesthetized with an iontophoresis procedure. Thus, the patient may be treated while awake. Devices and methods for locally anesthetizing the tympanic membrane are disclosed in co-assigned patent application U.S. Ser. No. 11/962,063, U.S. Ser. No. 11/749,729, and U.S. 61/085,360, the entireties of which are incorporated by reference herein.  FIG. 1A  shows a view of an outer ear. The outer ear includes a major element known as the Auricle or Pinna  100 . The outer ear serves as a funnel for directing sounds into the internal portions of the ear. The major physical features of the ear include the Lobule  102 , Concha  104 , Athelix  106 , Helix  108 , Scapha  110 , Triangular fossa  112 , Externam acoustic meatus  114 , Tragus  116 , and Antitragus  118 . 
         [0004]      FIG. 1B  shows a cross-section of the inner and outer portions of the ear. The pinna  100  is shown connected to the External auditory meatus  118 , or ear canal. The ear canal  118  is shown as a relatively straight passage, but is often a tortuous passageway. The ear canal  118  is connected to the middle ear  120 , which includes the ear drum  122 . The middle ear  120  in turn is connected to the internal ear  124 . When the middle ear  120  becomes infected, fluid swells inside the ear drum  122 . Fluid expansion causes extreme pain to one with a middle ear infection. 
         [0005]    Fluid in the middle ear is commonly known as serous otitis media or “effusion”. Effusion is normally drained through the tympanocentesis procedure. However, effusion may thicken and thus be difficult to remove or drain. Thickening of effusion is common with patients who suffer from chronic ear infections. Accordingly, a tympanocentesis procedure may not be effective in patients with lodged or thickened effusion. 
         [0006]    Tympanocentesis procedures, which implement iontophoresis, often require iontophoresis fluid to be evacuated before the tympanic membrane is punctured. Evacuation of fluid is commonly performed through low pressure suction via a syringe or suction cannula. Fluid evacuation is often a painful and uncomfortable process because large amounts of noise are created by fluid cavitation. Thus, fluid evacuation by suction may cause pain and emotional discomfort which may prevent the completion of the tympanocentesis procedure. It should be noted that many patients are young, 5 and under, and also have endured many hours or days of a painful ear infection, and thus may be uncooperative and difficult to treat. Fluid may also be removed by swabbing the ear with an absorbent material, however this can be irritating to the patient and ineffective as well. Swabbing also requires the patient to vigorously shake their head side to side, which many young patients refuse to comply with. 
       BRIEF SUMMARY OF THE INVENTION 
       [0007]    One embodiment of the invention may include a method for clearing effusion from an ear. The method may include applying liquid to an ear canal, which is proximal to a perforated tympanic membrane, which is proximal to a middle ear containing effusion. The perforated tympanic membrane may have been intentionally perforated in a prior tympanocentesis procedure. The effusion may not have been removed by the normal tympanocentesis procedure. The method may also include applying an ear device to seal and pressurize the liquid inside the ear canal, the ear device regulating the amount of pressure inside the ear canal. The method may also include inducing a Eustachian tube, which is distal to the middle ear, to open, which causes the fluid to displace the effusion into the Eustachian tube. 
         [0008]    Another aspect of the invention may include a method for clearing effusion from an ear, the method including applying an ear device to seal an ear canal, which is proximal to a perforated tympanic membrane, which is proximal to a middle ear containing effusion. The method may also include pressurizing the ear canal with air, and inducing a Eustachian tube, which is distal to the middle ear, to open, which causes the pressurized air to displace the effusion into the Eustachian tube. 
         [0009]    Yet another aspect of the invention may include a device for pressurizing an ear canal, the device including a first ear cup which encloses a first external ear, the first ear cup having a first sealing member which fluidly seals around the first external ear, the first ear cup having a first port which is in fluid communication with the sealed first external ear. The device may also include a second ear cup which encloses a second external ear, the second ear cup having a second sealing member which fluidly seals around the second external ear, the second ear cup having a second port which is in fluid communication with the sealed second external ear. A headpiece may connect to each ear cup, the headpiece being configured for applying sealing pressure to each sealing member and retaining each ear cup on each respective external ear. 
         [0010]    Yet another aspect of the invention may include a method for clearing liquid from an ear canal, the method including applying a device including a wicking tip to a liquid solution inside an ear canal to wick the liquid from the ear canal. The liquid may be left from a iontophoresis procedure. The method may also include applying negative pressure to the device to aid in wicking the liquid, wherein the wicking tip regulates turbulence to reduce noise caused by wicking the liquid. 
         [0011]    Yet another aspect of the invention may include a device for clearing liquid from an ear canal, the device including an elongated cannula including a first end and a second end. The device may also include an elongated foam member including a distal end and a proximal end, a portion of the elongated foam member compressed within the cannula, the distal end uncompressed and exposed past the first end, the proximal end uncompressed and exposed past the second end, wherein the proximal end is larger than the distal end to provide a wicking action to the distal end, and wherein the proximal end will enlarge when fluid is wicked from the distal end into the proximal end. 
         [0012]    Yet another aspect of the invention may include a device for silently removing liquid from an ear canal, the device including an elongated multi-lumen cannula including a distal end and a proximal end, wherein each lumen includes a cross-sectional area which reduces cavitation during suction. A suction apparatus may be coupled to the proximal end of the multi-lumen cannula. 
         [0013]    Yet another aspect of the invention may include a method for removing liquid from an ear canal, the method including receiving a trigger to apply suction to a device in an ear canal filled with liquid, the device including a lumen for removing the liquid. Suction may be applied to the device. The method may also include monitoring an electrical signal from the device. The method may also include detecting an imminent creation of noise, or noise, caused by the suction; and reducing suction until the imminence of noise, or noise, subsides. 
         [0014]    Yet another aspect of the invention may include a system for removing liquid from an ear canal. The system may include a suction probe, which includes at least one noise sensor. A pressure regulator may be coupled to the suction probe, the pressure regulator being configured to supply negative pressure to the suction probe. A processor may also be electrically coupled to the at least one noise sensor and pressure regulator, the processor being configured to detect, based on signals from the at least one noise sensor, imminent creation of noise, or noise, caused by the suction probe, the processor being further configured to modify pressure supplied by the pressure regulator based on the signals. 
         [0015]    Yet another aspect of the invention may include a device for silently removing liquid from an ear canal. The device may include an elongated cannula. Filtering material may be disposed within the cannula. A portion of the filtering material may be extended out of an end of the elongated cannula. 
         [0016]    Yet another aspect of the invention may include a method for silently removing effusion from a middle ear. A tympanostomy tube including a central lumen may be implanted into a tympanic membrane. A device having an Archmides&#39; screw may be inserted into the central lumen. The Archmides&#39; screw may be actuated to remove effusion lodged adjacent to the tympanic membrane. 
         [0017]    Yet another aspect of the invention may include a system for silently removing effusion from a middle ear. The system may include a tympanostomy tube including a central lumen. An elongated cannula may be configured to be slidably engaged with the lumen. An Archmides&#39; screw may be rotatably disposed within the cannula. 
         [0018]    To better understand the nature and advantages of the invention, reference should be made to the following description and the accompanying figures. It is to be understood, however, that the figures and descriptions of exemplary embodiments are provided for the purpose of illustration only and are not intended as a definition of the limits of the scope of the present invention. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0019]      FIG. 1A  shows a direct view of an outer ear. 
           [0020]      FIG. 1B  shows a cross-sectional view of an outer, middle, and inner ear, and a Eustachian tube. 
           [0021]      FIG. 2A  shows a cross-sectional view of an earplug, according to one embodiment of the invention. 
           [0022]      FIG. 2B  shows a perspective view of an earplug in use, according to one embodiment of the invention. 
           [0023]      FIG. 2C  shows a flow chart of a method for removing effusion from a middle ear, according to one embodiment of the invention. 
           [0024]      FIG. 2D  shows a frontal view of a device for sealing both ears of a patient, according to one embodiment of the invention. 
           [0025]      FIG. 2E  shows a frontal view of a device for sealing both ears of a patient in use, according to one embodiment of the invention. 
           [0026]      FIG. 2F  shows a perspective view of a device for sealing both ears of a patient, according to one embodiment of the invention. 
           [0027]      FIGS. 2G and 2H  show frontal and side views, respectively, of a device for sealing both ears of a patient in use, according to one embodiment of the invention. 
           [0028]      FIG. 3A  shows a side view of a device for silently removing liquid from an ear, according to one embodiment of the invention. 
           [0029]      FIGS. 3B and 3C  show frontal views of a device for silently removing liquid from an ear in use, according to one embodiment of the invention. 
           [0030]      FIGS. 4A-4F  show frontal views of liquid removal devices, according to embodiments of the invention. 
           [0031]      FIGS. 4G-4I  shows frontal views of liquid removal nozzles, according to embodiments of the invention. 
           [0032]      FIG. 5A  shows a side view of a device for silently removing liquid from an ear, according to one embodiment of the invention. 
           [0033]      FIG. 5B  shows a cross-sectional view of a device for silently removing liquid from an ear, according to one embodiment of the invention. 
           [0034]      FIG. 5C  shows a cross-sectional view of a device for silently removing liquid from an ear in use, according to one embodiment of the invention. 
           [0035]      FIG. 6A  shows a perspective view of a device for silently removing liquid from an ear, according to one embodiment of the invention. 
           [0036]      FIG. 6B  shows a cross-sectional view of a prior art device for removing liquid from an ear in use. 
           [0037]      FIG. 6C  shows a cross-sectional view of a device for removing liquid from an ear in use, according to one embodiment of the invention. 
           [0038]      FIG. 7A  shows a system diagram of a system for silently removing liquid from an ear, according to one embodiment of the invention. 
           [0039]      FIG. 7B  shows a flow chart for a method for silently removing liquid from an ear, according to one embodiment of the invention. 
           [0040]      FIG. 8A  shows a cross-sectional view of a device for silently removing liquid from an ear, according to one embodiment of the invention. 
           [0041]      FIG. 8B  shows a side view of the device of  FIG. 8A  coupled to a suction catheter, according to one embodiment of the invention. 
           [0042]      FIG. 9A  shows a cross-sectional view of a device for removing liquid from an ear, according to one embodiment of the invention. 
           [0043]      FIG. 9B  shows a cross-sectional view of the device of  FIG. 9A  in use, according to one embodiment of the invention. 
           [0044]      FIG. 9C  shows a side view of an alternative embodiment of the device of  FIG. 9A , according to one embodiment of the invention. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0045]    Effusion Removal: 
         [0046]      FIG. 2A  shows an earplug  200 , according to one embodiment of the invention. The earplug  200  includes a main lumen  202 . One or more sealing members  204  extend from the main lumen  202 . The sealing members  204  are umbrella shaped, and configured to partially deform within an ear canal to form a fluid tight seal. The sealing members  204  are shown to be integral from the main lumen  202 , but may also be separately attached. The sealing members  204  are preferentially more flexible than the main lumen  202 , as the main lumen  202  should remain at least partially open in use. A lumen seal  206  is placed within the main lumen  202 , which prevents fluid and pressure from exiting the lumen. The lumen seal  206  is shown configured as a duckbill valve, but may include other configurations. For example, the lumen seal  206  may be an elastomeric plug, or wall, with a compressed lumen, which may be expanded by a device for inserting fluid, such as a syringe. The earplug  200  may be constructed from various flexible materials, for example rubber or silicone. Various configurations of the earplug  200  are possible, such as shown in previously incorporated by reference U.S. Provisional Patent Application No. U.S. 61/085,360. 
         [0047]      FIG. 2B  shows the earplug  200  in use, according to one embodiment of the invention. As shown, a portion of the earplug  200  has been inserted into an ear canal and another portion remains exposed adjacent to the outer ear  208 . The ear shown may have undergone a tympanocentesis procedure, shortly before insertion of the earplug. A sealing member  204  is also shown in a partially compressed state. Thus, the earplug  200  is fluidly sealed within the ear canal. A bulb device  210  or syringe may be coupled with the earplug to supply fluidic pressure into the ear canal. The fluid may be a liquid, such as iontophoresis fluid, saline, or water, or a gas, such as air. As the ear has undergone a tympanocentesis procedure, the tympanic membrane has been punctured, and the ear canal  118  is in fluidic communication with the middle ear  120 . The patient may be instructed to swallow, and thus induce the Eustachian tube to open. This action causes a pressure differential between the Eustachian tube and the ear canal. Thus, fluid in the ear canal will pass through the middle ear, and flush solid or semi-solid effusion inside the middle ear into the Eustachian tube. Alternatively, the bulb device  210  may be used without instructing the patient to swallow. Creating a large enough pressure differential between the ear canal and Eustachian tube will force the Eustachian tube to open and move fluid through the middle ear. Care should be taken to avoid damage to the tympanic membrane. In an alternative embodiment, a relief valve is included to prevent over-pressurization of the ear canal. This procedure may also be performed on both ears simultaneously, and with the patient sitting upright. 
         [0048]      FIG. 2C  shows a flow chart of a method  212  for removing effusion from a middle ear, according to one embodiment of the invention. In operation  214 , a liquid is applied to the ear canal. The fluid may be liquid such as iontophoresis fluid, saline, or water. The liquid is preferably at room temperature, or higher, in order to prevent discomfort to the patient. In an alternative embodiment, no liquid is provided for operation  214 , and the method begins at operation  216  using only gas as a fluid. At operation  216  an ear device is applied to the ear canal of the patient, to form a fluid tight seal between the ear canal and the surrounding atmosphere. The ear device may, for example, be device  200  as shown in  FIGS. 2A and 2B . At operation  218  the ear device is pressurized with fluid, which may be a gas or liquid. The ear device may be pressurized with an external device such as a syringe, catheter, or bulb device as shown in  FIG. 2B . At operation  220  the Eustachian tube is induced to open, which may occur from the patient swallowing or from the pressure created in operation  218 . In operation  222  it is determined whether more fluid is required to complete the procedure. If not, then the procedure is complete and ends at  224 . If more fluid is required then the method  212  reverts to operation  218 . 
         [0049]      FIG. 2D  shows a device  228  for sealing both ears of a patient, according to one embodiment of the invention. The device includes ear cups  230 . Each ear cup  230  includes sealing members  232 , which are configured to fit over and fluidly seal the outer ear of a patient. Each ear cup  230  is provided with a fluid chamber  234 , which fluidly communicates with an ear canal. Each fluid chamber  234  in turn is in fluid communication with a port  236 . The ports  236  include seals  238  for sealing the fluid chambers from the external atmosphere. The seals  238  may be constructed from a flexible material, such as silicone or rubber. The ports  236  may couple to an external device which provides fluidic pressure, for example a syringe, catheter, or bulb device as shown in  FIG. 2B . In an alternative embodiment each port  236  is connected to an integral air pump, which pressurizes each fluid chamber when manually or electrically activated. In another alternative embodiment, a relief valve is included to prevent over-pressurization of the ear canal. A band  240  connects each ear cup  230 , and provides spring force for sealing each ear cup  230  to a patient&#39;s head.  FIG. 2E  shows a front view of patient wearing the device  228 . 
         [0050]      FIG. 2F  shows a device  242  for sealing both ears of a patient, according to one embodiment of the invention. The device includes ear cups  230 , which may be constructed as described regarding  FIG. 2D . The device  242  includes a wrap-around headband  242 . The headband  242  wraps around the entire head of a patient, and thus will not easily be disturbed during a procedure. The headband may be constructed from an elastic material, such as rubber or silicone.  FIGS. 2G and 2H  show side and front views, respectively, of the device  242  in use on a patient. 
         [0051]    Silent Liquid Removal: 
         [0052]      FIG. 3A  shows a device  300  for silently removing liquid from a patient&#39;s ear, according to one embodiment of the invention. Removing liquid in the ear after a tympanocentesis procedure may be very disturbing to a patient, as a large amount of noise is created in the ear by conventional suction devices. The device  300  includes a syringe  302 , a nozzle  304 , and an absorbent tip  306 . The syringe  302  provides negative pressure for suctioning and retaining liquid. The nozzle  304  should be flexible to allow insertion into a tortuous ear canal without causing patient discomfort. The nozzle  304  should also be flexible and long enough to reach the tympanic membrane without buckling or kinking. The nozzle  304  may be constructed from a polymer, for example nylon, polycarbonate, polypropylene, polyethylene, silicone, or an annealed or super elastic alloy. The distal portion of the nozzle  304  may include an outer diameter ranging from 0.5-3.0 mm, which allows passage through a speculum and visualization past the nozzle to ensure proper placement within the ear canal. The proximal portion of the nozzle  304  includes a luer fitting for coupling to the syringe  302 . The absorbent tip  306  is located within the distal portion of the nozzle  304 . The absorbent tip  306  may be constructed from absorbent materials such as porous fibers or foam, which will wick liquids. Suitable materials include polyvinyl acetate, rayon, and various blends of the two materials. The absorbent tip  306  may include pore sizes and interstitial spaces which attract liquid and retain particles. The absorbent tip  306  may extend 1-5 mm past the distal portion of the nozzle. 
         [0053]      FIG. 3B  shows device  300  in use, according to one embodiment of the invention. The device  300  is shown in use in an ear canal model  308  which is partially filled with a liquid solution. The absorbent tip  306  is initially placed in the ear canal and adjacent to the tympanic membrane. Contact with the liquid solution causes an immediate wicking action, which draws the liquid solution into the device  300 . The wicking action is completely silent, and thus will not disturb a patient.  FIG. 3C  shows the syringe  302  has been slowly drawn back to suction the remaining liquid solution, accordingly, the liquid solution is silently and quickly removed. This method may be performed implementing a one-handed technique by the operator. 
         [0054]      FIGS. 4A-4F  show devices which may be used in lieu of the syringe  302  with respect to device  300 , according to different embodiments of the invention.  FIG. 4A  shows a syringe with finger adapters which allows an ergonomic one-handed suction motion.  FIG. 4B  shows a spring-loaded syringe, which requires minimal effort to use.  FIG. 4C  shows a otology suction device, which may connect to a standard suction line.  FIG. 4D  shows a suction bulb, which is compressed before use.  FIG. 4E  shows a suction pipette, which is compressed before use.  FIG. 4F  shows a bellows-type suction device, which is compressed before use. 
         [0055]      FIGS. 4G-4I  show devices which may be used in lieu of the nozzle  304  with respect to device  300 , according to different embodiments of the invention.  FIG. 4G  shows a straight nozzle, which may offer better visibility in use.  FIGS. 4H and 4I  show shapeable nozzles of different lengths, which may be shaped in the field by the operator for better access and visibility. 
         [0056]      FIGS. 5A and 5B  show a device  500  for silently removing liquid from a patient&#39;s ear, according to one embodiment of the invention. The device  500  includes an elongated cannula  502 . The elongated cannula  502  may be pre-shaped to include a bend as shown, or in a straight configuration. The elongated cannula  502  may constructed from a malleable metal, and bent in the field by an operator for better access and visibility. The elongated cannula  502  includes an outer diameter which is small enough to reach the tympanic membrane, for example 1-3 mm. An elongated foam member  504  resides within the elongated cannula  502 . The elongated foam member  504  includes a distal foam portion  506  and a proximal foam portion  508 . The distal foam portion  506  extends past the elongated cannula  502  by a small amount, e.g. 1-3 mm, in comparison to the proximal foam portion  508 . A compressed region of foam  510  resides within the elongated cannula, and connects the distal and proximal foam portions. The foam may include pore sizes which can capture particulates. 
         [0057]      FIG. 5C  shows the device  500  in use, according to one embodiment of the invention. The distal foam portion  506  is shown placed in a liquid solution. The distal foam portion  506  expands slightly upon immersion, but is largely restrained by the elongated cannula. Liquid is wicked silently from the distal foam portion  506  to the proximal foam portion  508 . The proximal foam portion  508  has a larger volume than the distal foam portion  506 , and thus acts as a fluid depository. Accordingly, liquid is wicked from the distal foam portion  506  to the proximal foam portion  508  in a quick and silent manner. The device  500  requires no actuation other than placement in the ear. The proximal foam portion  508  may be compressed to remove wicked fluid and reused during the procedure or in the other ear. 
         [0058]      FIG. 6A  shows a device  600  for silently removing liquid from a patient&#39;s ear, according to one embodiment of the invention. The device  600  is configured as a multi-lumen tube. The tube includes an outer diameter which is small enough to reach the tympanic membrane, for example 1-3 mm. The lumen diameters may range from 0.05-0.5 mm. The device  600  may be connected to a suction device, for example a suction line or syringe. The device may also be flexible or constructed from a malleable material. Noise may be created when air mixes with liquid in a low pressure environment to cause cavitation and create a noisy “slurping” sound, as depicted in prior art device of  FIG. 6B . Thus, the larger the inner diameter of the suction device, the more likely noise will be produced, as any given cross-section of a large lumen may occupy both air and water. Device  600  prevents unwanted cavitation by using several smaller diameter lumens, which ensures that only air or water occupies a given cross-section of a lumen at a given time, as shown in  FIG. 6C . Accordingly, the device  600  eliminates or greatly reduces cavitation to provide a silent liquid evacuation procedure. 
         [0059]    Closed-Loop Control System: 
         [0060]      FIG. 7A  shows a system  700  for silently removing liquid from a patient&#39;s ear, according to one embodiment of the invention. The system  700  is configured to gate the rate of suction, to a device, using a closed loop control method. The system  700  includes a suction probe  702 , which includes a probe tip  704 , and at least one noise sensor  706 . The suction probe  702  may be configured similarly to any of the devices disclosed herein, or may be a standard suction cannula. The sensor  706  may detect noise (e.g. sound) and/or pressure and/or flow rate at or about the probe tip  704 , or any measurable artifact which is related to noise production. For example, as suction noise is caused by turbulence in a liquid stream, which is detectable at the fluid/air interface at the probe tip  704 , detection of turbulence (e.g. presence, discontinuity, increase/decrease) may be used a detectable sensor artifact. Other measurable artifacts include heat/electrical conductivity (e.g. between two points in a probe using the liquid as a conductive medium where conductivity decreases with additional turbulence), evaporation, oxygen content, temperature, or some other micro-environmental variable. Alternatively, several sensors may monitor conditions throughout the entire suction probe  702 . The sensor  706  is electronically coupled to a processor  708 . The processor  708  may be a portion of an embedded computer. A trigger  710  sends user command signals to the processor  708 , for example through a foot or hand switch. The suction probe  702  receives suction from a regulator  714  which is further connected to a suction source  712 . The regulator  714  is electronically coupled to the processor  708 . The processor  708  controls the regulator  714  to vary the rate and amount of negative pressure supplied to the suction probe  702 . The sensor  706  may be configured to detect noise, or the imminent creation of a predetermined noise level, and indicate the noise detection to the processor. The processor  708  may modify, e.g. reduce or eliminate, negative pressure supplied to the suction probe  702  based on the sensor  706  signal. In one example, the sensor is used to sense a waveform which increases in amplitude. Thus, when the waveform increases to a predetermined level in velocity or amplitude, and/or accelerates at a predetermined rate, the processor  708  can reduce negative pressure to the suction probe  702 . Accordingly, the imminent increase/creation of noise to a predetermined level can be abated, as the processor prevents the waveform from increasing. If no noise (e.g. no noise of a significant discomfort level) is sensed by the sensor  706 , then the processor  708  may increase negative pressure to the suction probe until a predetermined level is reached. A test cycle may also be implemented by the processor on start-up or shut-down by sending a test pulse of negative suction to create a suction-wave in the system  700  to check if noise is initially present, which may occur if the probe tip is only partially submerged in liquid, before full negative pressure is enacted by the regulator. Thus, negative pressure may not be applied at a full rate and in a continuous mode if the probe is not fully immersed in liquid. Accordingly, the system  700  automatically prevents the creation of noise during a liquid evacuation procedure, and prevents discomfort to the patient. 
         [0061]    The system  700  may include many of the components of a personal computer, such as a data bus, a memory, input and/or output devices (including a touch screen), and the like. The system  700  will often include both hardware and software, with the software typically comprising machine readable code or programming instructions for implementing one, some, or all of the methods described herein. The code may be embodied by a tangible media such as a memory, a magnetic recording media, an optical recording media, or the like. The system  700  may have (or be coupled to) a recording media reader, or the code may be transmitted to the processor  708  by a network connection such as an internet, an intranet, an Ethernet, a wireless network, or the like. Along with programming code, the system  700  may include stored data for implementing the methods described herein, and may generate and/or store data that records parameters reflecting the treatment of one or more patients. 
         [0062]      FIG. 7B  shows a method  716  for silently removing liquid from a patient&#39;s ear, which may be used with system  700 , according to one embodiment of the invention. A trigger occurs at input  716  to supply suction to the suction probe  702 . At operation  720  a processor  708  controls a regulator  714  to supply suction to a suction probe  702 . At operation  722  a sensor  706  monitors noise at a probe tip  704  and sends a signal to the processor  708 . At operation  724  it is determined whether the signal indicates noise, or imminent noise. If no noise, or imminent noise, is detected, then the method  716  loops back to operation  720 . If noise, or imminent noise, is detected, then at operation  726  the processor  708  instructs the regulator  714  to reduce suction. At operation  728  it is again determined whether the signal indicates noise, or imminent noise, after suction reduction. If no noise, or imminent, noise is detected, then the method  716  loops back to operation  720 . If noise, or imminent noise, is detected, then at operation  726  the processor  708  instructs the regulator  714  to reduce suction again. Accordingly, the method  716  automatically prevents the creation of noise during a liquid evacuation procedure, and prevents discomfort to the patient. 
         [0063]      FIG. 8A  shows a device  800  for silently removing liquid from a patient&#39;s ear, according to one embodiment. The device  800  includes a cannula  802 . In one embodiment the cannula  802  is a 0.075″ ID/0.083″ OD PTFE tube approximately 3.2 cm in length, with a 3/32″ thick polyolefin material heat shrunk about the PTFE tube surface. The device  800  includes a filter material  804  within the cannula  802 . In one embodiment the filter material is 65 thread count cotton gauze strands which are 1.5-1.7 cm long. In one embodiment, the filter material may be fibers of the cotton gauze longitudinally arranged within the cannula  802 . Alternatively, the filter material may be constructed from porous foam strands. A portion  806  of the filter material  804  extends from the distal end of the cannula  802 . The portion  806  may be frayed to resemble a mop head. The device  800  can be coupled to a commercially available 6 Fr suction catheter  808  as shown in  FIG. 8B . 
         [0064]    In use, the device  800  is applied to a liquid and/or, light effusion within a patient&#39;s ear and suction is applied to the device  800 , for example, by using the catheter  808 . The filtering material  804  acts as a sound buffer by transferring the suction noise from the extreme distal end of the device to a more proximal location within cannula  802 . In other words, the noise of suction does not occur at the extreme distal end, near the patient&#39;s ear drum, but instead occurs more proximally within cannula  802 . Accordingly, the patient is protected from excessive noise due to the suction. The portion  806  extending from the cannula  802  may also cushion against unintended contact with portions of the ear canal and/or be used to physically abrade lodged effusion. 
         [0065]      FIGS. 9A and 9B  show a system for silently removing liquid from a patient&#39;s ear, according to one embodiment of the invention. The device  900  includes a cannula  902  and an Archimedes&#39; screw  904  rotatably disposed within the cannula  902 . The Archimedes&#39; screw  904  may be coupled to a drive motor (not shown) to rotate at a relatively slow revolution, for example at 50-500 RPM, and at a constant torque. The cannula  902  may include a flared tip  906 . The Archimedes&#39; screw  904  may be configured to move in and out of the cannula. The cannula  902  may be configured to pass through a lumen  908  of a tympanostomy tube  910 . A suction source may be coupled to the proximal end of the device  900 . 
         [0066]    In use, the tympanostomy tube  910  is first implanted within a tympanic membrane TM of an ear of a patient, as shown. Devices and methods for locally anesthetizing the tympanic membrane for such a tube implant procedure are disclosed in co-assigned patent application U.S. Ser. No. 11/962,063, U.S. Ser. No. 11/749,729, and U.S. 61/085,360, which were incorporated by reference above. The device  900  can then be inserted into the lumen  908  of the tympanostomy tube  910  and applied to a lodged effusion E. The Archimedes&#39; screw  904  may rotate at a relatively slow RPM, and accordingly does not generate excessive noise, i.e. sputtering, to disturb the patient. Rotation of the Archimedes&#39; screw  904  causes the effusion E to engage Archimedes&#39; screw  904  and travel out of the ear canal. The Archimedes&#39; screw  904  may rotate at a constant torque to prevent jamming with particularly thick effusion. The Archimedes&#39; screw  904  may also be actuated in and out of the cannula to help disrupt the lodged effusion. Suction may be applied to the proximal portion of the device  900  to aid in effusion removal. 
         [0067]      FIG. 9C  shows an alternative embodiment of the device  900 . A cannula  914  includes a laterally exposed portion  914 , which exposes the tip of the Archimedes&#39; screw  904 . The exposed portion  914  may allow the Archimedes&#39; screw  904  to help initiate transport of the effusion. 
         [0068]    It should be noted that the silent liquid removal systems and devices shown and described herein may also be used to remove effusion. For example, the silent liquid systems and devices shown and described herein may be inserted into an ear canal to remove effusion. The silent liquid systems and devices shown and described herein may also be inserted directly into the middle ear, following a myringotomy or tympanostomy, to remove lodged effusion. Accordingly, the systems and devices for silent liquid removal described herein are not limited to removing liquid drug solution, and may be used to remove any liquid and fluidic particulates within the ear. 
         [0069]    As will be understood by those skilled in the art, the present invention may be embodied in other specific forms without departing from the essential characteristics thereof. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific embodiments of the invention described herein. Such equivalents are intended to be encompassed by the following claims.