Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-10T13:06:59.330Z Has data issue: false hasContentIssue false
  • English
  • Français

Ventilation and clearance of the middle ear

Published online by Cambridge University Press:  24 September 2009

D Cohen ,
D Raveh ,
U Peleg ,
Y Nazarian  and
R Perez
D Cohen*
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Center (affiliated with the Hebrew University and Hadassah Medical School), Jerusalem, Israel
D Raveh
Affiliation:
Infectious Diseases Unit, Shaare Zedek Medical Center (affiliated with the Hebrew University and Hadassah Medical School), Jerusalem, Israel
U Peleg
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Center (affiliated with the Hebrew University and Hadassah Medical School), Jerusalem, Israel
Y Nazarian
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Center (affiliated with the Hebrew University and Hadassah Medical School), Jerusalem, Israel
R Perez
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Center (affiliated with the Hebrew University and Hadassah Medical School), Jerusalem, Israel
*
Address for correspondence: Dr David Cohen, Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Center, PO Box 3235, Jerusalem, Israel91031. Fax: +972 2 6510808 E-mail: cohendv@netvision.net.il
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate the ventilation and drainage mechanism of the middle ear.

Study design:

Prospective.

Setting:

We observed 304 (of 337) middle ears with tympanic membrane perforation or myringotomy (102 normal, 90 with otitis media with effusion and 112 with chronic otitis media); 912 observations were recorded overall. Perforations were covered with solution, creating a fluid film, and inspected for gas bubbling at rest, and for outward and inward movement of the fluid film during swallowing. We also noted the inflammatory condition of the ear (i.e. dry, wet or purulent) and the perforation size.

Results:

Ears sometimes reacted differently in various sessions. Due to these differences, reactions were classified as ‘types’ of reactions rather than ‘ears’. We refer to 449 ‘types’ of 304 ears. Spontaneous gas bubbling at rest (indicating gas production) was observed in 98 per cent of normal types, 68 per cent of otitis media with effusion types and 65 per cent of chronic otitis media types. Evacuation towards the eustachian tube was observed in 47 per cent, no movement in 46 per cent and outward movement in 9 per cent. During swallowing, inward movement of the fluid film was observed in 74 per cent of normal types, 41 per cent of otitis media with effusion types and 32 per cent of chronic otitis media types.

Conclusions:

We found no support for the theory that the eustachian tube supplies air to the middle ear during swallowing. The normal middle ear produces gas which is evacuated by the Eustachian tube. In ears with otitis media, this mechanism appears to be impaired.

Keywords

Middle EarEustachian TubeSwallowingMyringotomyMiddle Ear VentilationOtitis Media
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 12 , December 2009 , pp. 1314 - 1320
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Aoki, K, Mitani, Y, Tuji, T, Hamada, Y, Utahashi, H, Horiyama, H. Relationship between middle ear pressure, mucosal lesion, and mastoid pneumatization. Laryngoscope 1998;108:1840–5CrossRefGoogle ScholarPubMed
2Sade, J, Ar, A. Middle ear and auditory tube: middle ear clearance, gas exchange, and pressure regulation. Otolaryngol Head Neck Surg 1997;116:499–524CrossRefGoogle ScholarPubMed
3Takahashi, H, Hayashi, M, Sato, H, Honjo, I. Primary deficits in Eustachian tube function in patients with otitis media with effusion. Arch Otolaryngol Head Neck Surg 1989;115:581–4CrossRefGoogle ScholarPubMed
4Tideholm, B, Carlborg, B, Jonsson, S, Bylander-Groth, A. Continuous long-term measurements of the middle ear pressure in subjects without a history of ear disease. Acta Otolaryngol (Stockh) 1998;118:369–74Google ScholarPubMed
5Buckingham, RA, Ferrer, JL. Observations of middle ear pressures. Commentary with movie. Ann Otol Rhinol Laryngol 1980;suppl 68, 89:56–61CrossRefGoogle ScholarPubMed
6Buckingham, RA, Stuart, DR, Girgis, SJ, Geik, MR, McGee, TJ. Experimental evidence against middle ear oxygen absorption. Laryngoscope 1985;95:437–42CrossRefGoogle ScholarPubMed
7Ostfeld, E, Blonder, M, Crispin, M, Szeinberg, A. The middle ear gas composition in air ventilated dogs. Acta Otolaryngol (Stockh) 1980;89:105–8CrossRefGoogle ScholarPubMed
8Doyle, WJ. Experimental results do not support a gas reserve function for the mastoid. Int J Pediatr Otorhinolaryngol 2000;52:229–38CrossRefGoogle Scholar
9Doyle, W. Mucosal surface area determines the middle ear pressure response following establishment of sniff-induced under pressures. Acta Otolaryngol (Stockh) 1999;119:695–702CrossRefGoogle Scholar
10Magnuson, B. Functions of the mastoid cell system: auto-regulation of temperature and gas pressure. J Laryngol Otol 2003;117:99–103CrossRefGoogle ScholarPubMed
11Kawabata, I, Nomura, Y, Dohi, T. Middle ear pressure in patients with middle ear effusion – direct measurement by pressure microtransducer. Auris Nasus Larynx 1985;12(suppl 1):S108–10Google ScholarPubMed
12Doyle, WJ, Alper, CM, Seroky, JT, Karnavas, WJ. Exchange rates of gases across the tympanic membrane in rhesus monkeys. Acta Otolaryngol 1998;118:567–73Google ScholarPubMed
13Takahashi, H, Honjo, I, Hayashi, M, Fujita, A, Kurata, K. Middle ear pressures of children with otitis media with effusion. Ann Otol Rhinol Laryngol 1991;100:469–71CrossRefGoogle ScholarPubMed
14Tanabe, M, Takahashi, H, Honjo, I, Hasebe, S. Gas exchange function of the middle ear in patients with otitis media with effusion. Eur Arch Otorhinolaryngol 1997;254:453–5CrossRefGoogle ScholarPubMed
15Hergils, L, Magnuson, B. Regulation of negative middle ear pressure without tubal opening. Arch Otolaryngol Head Neck Surg 1988;114:1442–4CrossRefGoogle ScholarPubMed
16Luntz, M, Sade, J. Daily fluctuations of middle ear pressure in atelectatic ears. Ann Otol Rhinol Laryngol 1990;99:201–4CrossRefGoogle ScholarPubMed
17Goldstein, NA, Mandel, EM, Kurs-Lasky, M, Rockette, HE, Casselbrant, ML. Water precautions and tympanostomy tubes: a randomized, controlled trial. Laryngoscope 2005;115:324–30CrossRefGoogle ScholarPubMed
18Vlastarakos, PV, Nikolopoulos, TP, Maragoudakis, P, Tzagaroulakis, A, Ferekidis, E. Biofilms in ear, nose, and throat infections: how important are they? Laryngoscope 2007;117:668–73CrossRefGoogle Scholar
19Hall-Stoodley, L, Hu, FZ, Gieseke, A, Nistico, L, Nguyen, D, Hayes, J et al. Direct detection of bacterial biofilms on the middle-ear mucosa of children with chronic otitis media. JAMA 2006;296:202–11CrossRefGoogle ScholarPubMed
20Post, JC, Hiller, NL, Nistico, L, Stoodley, P, Ehrlich, GD. The role of biofilms in otolaryngic infections: update 2007. Curr Opin Otolaryngol Head Neck Surg 2007;15:347–51CrossRefGoogle Scholar
21Jacobs, MR, Dagan, R, Appelbaum, PC, Burch, DJ. Prevalence of antimicrobial-resistant pathogens in middle ear fluid: multinational study of 917 children with acute otitis media. Antimicrob Agents Chemother 1998;42:589–95CrossRefGoogle ScholarPubMed