[Sniff-induced negative pressure--a cause for the development of middle ear diseases?]

The significance of "sniffing" causing tubal dysfunction and thus leading to the development of cholesteatoma is discussed. We examined 244 healthy ears (18% sniff-positive), 21 ears with a traumatic perforation of the tympanic membrane (10% sniff-positive), 46 ears with chronic mesotympanic otitis (17% sniff-positive) and 40 ears with cholesteatoma (60% sniff-positive). Two different methods were used: on intact tympanic membranes the pressure chamber impedance method described by Munker-Pedersen (1972), and for perforated tympanic membranes a pressure transducer. Our results show that: (1) "sniffing" can cause negative pressure in the middle ear space; (2) the traditional concept of opening failure is no longer sufficient to explain tubal dysfunction; (3) sniff-induced negative pressure is a further possible cause of tubal dysfunction; (4) sniff-induced negative pressure seems to be an important factor in the development of cholesteatoma.