THE EFFICACY OF THE VIBROMETER IN APPLYING VIBRATORY MASSAGE IN AURAL DISEASES


THE EFFICACY OF THE VIBROMETER IN APPLYING VIBRATORY MASSAGE IN AURAL DISEASES. SINCE presenting my paper before the American Institute, in June of last year on “Vibratory Motion as a Method of Massage in Aural Diseases,” I have been using an instrument specially devised for that purpose called the “vibrometer.” This instrument is in shape like a banjo, and has four strings stretched across its length resting on a bridge, which sets upon a diaphragm. On each side, elevated above the diaphragm and supported by posts, are two horizontal bars, which support the mechanical appliances used for producing the various vibratory motions.


SINCE presenting my paper before the American Institute, in June of last year on “Vibratory Motion as a Method of Massage in Aural Diseases,” I have been using an instrument specially devised for that purpose called the “vibrometer.” This instrument is in shape like a banjo, and has four strings stretched across its length resting on a bridge, which sets upon a diaphragm. On each side, elevated above the diaphragm and supported by posts, are two horizontal bars, which support the mechanical appliances used for producing the various vibratory motions. This consists in what is called a yoke, in which revolves a shaft connected with the electro-motor by pulley-wheels and a belt.

Behind the diaphragm is a shallow air-tight compartment, leading from which are rubber tubes that are inserted in the external auditory canal during treatment, consequently any vibratory motion of the diaphragm, which must necessarily be an inward and a corresponding outward movement, would be exactly reproduced upon the membrana tympani, as the confined air, not being able to escape, will undergo an alternate condensation and rarefication in the external auditory canal.

Every vibratory movement of the strings of the instrument is communicated to the diaphragm by means of the bridge upon which it rests. These strings by varying their tension and length can be regulated to give a high or low rate of vibration as desired, for instance, the heaviest string left at its original length adjusted to a slight tension may make about fifty vibratory motions to the second, while the highest string on the instrument adjusted to a high tension and clamped down to one-fourth its original length would probably make three thousand vibratory motions to the second.

In the centre of the diaphragm is an attachment which works on a lever, and when hit by the cam on the revolving shaft lifts the diaphragm to a considerable extent, causing a powerful effect on the membrana tympani. This attachment can be adjusted at four different leverages, which causes a modification or increase of its intensity and can be regulated at from one to twenty-five vibratory movements to the second. This is only used in very bad cases and for not more than five minutes continuously.

The instrument which I have been describing in an improvement on the first manufactured, and as far as I know, is the only one which offers the same facilities for applying this method of massage. The class of patients in my experience who are generally benefited from the first, are those in which the mucous membrane lining the tympanic cavity and Eustachian tubes is in a hypertrophic condition. The membrana tympani are depressed, opaque, and thickened. They usually complain of a stiffed sensation in the ears, with a great deal of tinnitus aurium, and that their hearing is worse during a cold.

In cases where the mucous membranes are atrophied with a large external auditory canal perfectly dry and Eustachian tubes patulous, and generally very little tinnitus, this or no other treatment has done very much good in the majority of cases, and in looking ever my records I find that only about five per cent. have been relieved, while in the before-mentioned cases the good results reach at least seventy-five per cent. In treating persons, I always select the rate of vibration which corresponds in pitch, if possible, to that caused by the diseased condition of the ears.

If there is no tinnitus to guide me, I find whether the patient can hear a high or low sound better; if it is a low sound, a high rate of vibration is used in treatment, and vice versa, A point which I would like to explain here is this: It is not necessary that the sound from the instrument should be of the same quality of the tinnitus experienced by the patient, but merely the same pitch. for instance, if a banjo, where one of the strings was adjusted when sounded to produce a certain note, and a musical instrument of any other kind, whose quality of tone was entirely different, was made to sound the same note in a room, the string on the banjo would vibrate in sympathy, which has been proven by experiment, any other note, no matter how loud, would have no effect.

Another point is in the way the strings of the vibrometer are set in motion. On the revolving shaft is a wheel projecting from which are metallic picks which hit the string it is adjusted over. It does not make any difference in the number of vibratory motions per second, whether the string is hit fast or slow, but at the time the string is first hit the intensity is greater than it is just before being hit again, and as the motion of the wheel is perfectly rhythmic, revolving so many times to the second, it has just as good an effect as if the intensity during the fraction of a second did not vary at all.

The idea of using vibratory motion, as I have said before, originated within my mind some years ago, and later put into practical operation, and as far as I know, was the first to lay before the profession in a scientific manner, this method of massage.

I have found that when two of the strings upon the vibrometer were regulated in such a way that when both were set in vibration at the same time, producing the sensation of a harmonious sound, the effect in some cases on the tinnitus was especially beneficial, relieving, where the various kinds of vibrations produced by a single string failed. Sub-acute cases of deafness, accompanied by tinnitus aurium, are quickly relieved, as the following case will illustrate:.

Mrs. M. Young, married lady, aet. 26, called at my office, April 1, 1893, complaining of partial deafness and tinnitus aurium. She had a stuffed sensation, or as if cotton had been packed in the external auditory canal. She says the tinnitus was so annoying as to prevent sleep. On examination, found considerable retraction of the membrana tympani, and hearing for the watch, on the right side five inches, on the left, seven inches. The Eustachian tube were partially closed, which made inflation somewhat difficult, giving slight relief. I used several of the vibrations on the different strings without immediate benefit.

April 4th.-She came again, and reported that no improvement had taken place. I again inflated her ears, after which she sat down to the vibrometer. The central attachment was used with considerable force continuously for four minutes, after which she declared that the tinnitus had entirely ceased in the right ear, and greatly modified in the left; the hearing for the watch had increased for both ears to fourteen inches, and the stuffed sensation had almost entirely disappeared.

On inspection of the membrana tympani, found them comparatively very slightly retracted. On April 8th, found improvement had continued, when the same treatment was used for three minutes; after which she declared herself completely relieved of the tinnitus and stuffed sensation, with hearing powerfully restored. Saw her again on April 13th, when she declared the good results from last treatment to have still continued.

I find that in the majority of cases, when the strings of the instrument are used it is only necessary to strike them lightly with the friction wheel. In vibrating the heavy string, I generally set the bridge back behind the central attachment, and adjusting the motor in such way that the belt is at a considerable tension, so that the pulley-wheel revolves slowly. I also generally use this adjustment when setting in motion two strings at one time.

The principle of this method of treatment embraces two essential features which to my mind makes this system of massage the only scientific one applicable to the membrana tympani and its associate sound-conducting parts. Message is the application of motion to disease, and its scientific administration consists of its application in a systematic manner. In applying massage in aural diseases, it is necessary to produce a to-and-fro movement of the membrana tympani, and, if possible, by a force which is harmless and at the same time effective. The vibrometer fulfils these conditions.

Any of the strings on the instrument that may be set in motion by the friction-wheel, will produce a certain number of vibratory movements to the second of time, and the movements of the central attachment are also measured. What could be more systematic than this? The motions of the membrana tympani were intended by nature to its vibratory, and as the vibrometer generates measured motion, and these motions are vibratory, theoretically we have a scientific and effective method of massage in aural diseases; and, as demonstrated practically by the use of the vibrometer, we have in fact a great scientific advance over all previous methods.

Since the introduction of this treatment in aural diseases, it makes possible a more or less benefit in cases of deafness heretofore considered hopeless, and has opened up the field for the treatment of aural diseases to such an extent that the number of deaf patients seeking relief at the aurist’s hands will at least double itself.

DISCUSSION.

H.C. HOUGHTON, M.D.: Dr. Garey’s admirable paper gives us the description of the vibrometer, an instrument devised under his personal direction and inspection, for the purpose of applying massage to the ear. It is the only instrument of the kind on the market, so far as I am aware, and after a somewhat prolonged use of it, I am prepared to recommend the latest production of the vibrometer company.

Henry F. Garey