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Can the negative pressures found in obstructive sleep apnea and Eustachian tube dysfunction be related?

Sadia T Ahmed1, Juan Lin2, Howard S Moskowitz3

  • 1Albert Einstein College of Medicine, United States of America.

American Journal of Otolaryngology
|February 28, 2021
PubMed

Insights

Obstructive sleep apnea (OSA) in children is linked to negative middle ear pressure (MEP), suggesting pressure transmission to the ear. In adults, severe OSA correlates with positive MEP, indicating a different effect on Eustachian tube dysfunction (ETD).

Area of Science:

  • Otolaryngology
  • Pediatric Sleep Medicine
  • Respiratory Physiology

Background:

  • Obstructive sleep apnea (OSA) and Eustachian tube dysfunction (ETD) frequently coexist in pediatric patients.
  • Adenoid enlargement is a common cause, but negative pharyngeal pressure from OSA may also contribute to middle ear pathology.
  • Middle ear pressure (MEP) can serve as a quantifiable measure of ETD.

Purpose of the Study:

  • To investigate the association between the severity of OSA and MEP in pediatric and adult patients.
  • To explore the transmission of negative pharyngeal pressure from OSA to the middle ear in children.
  • To use MEP as a quantifiable indicator of ETD in the context of OSA.

Main Methods:

  • Retrospective chart review conducted at a tertiary academic center from January 2000 to January 2018.
  • Analysis of the relationship between the apnea-hypopnea index (AHI) and MEP.
  • Utilized a non-anatomic model to support the proposed causal pathway.

Main Results:

  • The study included 34 pediatric and 23 adult patients.
  • In children, a moderate negative correlation was observed between REM AHI and MEP (r = -0.265).
  • Severe OSA in children was associated with more negative MEP, while severe OSA in adults showed a trend towards more positive MEP.

Conclusions:

  • Increasing OSA severity in children correlates with more negative MEP, supporting the hypothesis of negative pressure transmission to the middle ear.
  • In adults, increasing OSA severity is associated with a more positive MEP.
  • These findings suggest distinct mechanisms of middle ear pressure changes in pediatric versus adult OSA patients related to ETD.
Abstract

Keywords:
Eustachian tube dysfunctionMiddle ear pressureObstructive sleep apnea

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