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Changes in middle ear pressure in daily life
Y Sakikawa1, H Kobayashi, Y Nomura
1Department of Otolaryngology, Showa University, Tokyo, Japan.
Abstract:
The present study was performed to estimate changes of middle ear pressure (ME-P) during actions of daily life such as nose blowing and sniffing. ME-P was measured in 18 patients with perforation of the eardrum. They were asked to perform actions which included nose blowing and sniffing. Eustachian catheterization and politzerization were also applied. Change of ME-P before and after these actions was recorded using a pressure monitor. Results showed that changes of ME-P after nose blowing with both nostrils closed were large and rapid. The mean value of ME-P after nose blowing was 252 mmH2O. In our previous study, the mean value of cerebrospinal fluid pressure (CSF-P) after nose blowing was 388 mmH2O. Therefore, the pressure gradient across the cochlear windows is about 130 mmH2O during nose blowing. The cochlear windows may have been pressed toward the middle ear side. After sniffing, ME-P was unchanged. These results suggest that nose blowing may be an important cause of perilymphatic fistula (PLF) via the "explosive route", while sniffing is not likely to cause PLF.
Insights
Nose blowing significantly increases middle ear pressure (ME-P), potentially causing perilymphatic fistula (PLF) by forcing cochlear windows inward. Sniffing does not alter ME-P and is unlikely to cause PLF.
Area of Science:
- Otolaryngology
- Audiology
- Neurosurgery
Background:
- Understanding middle ear pressure (ME-P) dynamics is crucial for diagnosing and preventing inner ear conditions.
- Perilymphatic fistula (PLF) is a potential complication of pressure changes in the middle ear.
Observation:
- ME-P was measured in 18 patients with eardrum perforations during daily actions.
- Nose blowing with closed nostrils and sniffing were performed, along with Eustachian catheterization and politzerization.
- Pressure changes were recorded using a specialized monitor before and after each action.
Findings:
- Nose blowing resulted in large, rapid ME-P increases (mean 252 mmH2O), creating a significant pressure gradient across cochlear windows.
- Cerebrospinal fluid pressure (CSF-P) changes during nose blowing were previously found to be 388 mmH2O.
- Sniffing did not cause significant changes in ME-P.
Implications:
- Nose blowing may be a primary cause of PLF through an "explosive route" due to inward pressure on cochlear windows.
- Sniffing is unlikely to contribute to PLF formation.
- These findings inform clinical recommendations regarding nasal hygiene practices in patients with eardrum perforations.