Increase In Middle Ear Pressure Research Articles

Effect of Valsalva Maneuver by Heavy Weight Lifters on Ear and Its Attributes.

It is observed that people hold their breath while heavy weight lifting to get extra strength. Holding the breath during weight lifting can lead to abnormal increase in middle ear pressure which can lead to several hearing/auditory complications. The objective of the study was to investigate the impact of heavy weightlifting on various parameters related to ears like blocking sensation, tinnitus, vertigo, headache and temporary threshold shift across light and heavy weightlifters, as amateur weightlifting among youth is rapidly increasing. A cross-sectional survey design was used in this study. Based on the random sampling strategy, 40 participants in the age range of were selected across various gyms in Gurgaon India. The participants were equally divided into two categories; light weigh-lifters (LWL) who lifted half of the body weight and heavy weightlifters (HWL) who lifted equal or more than the body weight. A questionnaire was developed, validated and administered which consists of 23 questions targeting blocking sensation, tinnitus, vertigo, temporary threshold shift and headache. Chi-square analysis revealed that higher proportion of HWL group experienced blocking sensation (65% vs 25%), tinnitus (70% vs 35%), vertigo (75% vs 40%), headache (80% vs 35%), and temporary threshold shift (60% vs 35%) then the LWL group. Strenuous exercises like heavy weight lifting can lead to various ear problems such as blocking sensation, temporary threshold shift, tinnitus, and vertigo, which, may lead to hearing loss.

A rare case of spontaneous otogenic pneumocephalus with pictorial illustration of temporal evolution

Pneumocephalus is commonly seen on imaging in the setting of craniofacial trauma, skull base tumours, intracranial infection and after neurological intervention. Spontaneous pneumocephalus in the absence of these conditions is exceedingly rare, with only approximately 30 cases reported in the literature to date. Spontaneous otogenic pneumocephalus (SOP) is believed to occur as a result of anomalous communication between the intracranial space and a hyper-pneumatised temporal bone, with either positive extra-to-intracranial pressure or negative intracranial pressure gradient. These anomalous communicating channels may only become clinically apparent when triggered by episodes of acute increase in middle ear pressure during coughing, sneezing, Valsalva manoeuvre or significant change in atmospheric pressure. Patients may exhibit a wide range of neurological symptoms and the aim of treatment is to reduce the risk of complications such as infection and intracranial hypertension. Both conservative and neurosurgical approaches have been described. We report a case of SOP in which the patient was conservatively managed, and spontaneous resolution of pneumocephalus was documented on serial computed tomography (CT) scans. This unique case clearly demonstrates the natural history and temporal evolution of SOP without surgical intervention. This knowledge may potentially obviate the need for surgery, thus reducing morbidity and mortality in patients who are poor surgical candidates.

Middle Ear Pressures in Wind Instrument Musicians.

This study aimed to assess if playing wind instruments leads to a measurable increase in middle ear pressure during note generation and to provide evidence to clinicians to advise musicians undergoing middle ear surgery. An observational cohort study of 40 volunteers in 7 different wind instrument categories underwent tympanometry at rest and during note production. Community. Recreational musicians aged over 18 years recruited from the student body attending Birmingham University, UK. None. Tympanometry is used as a noninvasive measure of middle ear pressure. The pressure at which peak compliance occurred was taken as an indirect measure of middle ear pressure. The data produced at rest and during note production was statistically analysed with paired t testing and significance set at a p value less than 0.01. Overall a statistically significant increase in middle ear pressure change of 0.63 mm Hg (p = 0.0001) during note production was identified. Musicians playing the oboe and trumpet demonstrate the largest increase in middle ear pressure of 1.46 mm Hg (p = 0.0053) and 0.78 mm Hg (p = 0.0005) respectively. The data provided by this study gives evidence for the first time that playing wind instruments does increase middle ear pressure. Although the clinical significance of this is yet to be determined the authors would advise that musicians who undergo otological procedures should refrain from playing their instruments until full recovery has been achieved as advised by their clinician following direct microscopic review.

Effects of steep Trendelenburg position and pneumoperitoneum on middleear pressure in patients undergoing robotic radical prostatectomy.

The aim of this study was to quantify the changes in middle ear pressure (MEP) during robot-assisted radical prostatectomy (RARP). Thirty patients undergoing RARP were included in this study. MEP was obtained at the following time points: awake (T1), postintubation (T2), pneumoperitoneum + 1 h of Trendelenburg position (T3), pneumoperitoneum + 2 h of Trendelenburg position (T4), pneumoperitoneum + 3 h of Trendelenburg position (T5), desufflation + supine position (T6), and 1 h after extubation in the postanesthesia care unit (T7). Heart rate, mean arterial pressure (MAP), peak airway pressure (PAP), tidal volume, minute ventilation, EtCO2, and blood gas values were recorded. MEP was significantly higher at T4, T5, T6, and T7 as compared to T1 values. PAP values were significantly increased at T3, T4, and T5 compared to T2. MAP values at T3, T4, and T5 were significantly higher compared to T1. PaCO2 increased significantly at T4, T5, and T6 and pH decreased significantly at T4 and T5 when compared to T2. The combination of steep Trendelenburg position and pneumoperitoneum during RARP caused a significant increase in MEP, PaCO2, and EtCO2 levels. This propensity for increased MEP may cause problems in patients with preexisting ear disease.

Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects

IntroductionThe diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results. ObjectiveTo evaluate the variation in middle ear pressure in patients with tympanic membrane retraction and in normal patients during tube function tests, as well as to evaluate intra-individual variation between these tests. MethodsAn observational, contemporary, cross-sectional study was conducted, in which the factor under study was the variation in middle ear pressure during tube function tests (Valsalva maneuver, sniff test, Toynbee maneuver) in healthy patients and in patients with mild and moderate/severe tympanic retraction. A total of 38 patients (76 ears) were included in the study. Patients underwent tube function tests at two different time points to determine pressure measurements after each maneuver. Statistical analysis was performed using SPSS software, version 18.0, considering p-values <0.05 as statistically significant. ResultsMean (standard deviation) age was 11 (2.72) years; 55.3% of patients were male and 44.7% female. The prevalence of type A tympanogram was higher among participants with healthy ears and those with mild retraction, whereas type C tympanograms were more frequent in the moderate/severe retraction group. An increase in middle ear pressure was observed during the Valsalva maneuver at the first time point evaluated in all three groups of ears (p=0.012). The variation in pressure was not significant either for the sniff test or for the Toynbee maneuver at the two time points evaluated (p≥0.05). Agreement between measurements obtained at the two different time points was weak to moderate for all tests in all three groups of ears, and the variations in discrepancy between measurements were higher in ears with moderate/severe tympanic retraction. ConclusionIn this study population, the mean pressure in the middle ear showed significant variation only during the Valsalva maneuver at the first time point evaluated in the three groups of ears. Normal ears and those with mild retraction behaved similarly in all tests. The tested maneuvers exhibited weak to moderate intra-individual variation, with the greatest variation occurring in ears with moderate/severe retraction.

Effect of sevoflurane versus isoflurane on middle ear pressure during tonsillectomy operation

Background Increase in middle ear pressure (MEP) (mmH 2 O) is an undesirable condition because of its potential complications. The aim of this randomized study was to compare the effects of isoflurane and sevoflurane on MEP. Patients and methods Patients in American Society of Anesthesiologists (ASA) group I-II between 6 and 14 years of age undergoing tonsillectomy operation were randomized into two groups. Group 1 received isoflurane and group 2 received sevoflurane for maintenance of anesthesia after induction with thiopental and suxamethonium in both groups. MEPs were measured and recorded 1 day before the operation (T0), with the patient lying supine on the operating table (T1), after the induction of anesthesia and endotracheal intubation (T2), and soon after withdrawal of anesthesia (T3). Finally, MEP values were compared intragroup with the baseline value (T0) and between groups. Results In comparison with the baseline value in T0, MEP was significantly increased in T1, T2, and T3 in the two groups. There were no differences between groups at all times, but at the end of anesthesia at T3, the increase in MEP was significantly lower in group 1 (isoflurane group) than in group 2 (sevoflurane groups) (103 ± 68 vs. 138 ± 99, P P Conclusion There was an increase in MEP after anesthesia with both the inhalational anesthetics, but the increase in MEP was significantly lower during isoflurane anesthesia, which makes it more suitable during middle ear surgery.

Investigation of Middle Ear Pressure Changes During Prone Position Under General Anesthesia Without Using Nitrous Oxide

The effects of different body positions on the middle ear were reported in several studies, but there are no data about the effects on patients under general anesthesia. The aim of this study is to determine the effect of prone position on middle ear pressure (MEP) during general anesthesia without using nitrous oxide. Twenty patients under general anesthesia during prone position were included in the study. The performed anesthesia method was the same for all patients. Remifentanil was used for analgesia instead of nitrous oxide. MEPs were measured 5 times with a middle ear analyzer: before induction (BI), after intubation (AI), after turned to the prone position (PP1), at the end of the prone position (PP2), and after returned to the supine position (SP). Duration of prone position was also recorded. Of the 20 patients were 11 women and 9 men with a 49 ± 13 mean age. BI-AI, AI-PP1, PP1-PP2, and PP2-SP comparisons of both MEPs were statistically significant (P < 0.0001). Right mean MEPs were BI, -1 ± 23 daPa; AI, 41 ± 51 daPa; PP1, 124 ± 76 daPa; PP2, 152 ± 59 daPa; and SP, 63 ± 29 daPa; whereas left mean MEPs were BI, -24 ± 55 daPa; AI, 28 ± 34 daPa; PP1, 132 ± 67 daPa; PP2, 162 ± 48 daPa; and SP, 70 ± 89 daPa. Significant increases were detected at the start and continuation of the prone position. The mean duration of prone position was 98 ± 51 per minute. The significant MEP increases during the prone position under general anesthesia depend on a number of reasons. Among them are inhaler agents, pressure changes in mucosal blood vessels due to venous congestion, and the mastoid bone volume. Further researches are required to determine and explain the mechanisms of increase in MEP during prone position.

Comparison of the Effects of Desflurane and Sevoflurane on Middle Ear Pressure: A Randomized Controlled Clinical Trial

Objective: The aim of the present study was to compare the effects of two inhalation anesthetics, desflurane and sevoflurane, on middle ear pressure. Methods: After we obtained written consent from the patients and the approval from our institutional ethical committee, we included 56 ASA I-II patients aged between 18 and 60 years in this study. They were randomly divided into two groups of 28 patients each. Desflurane 4-6% (Group D) or sevoflurane 1-2% (Group S) were used for anesthesia management in patients. Baseline tympanometry was carried out and recorded before the induction of anesthesia on both ears, and 3 more measurements were done and recorded 5, 15 and 30 min after induction. Results: In both groups, middle ear pressure values were found to be significantly elevated when compared to baseline measurements (p < 0.05). When middle ear pressure was compared between the groups, no difference was found between the values obtained at baseline and at 5 min in Group S, while especially the values obtained at 15 min revealed significantly higher middle ear pressures in Group D. Conclusion: It was observed that the increase in middle ear pressure caused by sevoflurane was significantly lower than that caused by desflurane.

Nasal Septal Suture Technique versus Nasal Packing after Septoplasty

The aim of this study was to compare eustachian function and blood gas changes with nasal packing (NP) and nasal septal suturing (NSS) after septoplasty. Eighty patients who have nasal septal deviation and who otherwise are healthy were studied. Forty of these patients had finger glove NPs in their nasal cavities for 48 hours after septoplasty. Another 40 patients had NSS performed after septoplasty. Acoustic tympanometry and pH, P(CO2), and P(O2) analyses of arterial blood were performed preoperatively and 48 hours postoperatively. We observed a statistically significant increase in middle ear pressure (p < 0.001) and a significant reduction of P(O2) (p < 0.001) and increase of P(CO2) (p = 0.041) in the NP group but no difference in the NSS group, postoperatively. NSS should be preferred as an alternative to intranasal packing.

삼출성 중이염 환자에서 Politzer 이관통기후 중이압력의 변화

Background and Objectives: Otitis media with effusion is one of the most common diseases of young children. Impedance audiometry is an accurate method of detecting it. Middle ear inflation such as Politzerization had been used as a conservative method to treat the otitis media with effusion. Recently, the middle ear pressure regulation through gas exchange between the middle ear and blood is known. Several investigators suggest that middle ear inflation may not be useful to treat the otitis media with effusion because middle ear inflation initiates a process of gas exchange and causes an immediate increase in middle ear pressure and follows by rapid decrease to the level before inflation. So, We studied to know changes of middle ear pressure and therapeutic benefits after Politzer inflation. Materials and Methods: We studied to determine the effects of Politzer inflation in 44 ears with otitis media with effusion. The tympanometric peak pressure was used as indirect method to measure the middle ear pressure. The measurements were performed before, immediately, 10 min, 30 min, 1hr after Politzer inflation and every 3 days. Results: The middle ear pressure induced by Politzer inflation was gradually declined to 93.5% within 1hr. 11 ears were more negative pressure at 1hr than pre-inflation level. That of 6 ears with atelectasis was rapidly decreased to 98.2% within 10 min after inflation. The middle ear pressure of 32 ears with good result was shifted toward positive pressure zone after inflation every 3 days and it was restored to normal range. But that of 6 ears with poor result was fluctuated with incerased or decreased change and was not improved to it. Conclusion: Politzer inflation has several benefits to treat the otitis media with effusion such as restoration of negative middle ear pressure and promotion of drainage of fluid. (J Clinical Otolaryngol 2000;11:41–45)

Middle-ear pressure variations during total intravenous anesthesia with propofol, fentanyl, and ketamine

As the middle-ear cavity is one of the noncompliant gas-filled cavities, an increase in middle-ear pressure (MEP) instead of volume expansion is observed with inhalation of nitrous oxide (N2O). Changes in MEP cause many complications, such as ear pain, temporary hearing impairment, and postoperative emesis. Therefore, we investigated changes in MEP during total intravenous anesthesia (TIVA) with propofol, fentanyl, and ketamine (PFK) and inhalation of N2O. Twelve patients were anesthetized with PFK until 60 min after the induction of anesthesia, and then N2O (60%) inhalation was started. MEP was measured by impedance audiometry (ranging from -300 daPa to +200 daPa) at 10-min intervals during PFK, and at 2-min intervals after the inhalation of N2O. MEP gradually but significantly increased from the preanesthetic value of 16±8 to 34±12 (SEM) daPa 50 min after the induction of PFK. However, MEP did not exceed the normal limit. The values of MEP in all patients were more than 200 daPa within 36 min after the start of inhalation of N2O in oxygen. PFK had a minimal effect on MEP, whereas addition of N2O to PFK increased MEP dramatically. Therefore, TIVA, or at least PFK, would be a better choice for patients with middle-ear or upper-airway diseases.

Increases in Middle Ear Pressure Resulting from Counter-Diffusion of Oxygen and Carbon Dioxide into the Middle Ear of Monkeys

The mechanism of middle ear (ME) pressure regulation is incompletely understood. Previously, Hergels and Magnuson reported an unexpected increase in ME pressure for human subjects who partially evacuated their relative positive ME pressures by swallowing. They suggested that a novel, but unknown mechanism for the generation of gas was responsible for the pressure increase. In this experiment, the MEs of rhesus monkeys were inflated with N2 via the eustachian tube and post inflation ME pressures were recorded for up to three hours. Eleven of 20 experiments showed an initial increase in ME pressure caused by the inflation followed by stable pressures for the remainder of the followup period. In 9 of the experiments, a rapid and temporally discrete decrease in ME pressure was observed during the course of followup. Following the observed pressure decrease which was interpreted as a transient eustachian tube opening, ME pressures showed a progressive increase characterized by a kinetic pattern similar to that of the human experiment. To understand the mechanism responsible for this effect, the monkey experiment was simulated using a mathematical model of ME pressure regulation. Free parameters of the model were taken from experimental data for monkeys. The model accurately predicted the time course of pressure change documented in the monkey experiments. The effect is driven by a decrease in the preexisting ME partial pressures of CO2, O2 and H2O consequent to tubal openings at relative positive pressures, with the subsequent counter diffusion of those gases from blood to ME causing the observed increase in total ME pressure. The results reported by Hergels and Magnuson can also be explained by this mechanism.

Effects of intranasal challenge with histamine, bradykinin and prostaglandin on middle ear pressure and blood flow in cynomolgus monkeys.

Previous studies documented a significant increase in middle ear pressure following intranasal challenges with ascaris antigen or histamine in sensitized cynomolgus monkeys. To confirm that effects and investigate the mechanism, 4 monkeys were intranasally challenged at separate sessions with histamine (10 mg), bradykinin (1, 10 mg) and prostaglandin D2 (PgD2, 0.5, 1.0 mg) and followed for 90 min. Before and after challenge, middle ear pressure, mucosal blood flow, heart rate, blood pressure, body temperature and the partial pressures of O2 and CO2 in the venous blood were measured. The results showed that while bradykinin challenge had no effect on these measures, PgD2 provoked increased middle ear pressure, and histamine resulted in a biphasic pattern of increasing pressures followed by decreasing pressures. The pattern of change in middle ear pressure after histamine challenge was explicable by a mechanism involving transmucosal gas exchange, while that for PgD2 was related to increased mucosal inflammation. These results document the development of positive middle ear pressures during provoked nasal inflammation and may have relevance to similar observations in the clinical setting.

Effects of dopamine, dobutamine and phentolamine on middle ear pressure and blood flow in cynomolgus monkeys.

To test the hypothesis that changes in mucosal perfusion could influence gas exchange and thus, middle ear pressure, the effects of systemically administered drugs showing alpha adrenergic effects on mucosal perfusion and middle ear pressure were evaluated in 4 cynomolgus monkeys. Two drugs with well characterized sympathomimetic effects, dopamine and dobutamine, were studied, and dopamine was combined with an antagonist, phentolamine. For each experiment, the monkeys were anesthetized with pentobarbital and followed for a 90 min baseline period. Then, the drug was administered for 60 min with follow-up extending through that period and for an additional 60 min. Data consisted of repeated measurements of rectal temperature, heart rate, blood pressure, left middle ear pressure and right mucosal blood velocity, volume and flow. The results documented an increase in middle ear pressure after intravenous infusion of either dopamine or dobutamine and an attenuation of the response by concurrent administration of phentolamine. Laser Doppler measurements documented a variable, non-directional change in blood volume, velocity and flow. The changes in the middle ear pressure observed following systemic administration of autonomic drugs are consistent with the rapid establishment of a transmucosal pressure gradient secondary to changes in the supply and/or metabolism of gases.

ヘリウム，アルゴン吸入による中耳圧変化

Middle ear pressure is thought to be an important factor in the pathogenesis of otitis media. It is well known that body position, type of breathing, and kind of inhaled gas influence middle ear pressure. There is an increase in middle ear pressure when general anesthesia is induced with a gas such as nitrous oxide. In this study, an attempt was made to answer the question as to whether the inhalation of non-anesthetic inert gas can increase middle ear pressure.Eight ears were selected: 4 atelectatic ears and 4 infantile ears. Helium-oxygen mixture gas (He 79%, O2 21%) or argon-oxygen mixture gas (Ar 79%, O2 21%) was administered via face mask for 120 minutes, and middle ear pressure was measured with tympanometry just before and during gas inhalation. The middle ear pressure changes during gas inhalation were compared with those during air respiration.The results were as follows;1. Middle ear pressure was increased by the inhalation of argon-oxygen mixture gas. However, no specific pressure change was noted in the middle ear during inhalation of helium-oxygen mixture gas.2. The difference in pressure in the middle ear during helium-oxygen inhalation and argon-oxygen inhalation might be due to the different solubility coeffients of the two inert gases.

The Effect of Postural Change and Upper Respiratory Tract Infection on Middle Ear Pressure

The effect of a change in posture from sitting erect to lying supine and horizontal on middle ear pressure was investigated in 5 healthy adults and 5 adults with symptoms of an acute upper respiratory tract infection (URTI). The change in posture had no significant effect on middle ear pressure in the healthy subjects (p greater than 0.05). In those with URTI mean middle ear pressure increased from -39.5 daPa (erect) to -16.9 daPa (supine) (p = 0.026, n = 10). In the supine posture the middle ear pressure in subjects with URTI was raised. The cause of the increase in middle ear pressure is discussed in terms that the postural change may alter middle ear physiology such that in the supine posture there is a net production of middle ear gas as opposed to a net reabsorption in the erect posture. This may indicate that an increase in jugular venous pressure causes a net positive production of middle ear gas.

Effects of hypobaric pressure on the labyrinth:Cochlear Aqueduct Patent

Cats with the cochlear aqueduct patent were placed in a pressure chamber and exposed for 10 min to hypobaric pressures of 5.1 and 6.8 kPa relative to atmospheric pressure. The experiments were designed according to a program used for treatment of Meniere's disease. The perilymph, middle ear, cerebrospinal fluid (CSF), venous, arterial and chamber pressures were recorded. The results demonstrated that hypobaric effects on the labyrinth were mediated via pressure changes in the middle ear and not via a systemic vascular or CSF influence. A reduction in chamber pressure induced a relative increase in middle ear pressure. It was the rate of the hypobaric change as well as the patency of the cochlear aqueduct and the Eustachian tube function that determined the magnitude of the initial perilymph peak pressure and the duration of this pressure increase. A rapid versus a slow rate induced an initial perilymph increase of 3.4 and 2.2 kPa, respectively. This relative pressure increase was eliminated within 1 min via the patent aqueduct. Thus, neither did a longstanding perilymph pressure increase occur during the hypobaric exposure, nor did a prolonged significant reduction in perilymph pressure occur after atmospheric pressure was restored.

Middle-ear pressure changes during general N2O anaesthesia in adeno-tonsillectomies due to post-nasal packing.

During adeno-tonsillectomies performed under general anaesthesia with N2O we observed and measured a serious increase in middle-ear pressure (M.E.P.). This is due to the fact that the rate of diffusion of N2O is greater inwards than outwards. This rise in the middle-ear pressure is due to the packing of the nasopharynx after adenoidectomy for haemostasis.