Middle-ear analysis in the nose/ear distress syndrome

The Nose/Ear Distress Syndrome is defined as 'the combination of nasal septal deformity and eustachian dysfunction in the absence of any other pathology' (McNicoll and Scanlan, 1979). One hundred and two recruits to the Submarine, Diving and Aircrew branches of the Royal Navy, who at initial assessment had been found to have an intact, immobile tympanic membrane, when the Valsalva, Toynbee or Politzer manoeuvres were performed, were referred to the ORL Department, Royal Navy Hospital, Haslar, for further assessment as to their ability to serve in environments of primarily increased ambient pressure. Forty-two qualified members of the Submarine and Diving Branches acted as controls, as they were known to have positive eustachian function, and also clinically mobile tympanic membranes on performance of the Valsalva manoeuvre. Both groups underwent middle-ear analysis, using a Grason Stadler 1723 Middle-Ear Analyser, which has an additional facility for testing eustachian tube function. Those subjects not in the control group were subjected to an increase in ambient pressure in the compression chamber at HMS Dolphin. The ability to equilibrate an increase in ambient pressure of 10 metres of water was regarded as the ultimate criterion of positive eustachian function, those who were unable to do this were diagnosed as suffering from the Nose/Ear Distress Syndrome.