The Effect of CPAP on Middle Ear Pressure: A Systematic Review and Meta-analysis

To assess the effect of short-term and long-term continuous positive airway pressure (CPAP) use on middle ear pressure (MEP) in adult ears.

PubMed, Scopus, and Embase were searched through October 2020. Search strategies used a combination of subject headings (e.g., MeSH in PubMed) and keywords for CPAP and middle ear pressure.

English-language articles studying changes in MEP as measured by tympanometry or tympanograms in patients using CPAP were selected for inclusion. Data extraction from included articles included demographics, baseline, and follow-up data.

A total of 7 articles representing 664 patients with weighted mean age of 42.5 years (range 34.9-57.8 yrs) were included. Meta-analysis of three qualifying studies demonstrated a positive correlation between higher CPAP pressures and degree of MEP rise during CPAP use compared to baseline with mean difference of 25.1 daPa (95% confidence interval [18.7, 31.4]) at 5 cm H2O and 81.9 daPa (95% confidence interval [60.2, 103.5]) at 10 cm H2O. Short-term effects of CPAP use were reviewed in four studies that showed a transient rise in MEP. Three separate studies examining the long-term effects of CPAP use showed resting MEP was higher in patients with severe obstructive sleep apnea (OSA), which might be related to progressive eustachian tube dysfunction as a complication of severe OSA.

Short-term CPAP use is associated with transient elevations of MEP in adult ears. Long-term CPAP use might produce beneficial MEP changes, especially in patients with OSA and eustachian tube dysfunction.