The possible relation of ventilation ear tubes with nocturnal noise-induced discoordination of the stress response axis – Anatomical and physiological considerations

Abstract

Nocturnal noise above 30 dB Leq can impact the hypothalamus–pituitaryadrenal axis and discoordinate cortisol circadian rhythms, affecting, among others, blood pressure, sleep architecture, and behavior. A physiologic middle ear-based model suggested in this article may attenuate noise during sleep, especially at low frequencies. As a significant part of gas exchange occurs viadiffusion, caused by the partial pressure gradient of gases between the middle ear cleft and submucosa capillaries, physiologically expected hypoventilation during sleep may account for hypercapnia and CO2 accumulation in the middle ear due to its rapid diffusion rate and the Eustachian tube’s relative dysfunction during sleep. Pressure on the tympanic membrane can render it less compliant, thus attenuating low-frequency noise. However, this model does not function with a perforated tympanic membrane, as in the case of children having ventilation tubes (VT) placed for otitis media with effusion. Thus, we hypothesize that children treated with VT present with cortisol circadian rhythm discoordination. We propose the evaluation of morning urine or salivary samples and arterial pressure levels along with questionnaires concerning behavioral parameters in children with VT and their comparison with the corresponding measurements of a referral population, weighted for age, endocrinology history, medications, and household noise levels. The findings mayunderline the need to reconsider therapeutic options for otitis media with effusion in selected cases by relying on more physiologically-oriented therapeutical approaches, like the endoscopic balloon Eustachian tube dilatation.