Patent eustachian tube in the underaerated middle ear: a paradox.

Secretory otitis media, middle ear atelectasis, and retraction type cholesteatomas are the most frequently occurring chronic middle ear diseases; and eustachian tube obstruction and the generation of negative or less than atmospheric middle ear pressure is said to be an essential factor in the pathogenesis of these diseases. It has been found that habitual sniffing causes high degrees of negative middle ear pressure in diseased ears; this finding demonstrates eustachian tube patency rather than obstruction. Ears intubated for chronic secretory otitis media, middle ear atelectasis, and cholesteatoma were examined to identify patent eustachian tubes. More than one third of the patients aspirated a solution into the middle ear with one or more sniffs by aspirating air from their middle ears, demonstrating eustachian tube patency rather than obstruction.