US2458959A - Portable device for continuous pressure politzerization - Google Patents

Description

1949- o. E. REYNOLDS ET AL 2,

PORTABLE DEVICE FOR CONTINUOUS PRESSURE POLITZERIZATION Filed Dec. 27, 1945 2 Sheets-Sheet 1 FIG. 1..

awe/whet: ORR E.RYNOLDS LOYAL GAGOFF Jan. 11, 1949. Q E. REYNOLDS ET AL 2,458,959

PORTABLE DEVICE FOR CONTINUOUS PRESSURE POLITZERIZATION Filed Dec. 2'7, 1945 2-Sheets-Sheet 2 ORR E.REYNOLDS LoYAL Q QFP Patented Jan. 11, 1949 clinic E ronTABLsnEvIoE FOI CONTINUOUS PRESSURE roLrrz-enrzn'rrou ()rr E. Reynolds, Washington, D. 0., and I Loyal G. Golf, Midway Island, Va. p

Application December 27, ism-smal ish: 637,408"

This invention. relates to politzerization and. more particularly to a method and apparatus for continuous pressure politzerization.

The. phenomenon" of ear: pain occurring as a result of. alterations in externallbarometric pressure has been known. and recognizedsince the beginnings of aviation. However, the. phenomenonwas. not fully described until 1937, when Armstrong. and. Helm published. their work The Efiect of Flight on the Middle Ear, on the anatomical and. physiological. causes ofthe disorder which they named aero-otitis media (an. inflammation of. the middle ear cavity caused by gas forces). A "description of the anatomical and. physiological etiology of this disease may be found in the above reference.

This phenomenon is extremely common in aviation in the case of aviators" both when suffering from colds and when forcedtoi descend: at high rates of speed, and to air passengers who may have structural abnormalities. These abnormalities include dental malocclusiomor scar tissue in the region of the ostium or over-growth of lymphoid tissue. Likewise, the persons may be suffering from upper respiratory tract infections, such as head colds, 01" they maysimplybe untrained in the-methods of clearing the'ears during barometric pressure changes. Prophylactic: measures such as indoctrinationrin efficient techniques for opening the Eustachian tube,. or by use of. vasodilator substances such as ephe-- drinze, neosynephrine, benzidrene,. and the like, maybe of great value: in preventing these symptoms. However, once a block of suflicient degree is reached, only two means are available. for relief. The first; and most obvious, isreascent until the pressure differential is reduced enough to: permit equalization. Thisv 'means', however, is impractical in the. great majority of cases. The other means is politzerizationfl The original Politzer method, developed by Adam Politzer, an Austrian? otologist, before aviation was sufficiently'developed to'" be a factor in ear maladies, consists of inflation of the Eustachian tube and middle ear by forcing air into the nasal" cavity through a nose piece by manually collapsing a pear shaped rubber bag (similar to a squeeze bulb) at the instant the patient swallows; This original Politzer method allows application of a momentary burst of high pressure at a time when the muscles of' the Eustachian tube are attempting to open it and in repeated attempts often produces relief. How ever,- this original method isdisa'dvantageous in that substantially perfect synchronization is re- 12 Claims.

quired in the efiorts'oi? boththe operator'and the? patient. Furthermore, there is no safety means such as arelief valve or pressure gauge,. and-consequently the operator .must be experr; ienced and performthe technique with caution.

in order to employ: only safe pressures.

Modifications of this original: method: havebeen' made by..the use of an external source of compressed air orgas: (from .30 to: 1000 lbs. per inch.) derived-eitheriromv a stationary-air pump or pressure cylinder which: necessitates the use of a reducing valve to control, the? pressure" within:

' pressure and swallowing, required with the instantaneoustechnique; 'Ilhese prior continuous pressure methods; while surmounting the prob lem in. theory, have not been completely success- .ful, however, and have been unsatisfactory on several counts; In: the first place relatively expensive'control equipmentis necessary to prevent the application ofzexcessive pressures which might cause permanent damage to thetissues'of the middle ear; and ear drum" of the patient.

fiecondlmth'e us'e' ofs gas, such as oxygen, is undesirable due to -the factthat it-is gradually absorbed through-the tissuesof the ear leaving the patient in 'th'e" same conditionas before politzerizati'on. Furthermore, there arenumerous phys-- ical disadvantages, such as expense of equipmentlackof portability'whic'h prevents it from i being: carried by a physician in' hisrhand-bag,

difficultyandexpense of maintenance and the I danger associated-with the handling and controlling of high pressure gases. The recharging of the cylinders :would "ber'a major problenr in some localities. Furthermore;.=most gases under pressure must be handled carefully to prevent an explosionofthebylindler; The use of a cylinder. necessitates the use of a reducing v'alve which creates an add-ition'al expense and another possible source of mechanical iailure. Should the reducing valvedai'l to" function properly, and the full pressure from "thecylin'der be injected into the patients oral' nasal' cavity, rupture' of the ear drum'cculd' easily result. I 1

Havinginamind' the above and" other "defects 0 the prior art methods and apparatus, it is an object of-this invention to provide a method of and apparatusqfor practicing continuous re politzerizatibn that-is completely ieffec' mospheric air at low pressure, suchas a small hand pump, adapted to supply air to a pressure reservoir, which also acts as a surge tank, wherein the pressure is controlled and-maintained under a given maximum by a'suit'able safety relief valve or mercury manometer con structed to indicate pressure as well as to relieve pressure in the surgetank. An orificial applicator (preferably, but not necessarily, a nasal applicator) is in communication with the surge tank and consequently is adapted to supply a continuous pressurefiof atmospheric air that is constantly maintained below a pressure that might be injurious to the patient. It will be seen that in actual practice the applicator or nose piece may be placed in a nostril, ipsolateral to the ear blo'ck,.ar1d the other. nostril closed with the finger. In view of the fact that a constant or continuous pressure is being delivered through the nostril to the oral cavity, the patient may swallow to exercise the Eustachian tube at any time during the administration of the pressure and as saidpressureis built-up from zero to the maximum safe pressure, whereupon different degrees 'of safe pressure of ;air is admitted to the middle ear cavity until the patient experiences immediate relief. Thus, with the present invention absolute safety to the patient is assured and it does not require synchronization between the swallow of the patient. with the momentary blastor repeated blasts as in the original Pulitzer method.

The novel features that are considered characteristic of this invention are set forthwith particularity in the appended claims. .The invention itself, however, bothas to its organization and its method of operation, together with additional objects and advantages thereof, will best be understood'from the following de'scrip-.-

tion of specific embodiments, when read in connection with the accompanying drawings, wherein like reference characters indicate like parts throughout, and in which:

. Figure 1 is a front view in elevation of the preferred embodiment of the present politzerizer;

- Figure 2 is a front view in elevation of a modified structure particularly adapted for portability;

Figure 3 is a front view in elevation of a sphygmomanometer adapted to operate as a politzerizer;

Figure 4 is an exploded view, partially in crosssection, of the adaptor employed in the structure shown in Figure 3; and

Figure 5 is a fragmentary view in cross-section showing the safety valve employed in the structure shown in Figure 2.

7 According to one modification of the apparatus, which is particularly suitable for general use, reference being made to ,Fig; 1 of the drawings, the instrument may comprise a hand pump l, in the form of an ordinary collapsible bulb,

which is provided at or adjacent itsintake end with acheck valve 2and at or adjacent its dis- 7 tube.

charge end a check valve 2a, these check valves being unidirectional, and the bulb is connected by a tube 3 to a T fitting 4 that is connected by a tube 5 to an orificial applicator l. The T fitting may also be connected by a tube 8 to an inlet 9 of a pressure surge tank Ill. The check valve 2 admits air into the hand bulb i when the latter is extending and closes when the latter is collapsed while the check valve 2a opens when the bulb is collapsed and closes when being inflated or extended. The surge tank i9 is in communication, through outlet [2 and tube l3, with manometer [4. The manometer M is shown in Fig. l as being of the mercury type which comprises a U-shaped tube containing a predetermined quantity of mercury. As a safety feature for use in the event of transporting the apparatus, and preventing mercury loss from the tube 14, the upper extremities of the mercury manometer are fitted with stop-cocks i 5 which may be closed to trap the mercury within the The outlet end of the manometer i4 is connected by a tube Hi to the inlet I! of a trap l8 that is provided with a vent IS. A scale 20 is positioned adjacent the outlet reach of the manometer tube M, the lower end of the scale in being positioned substantially level with the surface of the mercury when it is in position of rest. As a matter of convenience the aDDtratus may be attached, as by clips 2|, to a supporting board 22 that is mounted in a generally upright position on a base 23.

A hand source of pressure, such as the hand bulb l, is preferred to operate the instrument as it does not require the use of elaborate mechanical appliances and affords the greatest economy, efficiency and dependability.

Besides serving in the capacity of furnishing steady, even pressure, the pressure surge tank I0 is located between the orificial applicator 'l and the mercury manometer l4 and thereby serves in a safety capacity. Should the patient suddenly gasp. and subject the manometer It to excessive reverse pressure, the mercury would be withdrawn from the manometer. By the present construction, however, the mercury will be retained in the surge tank It and not inhaled by the -patient. The surge tank H1 is preferably of 500 cc. capacity, which is suificient to deliver a constant flow of air in the necessary quantity for efficient performance of the instrument but, on'the other hand, is small enough to preclude bulkiness. The capacity of the surge tank It may vary, depending upon the output of the hand pump or bulb l and may vary between 200 cc. to 1000 cc. Any surge tank, however, above 1000 cc. restricts the portability of the device and, therefore would limit one of the advantages of the present device.

The U-column. mercury manometer i4 is calibrated in millimeters of mercury pressure and performs the dual functions of pressure determination and acting as a relief safety valve. The safety valve action is derived by the proper adjustment of the mercury column so that the mercury will be entirely displaced to the outlet arm of the manometer before a dangerously high maximum pressure is developed, thereby permitting the excess pressure to bubble through the mercury; Otherwise the excess pressure might be forced into the patients oral-nasal cavity, causing discomfort, if not injury. The accuracy of the mercury type of gauge is such that it is used to check and calibrate all mechanical gauges. It also has advantages over a mechanical gauge in that it contains: nothing *to' break down or" get out 'of'adj-ustnienu; andflis imore;

economical. l 1

The calibration of the manometer Mg by the scale- 20,- is in mm. Hg (millimeters of: mercury), and, as a matter of convenience; is divided into three sections identified as safe,' caution,

and extreme caution, which ar'e" colored"re spectively green, yellow an'djredi' The-fsafe or' green area is 23' mm. high, the caution or yel low is 27 mm. and theextreme-caution or red 50 mm. 111- determin-ingthe pressure used. the reading must be doubled as the difference in the mercury columns is twice the amount 'of' rise in theside calibrated. The sum of the green and eredby many authorities'to be the pressure for politzerization. I w v In some few persistent cases, however, pres-- sures up to and including 200 'nimHg have been used with excellent results and no undesirable eifects. For this reason, the instrument is ad'- justed to what is presently andgenerally considerecl safe-pressure delii erance'of- 20Q mm. of'

mercury, although this pressure may be} that which is physiologicallytolerable to the patient.

In' the majority of cases, however, 75 to' 1'00- of mercury is sufiicient for satisfactory politzer f ization. The manometer M-isadjusted so that pressurein excess of the predetermined maxi mum cannot be used through regulation'of the height of the mercury column when it is at rest.

The height. of'the mercurycolumn issuch that when the maximum pressure is reach'ed allthef mercury is transferred to the calibrated arm of the manometerallowing air-t0 bubble through it". thus maintaining a pressure not greater than that which has been predetermined.

In the use of this instrument thG'SllbjCfiOI patient is given a mouth full of water andf'is instructed to take a deep breath andhold it.

The nose piece 1 is placed in the nostrilof the" patient, ipsolateral tothe earblock and the other nostril closed with'th'e finger with h-ismouth closed, and the hand bulb- I is actuated repeat edly until the desired pressure is read Ion-the" scale 28* of the instrument, at which time the subject is told to swallow and immediate relief follows. In mild cases, the patient will, or win he told to, swallow when the pressure is about 7-5 mm-.; and, if relief is'nct experienced, the bulb will befurther actuated to deliver a continuouspressure to the patient until about 100- mm. is registered, when swallowing process should be repeated, and so on, until relief is; experienced or until the maximum safety limit of pressure has been reached. In swallowing, the throat muscles are contracted so that the openings to' the'middle ear cavity are stretched and allow the air, which is under constant or continuous and" safe pressure, to enter freely.

A. simplified and more compact structure; as

shown in Fig. 2, may be provided in portable form, in order to accommodate morewidespread' application of the present improvedmethod. In Fig. 2, a hand bulb l provided withche'ck- valves 2 and 2a, is connected by atube' 30 to a surge tank which is in the form or a portable box 31' forming an airtight chamber. An aneroid ma nometer 32 or other suitable pressure gauge'is' positioned in one wall of the box =3l,- the di'al 33 of the manometer being visible through a sealed aperture 34 in the box wall. The manometer 32: is in communication with the interior cal 'body fl thatis 'inturnedatits lower edges to yellow areas is 50 mm. which equals an actual pressure of100 mm; mercury. This is consid optimumf or the their we thati -the new: is-re ponsiv I the charm ber. The-tube 30* is -I connected withinthe box to 'ahd indi'cates the -p ifessure w h W to a tube '35 having the nasal nozzle or other type-of orificial-akpplicator "I at the other end thereof -A safety or relief *valve -36--i's' seated in one.-'wal1 -of the box 31 and iscommunication with- --the "cha nber thereih-in order to preclude the development. of pressures abovethe desiredmaxi-mum.

-"12he'-'relief valve 3B--i'sshown-indetail in Fig. 5.-

It -i's' or enow typ'eand may comprise a cylindriprevid'eshoulders 38 andaperture 39. Crossbarsqw-extend diametrically across the top of the bod y; to f orm afse'at'for a helical spring-M which normally seatsa valve 42 against the shoulders- 38. The 'b'ody 3'!- maybe seated in a walI- of thebox-313many" desired manner and isshown: as-havi'ng a threaded portion 43' adapted to cooperate with a threaded aperture Minthe wall-' of thebox 3 F; 'Will be understood that All prises" an air" tight "tubular bag (or cuff) the tensi'o'n ofthe spring 4 F maybe selected to resist pressures up to a predetermined maximum degree hereinbefore specified; Whenthe pressure exceeds the-desired limit thevalve' 42 is v forced upwardly and compresses the spring i i whereupon the air escapes-through the aperture 39-past valve diz through the body 3-! and past subject to "easy breakage and isnot required to be retained: in arr" upright -position during operation; as-=is' theacase with the apparatus in Fig.

1-. Onthe other hand; it"necessitates both a manometer of the mechanical type and a separate safetlyvalveto replace the mercury manometer. Nevertheless; this instrument affords an"easy-a"ndpractic'al application of the present improvedmethod under-all circumstances.

Stil'l another' era-an er application of the pres ent method ci -continuous pressurepolitzeriza-' tionlm'aybe efiec'ted by the ada'ption of the sphygmomanometen f0r=- this purpose. The sphygmomanome'ter; which" is used for 'determining blood pressure; i'sone of the basic pieces of a physicians" equipment. Accordingly, by adapting? this instrument,- continuous pressure v politzeri'zation may be univ'ersallypracticed. 'As

shown in Fig. 3, the sphygmomanometer com- 5t whi'ch i's usually made of rubberized "cloth. The bag -is -riormal1y provided with an extended tailpiece 52 or laterallyextending tapes 53 for securing it around a patients. arm. I A pressure gaug' 'e 54l i's connected to the-bag 50 by a tube 55, and a-h'an'd bulb- I having valves 2, 2a is con- In order to-a'dapt-thisinstrument for the practice 0f-pb1itzerizationthe tube 56 is cut and the severed'ends connected to'; the cross-arms of a- T section 4. The branch-arm of the T section dis connected by atubeito a nozzle such as the nasal applicator l in a manner identical to that shown'in Fig; 1. By this arrangement the bag 50perfo'rmsthe function of a surge tank wherein pressure may lee-developed bythe hand bulb i to the desired degreeas indicated by the gauge 54'. For most eificient use,-it is preferred that thebag 50 ,isrolled loosely andsecuredin-this posttion by the-tapes 53, orotherappropriate fasteners attached to tail- -piece -52, so as torestrict the volume capacityof the reservoir or surge tank formed by bag 50 to about 500 cc. or the capacity of about a pint. This pressure may-thenbe expended continuously through the nasal applicator l to effect politzerization in the manner: as

previously described. This adaptation: has the distinct advantage of providing the most inexpensive and universally available meansforeffecting politzerization. The sphygmomanometer shown in Fig. 3 isnot provided with a safety pressure relief valve, although this feature may be supplied by the use of ananeroidmanometer which are now commercially available. and designed to relieve pressure above a predetermined maximum. However," whether the safety valve feature is employed in sphygmomanometers is not critically dangerous in view of the fact that sphygmomanometers are used only by experienced doctors or technicians who are accustomed to regulating pressure within the instrument through the mediumof'the pressure gauge 54.

The T section 4 is preferably capable of dismemberment so that it may likewise be employed as a straight section. This construction is particularly desirable so that a sphygmomanometer maybe employed for its original purpose and likewise adapted as a politzerizer. As shown in Fig. 4, the section 4 may comprise a basic T member 60 having a tapered female element 6| in one cross-arm 62, and a tapered male element 63 on the other cross-arm 64. The branch arm 65 of the member 60 may be formed'as a plug with its outer surfaces 66. corrugated so as to be inserted and retained within the end ofvthe tube 5. A passageway 51 extends through the cross-arms 62 and 64 and forms a junctionwith apassage 68 which extends through branch-arm 65 and is in communication with the interior of tube 5. I 1;

Two plugs are arranged to beinserted within the severed ends of the tube 55', and these plugs are adapted to cooperate either with themselves,

or with the T member 60. Oneplug I having a passage H therethrough, is provided with a corrugated portion 12 to be seated within-one of the severed ends of the tube 56. The plug in also has a tapered male element l?) adapted to cooperate with a corresponding-female element. likewise has a corrugated portion 11 which is adapted to be seated in the other of the severed ends of the tube 56. The plug 15 is provided with a tapered female element l8. foregoing description, it will be seen that the male member 13 of the plug may be inserted within the female member 18 of the plug 15,

whereupon the tube 56 is unified and the sphygmomanometer may be employed as such. 0n the other hand, themale element 13 of; the plug 10 may be seated within the female element 6! of the T member BEL-and the female element 18 of the plug 15 may be seated over the male element 63 of the T member 60, whereupon the T section 4 is assembled and the apparatus is adapted as a politzerizer.

The present invention has advantages over all other continuous pressure politzerizers now in use. In the continuous pressure politzerizer using the oxygen equipment in an airplane or low pressure chamber as a sourceof pressure supply, two great dangers are evident." The greatest danger is the possibility of using excessive pressure caused The other plug :15, having a passage 16;

In view of the by mechanical failure of the reducing valve or improper bleeding of the pressure which might result in permanent damage to the tissues of the middle ear or ear drum. The other great disadvantage is the inflation of the middle ear cavity with pure oxygen. Within a few hours following descentfrom high altitudes of a person whose middle ear cavity has been inflated with pure oxygen, the oxygen will be absorbed through the tissues of the middle ear cavity leaving the patient in the same condition as before politzerization; If; this oxygen i absorbed from the middle ear cavity during sleep, the reduced pressure may cause-a serum exudate and even hemorrhage into the cavity producing a condition known as otitis mediaacute, with varying degrees of severity. In the present politzerization method and apparatus the above conditions are impossible because the middle ear cavity is always ventilated with normal atmospheric air and the pressure is so regulated that there is no danger of tissue damage, over inflation, or patient discomfort. 7

Another type of continuous pressure politzerlzer in use at the present time is the one installed in low pressure chambers and utilizing the pressure differential between the simulated altitude inside the chamber and the ground level pressure surrounding the chamber for its operation. The great disadvantage of this instrument is the extreme variation in the pressure differential. At high altitudes, if the continuous pressure is applied for even a short period of time. a suflicient accumulated pressure may be built up in the patients oral-nasal cavity to be harmful to the tissues of the middle ear cavity and ear drum if politzerization is accomplished. Patients being politzerized for the first time with this instrument are often difiicult to treat because of the psychological efiect of the hissing noise this instrument makes. Frequently, a number of attempts have to be made in order to accomplish successful politzerization. -At low altitudes the pressure differential is so reduced that the instrument is not efficient. -The wide range of pressures, running from 0 to approximately 500 mm. mercury pressure encountered in moving between sea level and 30,000 feet altitude, requires considerable variation in the technique of the application of this instrument and therefore, much experience on the part of the operator. In the politzerizer of this invention the pressure source is always constant so that no variation of technique need be employed, regardless of altitude. This simplicity of operation makes its use by inexperienced persons safe and easy. Also, the instrument is quiet and has nothing in its appearance to cause apprehension on the part of the; patient. Therefore, there is no patient psychology factor to overcome.

During descent from high altitudes a patient mayaccomplish politzerization himself through employment of the Valsalva maneuver, which consists in the patient holding his nose and synchronizing a downward movement of his shoulders anda forward movement of his head with a forceable exhalation allowing his cheeks to puff and throat to relax, while breathing oxygen. By the use of this maneuver there is danger that the patient may inflate his middle ear cavity with a suflicient concentration of oxygen to cause a delayed aero otitis media acute through the absorption'of this oxygen. If a'pressure difierential instrument isall that is available to treat the'patient, he must betaken to a simulated altitude great enough to produce a pressure difapparatus have se'vera'l distinct advantages over 'the prior art. The safety feature is evident in the fact' that it is impossible to use pressures which would be harmful to a:patient.' This means that should emergency. require the use of this instrument by an unskilled person, :sataeflicientw relief could be easily effected. The construction and operation oi'z'this instrument are such that its original cost would make it available to all persons having use for the instrument. There is no operating expense. The simplicity and the operation of the instrument make its-use such that any operator may safelyuse it after'a minimum of instru'ction 'and/ or experience. The portability of this instrument lends itself to the use by gen- ;y eralpractitioners whomay-be required to perfoimi;

politzerization in .placesother than their offices and operating rooms. Theforegoing features of this'instrument clearly demonstrate the ease of its operation which is onemof "its greatest advantages.

2 Although certain specific embodiments of the invention are shown and described, it is quite obvious that many modifications thereof are possible. The invention, therefore, is not to be restricted except insofar as is necessitated by the prior art and by the spirit of the appended claims.

That which is claimed, as new, is: v

1. A portable politzerizer apparatus for relieving total or partial evacuation of the middle ear and which comprises a manually activated device for producing pressure, a surge tank receiving the pressure developed by said device, a mercury manometer for indicating and relieving above a predetermined degree the pressure within said surge tank, and a nozzle in communication with said surge tank for continuously releasing pressure therefrom.

2. A politzerizer which comprises a surge tankof about 500 cc. capacity, a hand bulb for pumping air into said surge tank, a mercury manometer for indicating and controlling the air pressure within said surge tank to a predetermined maximum, and an orificial applicator in communication with said surge tank for continuously re- 5 leasing air under pressure therefrom.

3. A politzerizer which comprises a surge tank of about 500 cc. capacity, a hand bulb for pumping air into said surge tank, 'a, mercury manometer for indicating the air pressure within said surge tank and for releasin pressure above that which is physiologically tolerable (in the order of magnitude of 200 mm. Hg) therefrom, and an orificial applicator in communication with said surge tank for continuously releasing air under pressure therefrom.

4. A politzerizer which comprises a surge tank, a hand bulb for pumping air into said surge tank and in communication with said surge tank by means of a tube, a T section in said tube and having two of its arms connected, respectively, with said bulb and surge tank, an orificial applicator connected to the third of said arms of said T section to continuously release air under pressure from said tube, and a manometer in direct communication with said surge tank for indicating the air pressure therein.

5. A politzerizer which comprises a surge tank, a hand bulb for pumping air into said surge tank and in communication with said surge tank-by means of a tube, and a T section in said tube,

ar a m i an orificial applicator connected .toione'arm bf 'said 'T section and in 'c'omiriunication: with said.v

surge tank to release air underpressure therefrom, and a mercury: manometerin"communicationwith '6. Apolitzerizer-which comprise ta surge tank, andsaxhand bulb for-pumping "air; into said surge tankand in communication with said surge tank byirneans ofsa tube, ia T section in said tube and having two for its arms connected, respectively,

.p'lic'ator' connected to the third of said "arms of .;said section to release fair under .pr'essure trom said tube, 1 means r-inclu'ding a manome'terand safetypressureiexhaust having direct communication with said, surge tank for 'indicatingthe air pressure therein and for releasing air-therefrom e which is in excess of a predeterminedmaximum.

. :.7.'ln as'phygmomanometer, includih'g a pre's "sure bag, havingfia' inanometer in communication therewith and a hand bulb connected thereto by a tube, the improvement comprising the said tube connection being'separable, and a T section having one arm connected to an applicator for an orifice in the human head and its other arms being removably connected to said separable ends,

respectively, of said tube, whereby thesphygmomanometer may be employed as a portable .politzerizer.

8. A tube fitting for use with a sphygmomanometer to adapt the latter as a politzerizer, said fitting comprising a T section having communicating passagesextending through its arms, two

of the arms carrying separable extensions having passages therethrough, means on said extensions and the other of said arms of said section for receiving and retaining tubing thereto, and inter,- engageable means on said extensions for joining the latter together with their passages in communication, when said extensions are separated from said T section. 1

9. A politzerizer which comprises a surge tank, a hand bulb for pumpingair into said surge tank and in communication with said surge tank by means of a tube, said tube being severed to receive a jointed T section, said T section including two plug memberswhich are inserted in the severed ends of said tube, respectively, and a T member having a plug on its branch-arm, said plug members being adapted to be releasably joined to form a straight section or releasably joined with respective cross-arms of the T member to form a T section, an orificial applicator connected to the branch-arm plug of said T section and thereby in communication with said surge tank to release in communication with said surge tank for indicating the air pressure therein.

10. An apparatus ior relieving total or partial evacuation of the middle ear and which comprises a device for producing pressure, a surge tank for retaining pressure developed by said device, an orificial applicator in communication with said surge tank for releasing air under pressure therefrom, and a mercury manometer for indicating the pressure of the air released by said applicator and for relieving the pressure within said surge tank when it exceeds a predetermined maximum, said surge tank being'located between said applicator and said mercury manometer whereby said tank will trap the mercury if it is withdrawn 'from the manometer by atreverse pressure and .thereby prevent theexpulsion of the mercury 'tude,-,when the pressure in the surge tank has built ,up to any predetermined working pressure.

12. A portable politzerizer apparatus for relieving total or partial evacuation of the middle ear and-which consists of a manually actuatable air pressure producing device, a surge tank receiving the air pressure developed by said device, an orificial applicator connected inthe line between said air pressure producing device and said tank,

12" and a pressure responsive means in communication with the surge tank, other than thru the line of said applicator, for indicating the pressure within the surge tank and releasing from the surge tank a pressure above a predetermined maximum, whereby continuous air pressure may be emitted through the applicator without pressure fluctuations of wide amplitude, when the pressure in the surge tank has built up to any predetermined working pressure.

ORR E. REYNOLDS.

LOYAL G. GOFF.

REFERENCES CITED I The following referenees are of record in the file of this patent:

UNITED STATES PATENTS Number Name Date 1,433,679 Fisk Oct. 31, 1922 FOREIGN PATENTS Number Country Date 765,238 France Mar. 19, 1934

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