Eustachian tube closing failure. Occurrence in patients with cleft palate and middle ear disease

Previous studies in patients with middle ear disease have shown that high negative pressure is frequently induced actively in the middle ear cavity by sniffing. The present study concerns 84 ears in 42 patients with cleft palate and middle ear disease. Sniff-induced evacuation of the middle ear was studied by direct pressure recording or tympanometry. Sixty-one percent of diseased ears showed tubal closing failure; 18% had constantly or intermittently wide-open tubes. In most cases, negative intratympanic pressure was not equalized on swallowing. It is suggested that eustachian tube malfunction in patients with cleft palate is constituted by the combination of closing failure with evacuation of the middle ear on sniffing, and by a secondary opening failure with inability to equalize the sniff-induced negative intratympanic pressure.