Middle ear pressure during brief pathological conditions of the nose and throat

Middle ear ventilation was investigated by repeated tympanometry in different groups of patients with impaired air current in the upper airways. Among patients with total blocking of the nose by bilateral anterior packing, 46% had a negative pressure of -100 mm H2O or less, which quickly returned to normal after removal of the packing. Unilateral anterior packing produced no significant changes in middle ear ventilation. Unilateral posterior packing produced changes in 50% of ears, tonsillectomy in 60% of ears, amounting to a negative pressure of -100 mm H2O or less. Patients with infectious mononucleosis showed the poorest middle ear ventilation, 45% having pressure between -100 and -199, 45% between -200 and -350 mm H2O. Normalization of the pressure was very slow, but occurred in all cases after 2-4 weeks. The different pathogenetic possibilities, viz. direct occlusion of the tubal orifice, inflammatory mucosal reaction, insufficient swallowing, insufficient air current through the rhinopharynx, are discussed.