Evacuation of the Middle Ear by Sniffing: A Cause of High Negative Pressure and Development of Middle Ear Disease

Abstract

Previous research on eustachian tube function has been devoted mainly to the study of the tubal opening ability and pressure equalization. This article summarizes a series of experimental studies focusing on the closing ability of the tube. Results support the belief that the purpose of the tube should be seen primarily as protecting the middle ear from the extensive pressure variations that physiologically take place in the nasopharynx. A number of studies of diseased ears have shown that tubal malfunction was characterized mainly by a reduced ability to withstand negative pressure in the nasopharynx. Sniffing can evacuate the middle ear, causing high negative intratympanic pressure. It seems likely that this mechanism is involved in the development of middle ear effusion and manifest retraction-type middle ear disease.

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References

1. Politzer

: Diagnose und Therapie der Ansammlung serÖser FlÜssigkeit in der TrommelhÖhle. Wien Med Wochenschr 17: 244–247, 1867.

2. ZÖllner

: Wiederstandmessungen an der Ohrtrumpete zur prÜfung ihrer Wegsamkeit. Arch Ohren Nasen u Kehlkopfheilk 140: 137–141, 1936.

3. Bluestone

Beery

Andrus

: Mechanics of the eustachian tube as it influences susceptibility to and persistence of middle ear effusions in children. Ann Otol Rhinol Laryngol 83 (Suppl 11): 27–34, 1974.

4. Holmgren

: Experimental tubal occlusion. Acta Otolaryngol (Stockh) 28: 587–592, 1940.

5. Proud

Odoi

Toledo

: Bullar pressure changes in eustachian tube dysfunction. Ann Otol Rhinol Laryngol 80: 835–837, 1971.

6. Lidén

Renvall

: Impedance and tone screening in schoolchildren. Scand Audiol 9: 121–126, 1980.

7. Magnuson

: Tubal closing failure in retraction type cholesteatoma and adhesive middle ear lesions. Acta Otolaryngol (Stockh) 86: 408–417, 1978.

8. Magnuson

: On the origin of the high negative pressure in the middle ear space. Am J Otolaryngol 2: 1–12, 1981.

9. Falk

: Sniff-induced negative middle ear pressure: Study of a consecutive series of children with otitis media with effusion. Am J Otolaryngol 3: 155–162, 1982.

10.

10. Falk

: Negative middle ear pressure induced by sniffing—a tympanometric study in persons with healthy ears. J Otolaryngol 10: 299–305, 1981.

11.

11. Magnuson

: Tubal opening and closing ability in unilateral middle ear disease. Am J Otolaryngol 2: 199–209, 1981.

12.

12. Magnuson

: The atelectatic ear. Int J Pediatr Otorhinolaryngol 3: 25–35, 1981.

13.

13. Falk

Magnuson

: Test-retest variability of eustachian tube responses in children with persistent middle ear effusion. Arch Otorhinolaryngol (submitted for publication).

14.

14. Falk

Magnuson

: Eustachian tube closing failure—occurrence in patients with cleft palate and middle ear disease. Arch Otolaryngol 110: 10–14, 1984.

15.

15. Magnuson

: Tympanoplasty and recurrent disease. Am J Otolaryngol 2: 277–283, 1981.