Abstract: An oral suction device includes a suction catheter having a suction portion at a first end, a shell surrounding the suction portion, and a suction tubing connector on a second end opposite the first end. The shell includes a hydrogel.

Abstract: A laryngeal mask apparatus includes a mask portion, a breathing tube and a suction tube. The suction tube is adapted for connection to a suction-producing device. The suction tube further includes suction ports that suck fluids and secretions from the patient's hypopharyngeal region when suction is created within the interior of the suction tube. The breathing tube is adapted for connection to a ventilating system. Air flows through the breathing tube and into the mask portion. A capillary tube is positioned within the interior of the suction tube. When the mask portion is positioned within a patient's throat and suction is created within interior of the suction tube, the suction ports suck the fluids and secretions in the patient's hypopharyngeal region. At the same time, the suction tube and capillary tube cooperate to provide a stream of air that decreases the direct suction forces on the mucosa of the patient's throat that are caused by the suction ports.

Abstract: A patient interface is adapted to elastically deflect, under the application of a force, from an un-deflected configuration to a deflected configuration, and permanently deform when in the deflected configuration by mechanical creep deformation to a formed configuration.

Abstract: A directional lock or a headgear or interface assembly comprising one or more directional locks that include a catch arrangement for initiating or assisting in movement of a lock member of the direction lock. In some configurations, the catch arrangement assists movement of the lock member in only a portion of a range of travel of the lock member. In some configurations, the directional lock comprises a housing and a sleeve and the catch arrangement comprises a catch arm carried by the sleeve. The catch arm includes a catch end that contacts the lock member, which can be a lock washer in some configurations.

Abstract: This invention relates to a headgear comprising a semi-rigid frame engageable with the head of a user and a releasable connection system for releasable connection with a user interface, wherein the frame extends generally about a rear region of a user's head, generally about an upper region of a user's head, and generally about an ear or both ears of a user.

Abstract: A method and apparatus to deliver a variable flow of oxygen to a patient. The apparatus may include a flow control valve, a pressure sensor to detect a patient's breathing pressure and ambient pressure, an oxygen flow analyzer to measure oxygen flow to the patient, and a processor to analyze the breathing pressure values, ambient pressure value, and oxygen flow rate values and to determine when a patient is inhaling. When the processor determines the patient is inhaling, the processor calculates an optimal oxygen flow rate to deliver to a patient, which may depend on a pre-selected flow rate and an oxygen backlog, and the processor sends a signal to the flow control valve to deliver the optimal oxygen flow rate to the patient.

Abstract: A connecting valve structure and an anesthetic filling system are provided. When a valve core assembly is in the open state, a pipe and a filling port are in seal fit, besides, the connecting ring, the seal pipe, and the drug guiding pipe are integrated as a whole, when the seal pipe is inserted into or pulled out of the filling port of the evaporator, no BHT exudate occurs. In addition, an inner pipe wall of the seal pipe, a surface of the connecting ring facing towards a first pipe end, and an outer pipe wall of the drug guiding pipe opposite to the seal pipe together form a pressure stabilizing groove which is used to equilibrate pressure in the container and the evaporator during the open state.

Abstract: A system for delivering a fluid to a Eustachian tube (ET) of a patient includes a guide member and a tubular member. The guide member includes a shaft having a proximal portion, a distal portion, and a bend at the distal portion. The bend is configured to provide access to an opening in the ET. The system further includes a tubular member comprising a proximal end, a distal end, and a lumen extending therebetween. The tubular member is sized to fit within the ET. One or both of the tubular member and the guide member comprises a first stop member configured to engage the other of the tubular member or the guide member. The first stop member is configured to restrict a distal advancement of the tubular member relative to the guide member.

Abstract: At least two vertically-oriented lighting columns are respectively arranged on opposite lateral sides of a space that is at least partially enclosed, so as to be perceptible within a viewer's peripheral vision without obstructing or otherwise interfering with the viewer's primary field of focus. The structure that encloses the space defines a horizontal reference. A sensor detects angular movement of the structure, such as roll and/or pitch, and a controller illuminates points on the first and second lighting columns to define an angle with respect to the horizontal reference, which varies inversely relative to the sensed angle of movement. A virtual horizon represented by the defined angle provides orientation for the viewer, to reduce the likelihood of motion sickness.

Abstract: Methods of modifying the luminal profile of a body vessel are described. An example method comprises advancing a cannula out of the distal end of a catheter disposed within the lumen of a body vessel of an animal and toward a target site on the wall of the body vessel; passing contrast dye through the cannula toward the target site; simultaneously continuing the advancing and passing until the distal end of the cannula punctures the inner layer of the wall of the body vessel at the target site; and passing a bulking agent through the cannula and into a space between connective tissue layers surrounding the vessel wall at the target site. Medical devices, medical device assemblies, and kits are also described.

Abstract: Devices and methods for delivering fluid to the nasal cavity that include a delivery tube and cap configured to be connected to a container that houses the fluid. The delivery tube includes an inner cannula that is positioned within an outer cannula. Each of the cannulas includes a first outlet with one or more openings aligned along a first lateral section and a second outlet with one or more openings aligned along a second lateral section. The cap is configured to secure the delivery tube to the container. The delivery tube and cap are configured to provide relative axial movement between the cannulas. The cannulas are positionable between a first axial position that aligns the first outlets along the first lateral section of the delivery tube to deliver the fluid to a first portion of the nasal cavity, and a second axial position that aligns the second outlets along the second lateral section to deliver fluid to a second portion of the nasal cavity.

Abstract: Representative embodiments of the present invention provide for novel, minimally invasive implantable devices and methods for targeted tissue drug delivery of cardiovascular drugs.

Abstract: An inner catheter is disclosed, which includes an elongated inner shaft to be inserted into a blood vessel; and a hub connected to a proximal end of the inner shaft. The inner shaft forms a first shape at least a part of which is wound in a state where the inner shaft is suspended in a gravity direction, and forms a second shape at least a part of which is wound and in which a length of the inner shaft along the gravity direction is shorter than a length of the inner shaft along the gravity direction in the first shape in a state where the inner shaft is placed on a flat reference plane perpendicular to the gravity direction.

Abstract: A balloon catheter for use with a guidewire includes an elongated, tubular shaft extending in a longitudinal direction, said shaft having a proximal end and a distal end. An inflatable balloon is connected to the distal end of the shaft, the balloon including a working surface. A radiopaque identifier is provided for identifying the working surface. A receiver adjacent the proximal end of the shaft is adapted for allowing the shaft to move relative to the receiver in at least the longitudinal direction.

Abstract: A catheter manifold device includes one or more inlet ports and a discharge port. Each port has a housing with a height. Each port also includes a fitting with a height that is less than the housing height. The fitting for each port is concealed from contamination within the port housing. The catheter manifold device also includes a port channel extending from the inlet fitting to the discharge port. Where the catheter manifold has more than one inlet port, each inlet port has a channel. The channel of additional inlet ports may extend from the additional inlet port fitting, to the first port channel, and then to the discharge port. The fittings of the catheter manifold device may be connected to various external devices to protect the fittings or to allow the administration of fluids to a patient.

Abstract: A compact catheter assembly and methods of making such a catheter are disclosed. The catheter assembly incudes a receiver and a catheter sub-assembly. The catheter sub-assembly includes a gripping member and a catheter tube carried by the gripping member.

Abstract: Disclosed herein are steerable catheter assemblies and methods of steering catheters that utilize driver and follower mechanisms to accomplish independent control of catheter flex magnitude and catheter flex direction. Some embodiments include a catheter with a first pull wire and a second pull wire that flex the catheter, a control handle coupled to the catheter, a first follower connected to the first pull wire, a second follower connected to the second pull wire, and a driver disposed in the control handle and coupled to the first and second followers. The rotation of the driver coupled to the control handle moves the first and second followers in opposite directions, and axial movement of the driver moves the first and second followers in the same direction.

Abstract: Disclosed herein are steerable catheter assemblies and methods of steering catheters. Some embodiments include a catheter with first and second oppositely disposed pull wires and third and fourth oppositely disposed pull wires that flex the catheter, a control handle coupled to the catheter, a first follower connected to the first pull wire, a second follower connected to the second pull wire, a first driver coupled to the control handle and coupled to the first and second followers, a third follower connected to the third pull wire, a fourth follower connected to the fourth pull wire, and a second driver coupled to the control handle and coupled to the third and fourth followers. Rotation of the first driver moves the first and second followers in opposite directions. Rotation of the second driver moves the third and fourth followers in opposite directions.

Abstract: The needle-sized surgical tools used in arthroscopy, otolaryngology, and other surgical fields could become even more valuable to surgeons if endowed with the ability to navigate around sharp corners to manipulate or visualize tissue. A needle-sized bendable joint design that grants this ability. It can be easily interfaced with manual tools or concentric tube robots and is straightforward and inexpensive to manufacture. The bendable joint includes of a nitinol tube with several asymmetric cutouts, actuated by a tendon.

Abstract: A catheter steering assembly for steering a sheath catheter of an intravascular catheter system includes a first pull wire, a steering member, a first drive member, and a first pulley gear. The first pull wire is connected to the sheath catheter. The steering member rotates about an axis. The first drive member has a first drive member proximal end and a first drive member distal end. The first drive member distal end engages the steering member so that rotation of the steering member rotates the first drive member. The first pulley gear is coupled to the first pull wire. The first pulley gear engages the first drive member proximal end so that rotation of the first drive member rotates the first pulley gear and moves the first pull wire in a direction that is substantially parallel to the axis to articulate the sheath catheter.

Abstract: The present disclosure provides a means of holding, securing, or self-locking an actuating mechanism, such as a plunger-type or slide-type actuating mechanism, on a medical device having a deflected distal region using pinch points without the need for a secondary restraining or locking mechanism within the medical device. The present disclosure also provides a means to reduce the force experienced by a user during the deflection of a medical device such that use fatigue is lessened or eliminated. Various embodiments of the present disclosure are set forth herein.

Abstract: A full-surround contact antimicrobial dressing is disclosed. The dressing includes a transparent body that covers a skin insertion site through which a catheter assembly passes for disposal within the body of a patient. The transparency of the dressing body enables inspection of the skin insertion site. In one embodiment, therefore, an antimicrobial full-surround contact dressing for use with a medical device inserted into a skin surface of a patient via a skin insertion site is disclosed and comprises a transparent flat body, an antimicrobial adhesive substance disposed on a bottom surface of the body, and a slit defined in the body. The slit is configured to enable the body to be placed fully around a perimeter of the medical device on the skin surface at the skin insertion site such that the bottom surface of the body fully surrounds and contacts the skin insertion site.

Abstract: The present disclosure relates generally to the field of medical devices and methods to assist in the introduction of an instrument into a patient, and more particularly to medical devices for measuring and/or monitoring forces applied during introduction of an access sheath through a body lumen.

Abstract: The invention provides for methods and catheter apparatus for passing one or more guidewires (via the use of one or more telescoping guidewire lumens) through a chronic total occlusion of a vasculature. The catheter apparatus may include: a catheter shaft having a distal end; one or more telescoping guidewire lumen catheters passing longitudinally through the shaft, wherein the one or more guidewire lumen catheters are capable of telescoping beyond the distal end of the catheter shaft; an expansible distal portion of the shaft; and a retractable sheath covering at least a portion of the expansible distal portion of the shaft, wherein retracting the retractable sheath from the expansible distal portion of the shaft directly activates the expansible distal portion of the shaft causing expansion of the expansible distal portion of the shaft.

Abstract: A deep vein intravenous introducer has a wheel located toward the front end of the device that can be rotated by the index finger of the user. After placement of the needle in the lumen of the vessel, the user rotates the wheel, which turns a drive wheel. The drive wheel has an outer surface that advances the guide wire through the center of the needle and into the patient. Once the guide wire is advanced into the vessel lumen the catheter can be advanced over the guide wire with a hub or finger tab on the catheter close to the index finger. The operation can be performed by one hand without moving the hand from its initial position.

Abstract: A deflation catheter device, comprising: a catheter tube having a proximal end and a distal end; a stylet disposed within the catheter tube; a stylet handle attached to the stylet; and a y-connector disposed near a proximal end of the catheter tube, configured to provide fluid communication from the distal end of the catheter tube and a suction port, and configured to provide access for the stylet from the proximal end of the catheter tube to the distal end of the catheter tube.

Abstract: Catheter includes an outer shaft member having a proximal section and a distal outer member. The outer shaft has an inflation lumen defined therethrough. A balloon is in fluid communication with the inflation lumen and has a proximal balloon shaft, a proximal cone portion, a working length, a distal cone portion, and a distal balloon shaft. Catheter also includes a monolithic inner tubular member extending from the outer shaft proximal section through the distal outer member and through the balloon to form a tip. The distal balloon shaft has an inner diameter and comprises a distal seal portion coupled to the inner tubular member and a proximal portion free of attachment to the inner tubular member. The length of the proximal portion of the distal balloon shaft is at least about two times the inner diameter of the distal balloon shaft. Methods of making a catheter are also provided.

Abstract: An intravascular balloon catheter device is disclosed having an inner member, an outer member disposed about the inner member and further comprising a balloon. A sheath is disposed about the outer member that moves relative to the balloon so as to selectively expose a first portion of the balloon for inflation. A clamp may be used to selectively secure the sheath at a desired position relative to the balloon wherein the desired position is less than full retraction such that a second portion of the balloon remains within the sheath.

Abstract: A method and device for local delivery of a water-insoluble therapeutic agent to the tissue of a normal or diseased body lumen is disclosed. An expandable structure of a medical disposable device, such as a balloon of a balloon catheter, is coated with a non-durable coating which includes an amphiphilic polymer or copolymer, in embodiments polyethylene glycol, having a substantially water-insoluble therapeutic agent dispersed therein. In some embodiments, the coating may also include iodine. The medical disposable device is inserted into a body lumen, and expanded to contact the non-durable coating against the body lumen and deliver the substantially water-insoluble therapeutic agent to the body lumen tissue.

Abstract: This patent document discloses perfusion catheters and related methods for treating complications related to CTO interventions or dilating a vessel occlusion while maintaining a passage through the treated vessel segment. A perfusion catheter can include a balloon formed of an inflatable tube and an elongate shaft having a lumen for providing inflation fluid to, or withdrawing inflation fluid from, the balloon. The inflatable tube can be coiled in a helical manner around a central axis into a series of windings. Adjacent windings can be stacked against and bonded to each other, and an inner surface of the series of windings, when inflated, can define the passage. The elongate shaft can be eccentrically attached to a proximal portion of the balloon and the shaft's lumen can be in fluid communication with the interior of the balloon, specifically the inflatable tube. The inflatable tube can include two different polymer tubes, one slightly smaller than the other.

Abstract: Various systems and methods are provided for treating pulmonary edema. In general, a pump can be configured to be implanted within a patient at risk of developing edema. The pump can be configured to pump fluid out of the patient's lungs, e.g., out of the patient's interstitial and alveolar spaces. The pump can be configured to be fully implanted within the patient's body. The pump can be configured to continuously pump fluid, or the pump can be configured to be selectively actuatable in response to a trigger event. In an exemplary embodiment, the pump can include an inflow port coupled to an inflow tube in fluid communication with a lymphatic vessel of the patient, and can include an outflow port coupled to an outflow tube in fluid communication with a vein of the patient.

Abstract: A method of using an electronic toolset for locating, reading, adjusting and confirming adjustment of an implantable bodily fluid drainage system without requiring recalibration following adjustment from a current valve setting to a new valve setting using an electronic toolset including an adjustment tool having a magnetic element and an indicator tool including a sensor array. The need to remove the electronic toolset from the patient to recalibrate or zero the sensor array prior to confirming the new valve setting is eliminated. This is realized by disposing a ferromagnetic system component of the indicator tool in a magnet shield cage made of a metallic alloy to prevent magnetic fields produced by a magnetic element in the adjustment tool during the adjusting step from influencing the sensor array.

Abstract: A method for using an implantable programmable bodily fluid drainage valve including a fixed reference magnet and an adjustable valve unit having a pair of primary magnetic elements. In accordance with the present inventive method the implantable programmable bodily fluid drainage valve is operable using either an intended toolset including a sensor array for detecting a magnetic field or a non-intended toolset employing an analog type compass assembly instead of the sensor array, wherein a location of the fixed reference magnet in the implantable programmable bodily fluid drainage valve and size of the fixed reference magnet has substantially no negative influence on operation of the analog type compass assembly of the non-intended toolset when used to operate the implantable programmable bodily fluid drainage valve.

Abstract: Verifying whether a magnetic field resistance mechanism is properly engaged in a drainage valve having an adjustable valve unit including a rotating construct and a pair of primary magnetic elements for programming the valve unit. Using a toolset, a determination is made whether the magnetic field resistance mechanism is properly engaged. An alert is generated whether the magnetic field resistance mechanism is at least one of properly engaged or not properly engaged based on: (i) a measured angular position of a detected one of the pair of primary magnetic elements relative to a direction of flow of fluid through the valve; and/or (ii) a measured distance separation between respective centers of the pair of primary magnetic elements.

Abstract: A method for using a universal electronic toolset for indicating and adjusting of an implantable programmable bodily fluid drainage valve regardless of whether the valve includes a fixed reference magnet used to determine an angle of orientation of the implantable programmable bodily fluid drainage valve or not. A magnetic field detection sensor array in an indicator tool of the electronic toolset determines whether the fixed reference magnet is present in the implantable programmable bodily fluid drainage valve. If the presence of the fixed reference magnet is detected then the center and direction of flow of the adjustable valve unit is ascertained via electronic feedback from the electronic toolset; otherwise, the center and direction flow is ascertained via exclusively by manual physical palpation of the valve.

Abstract: A stent having an elongated tubular configuration consisting of at least one anchor section to inhibit migration. Said anchor section is fabricated by an expandable mesh of woven metallic or polymeric elements. The anchor is configured to minimize contact abrasion and irritation to the entrance of the lumen being stented, as well as to enervated tissue surrounding that entrance, as well as to better absorb forces and increase retention as the lumen is stretched.

Abstract: Drug delivery devices (700) are provided herein and include an elongated, elastic body (706) extending between a first end and a second end, wherein the elastic body comprises a water permeable wall structure (708) having defining an elongated drug reservoir lumen (714) extending between the first and second ends. One or more secondary lumens (718) are structured (e.g., positioned, sized, shaped, and optionally filled) to be effective to retard or prevent in vivodiffusion of (i) water into the drug reservoir lumen and/or (ii) solubilized drug out of the drug reservoir lumen.

Abstract: Methods and apparatus are provided for applying an fragment of a neurotoxin such as the active light chain (LC) of the botulinum toxin (BoNT), such as one of the serotype A, B, C, D, E, F or G botulinum toxins, via permeabilization of targeted cell membranes to enable translocation of the botulinum neurotoxin light chain (BoNT-LC) molecule across the targeted cell membrane to the cell cytosol where a therapeutic response is produced in a mammalian system. The methods and apparatus include use of catheter based delivery systems, non-invasive delivery systems, and transdermal delivery systems.

Abstract: To achieve stable administration of a medicine into a dermis by improving the operability of a device that inserts a microneedle into a skin. An impacting type applicator (1) for a microneedle patch is an applicator that applies a microneedle patch (3) to a skin includes a main body (5), a spring expanding/compressing lever (7), a resilient body (9), a lock mechanism (11), and a piercing switch (13). The spring expanding/compressing lever (7) is movably attached to the main body (5), and the microneedle patch (3) can be attached to a leading end of the spring expanding/compressing lever (7). The resilient body (9) is a member that imparts a biasing force to the spring expanding/compressing lever (7). The lock mechanism (11) is a mechanism that locks the spring expanding/compressing lever (7) in a state where the resilient body (9) exerts the biasing force on the main body (5).

Abstract: An applicator according to one embodiment includes a housing having a tubular shape with one closed end, and configured to house an elastic member and a piston plate for transmitting biasing force of the elastic member to the microneedles, and release means configured to release the piston plate engaged in a manner resisting against the biasing force of the elastic member in the housing, to cause the piston plate to move toward an opening of the housing along an axial direction of the housing. The release means is configured, when the release means releases the engagement of the piston plate by moving toward the housing in the axial direction, to transmit force in a direction toward the opening to the housing.

Abstract: An access port for subcutaneous implantation into a body of a patient is disclosed. The port is typically subcutaneously connected to a catheter, a distal portion of which is disposed within a vein or other vessel of the patient. The port is configured with enhanced fluid handling features to improve fluid flow therethrough while reducing the likelihood of clotting or occlusions in the attached catheter, thus improving system patency. In one embodiment, for instance, an implantable access port is disclosed and comprises a body defining a reservoir, a needle-penetrable septum covering an opening to the reservoir, a stem defining an outlet to the reservoir, and a deformable element included in the reservoir. The deformable element is operably connected to a main portion of the septum and deforms in response to displacement of the septum to counteract a change in volume within the reservoir and prevent blood ingress into the catheter.

Abstract: The invention is directed to an connector comprising a first part and a second part, each provided with a contact surface and at least one non-contact surface facing away from the contact surface, at least one opening in the contact surface having an fluid connection to at least one opening of the non-contact surface, a releasable covering of the opening in the contact surface, and complementary means for mechanically coupling the parts at the contact surfaces to form the connector. The complementary means for mechanically coupling the parts are configured to mechanically interlock with each other.

Abstract: An electrical discharge irrigation includes a power source to produce a first voltage, a circuit coupled to the power source to convert the first voltage to a second voltage, a discharge capacitor to receive the second voltage from the circuit, a transistor and/or a controlled rectifier coupled to the discharge capacitor to receive the second voltage, and an output tip. This tip is coupled to a transistor and/or a controlled rectifier and includes a first end, a second end, a longitudinal axis extending between them, an electrode located in an interior space of the tip to receive an electrical charge from the a transistor and/or a controlled rectifier and to release an electric discharge, and a ground return. The ground return is an outside surface of the tip. A space between the electrode and the ground return holds a conductive medium in contact with the electrode and the ground return.

Abstract: Methods and devices are provided for activating brown adipose tissue (BAT). Generally, the methods and devices can activate BAT to increase thermogenesis, e.g., increase heat production in the patient, which over time can lead to weight loss. In one embodiment, a medical device is provided that activates BAT by electrically stimulating nerves that activate the BAT and/or electrically stimulating brown adipocytes directly, thereby increasing thermogenesis in the BAT and inducing weight loss through energy expenditure.

Abstract: Methods for effectuating ovarian denervation include advancing a disruptor intravaginally to access an ovarian nerve and applying the disruptor to the ovarian nerve to denervate the ovarian nerve to limit ovarian sympathetic neural activity and control hormonal secretion.

Abstract: The invention relates to a process for manufacturing at least one implant for focal electrical stimulation of a nervous structure, said implant being of the type including in a supporting structure a network of cavities at the bottom of which are placed microelectrodes, the cavities being bounded by walls erected and located around the microelectrodes, the supporting structure being produced beforehand by implementing the following steps: deposition and etching, in a planar manner, on an insulating substrate, of electrical contacts, of electrical tracks and of microelectrodes, first tracks electrically connecting the microelectrodes and the electrical contacts, second electrical tracks being electrically connected to a ground.

Abstract: An apparatus for use in peripheral nerve field stimulation (PNFS) whereby a plurality of curved introducer needles, of varying curvatures, are provided to permit the physician to best locate the region of oligodendrocytes that contain the A Beta fibers by matching the lumbar lordosis. A wing device is also provided that is attachable to the hub of the curved needle introducer which gives the physician better ability to maneuver the needle during insertion as well as permitting tenting of the skin. The invention benefits a large number of painful disorders arising from pathology in the cervical, thoracic, and lumbar spine. In addition, this invention can also help a large number of other conditions including but not limited to failed back surgery syndrome/post-laminectomy pain, occipital/suboccipital headaches, scar pain, post herpetic neuralgia pain, mononeuritis multiplex, and pain following joint surgery (e.g., knee, hip, shoulder).

Abstract: This disclosure relates to an implantable lead for electrical stimulation of an organ and/or for collecting electrical potentials on this organ. The lead comprises a distal termination able to come into contact with the tissues of an organ, the termination comprising an insulating substrate and at least one conductive interface carried by the substrate. The lead further comprises a lead body having at least one bonding conductor connected to a respective conductive interface. The conductive interface comprises at least one deformable conductive wire with a woven, embroidered, braided or knitted configuration for anchoring the deformable wire to the substrate.

Abstract: A pacemaker has a housing and a therapy delivery circuit enclosed by the housing for generating pacing pulses for delivery to a patient's heart. An electrically insulative distal member is coupled directly to the housing and at least one non-tissue piercing cathode electrode is coupled directly to the insulative distal member. A tissue piercing electrode extends away from the housing.

Abstract: Various systems and methods provide iontophoretic delivery of anesthesia at a patient's tympanic membrane. Some implementations provide channel switching enabling a single current sink to pull current through two electrodes in an alternating fashion based on clock pulses. The iontophoretic delivery of anesthesia may be driven by an AC modulated current. Some implementations provide for continuous flow of fresh iontophoresis fluid to the ear canal during iontophoresis. The fluid flows from a source reservoir into the cavity between the tympanic membrane and a plug, and then drains out of the cavity to a reservoir. An iontophoresis system may also detect capacitance between an anode electrode and an auxiliary electrode in a patient's ear canal, watching for reduced capacitance to indicate presence of a bubble in the iontophoresis fluid.