Magnuson B, Falk B
J Otolaryngol. 1983 Jun;12(3):187-93.
Our traditional concepts relating to the development of middle ear disease are based on the assumption that obstruction of the Eustachian tube with reduced ventilation of the middle ear space leads to the development of high negative pressure in the middle ear and, ultimately, to the development of middle ear disease. This hypothesis, which focuses on Eustachian tube opening failure, has not been verified satisfactorily. Results of recent studies indicate that another approach to the problem can lead to a better understanding of the Eustachian tube pathophysiology leading to the development of ear disease. Direct measurements of middle ear pressure in patients with manifest ear disease have revealed that high negative intratympanic pressure is generated by the voluntary act of sniffing. This type of Eustachian tube malfunction is thus characterized by Eustachian tube closing failure. The repetitive barotrauma induced by sniffing or reverse Valsalva maneuvers seems to be a basic predisposing factor in the development of recurrent middle ear effusion and chronic middle ear disease, including adhesive otitis and cholesteatoma.
我们关于中耳疾病发展的传统观念基于这样一种假设，即咽鼓管阻塞伴中耳腔通气减少会导致中耳出现高负压，并最终引发中耳疾病。这一聚焦于咽鼓管开放失败的假说尚未得到令人满意的验证。近期研究结果表明，对该问题的另一种研究方法能够更好地理解导致耳部疾病发展的咽鼓管病理生理学。对患有明显耳部疾病患者的中耳压力进行直接测量发现，主动吸气动作会产生高的鼓室内负压。因此，这种类型的咽鼓管功能障碍的特征是咽鼓管关闭失败。由吸气或反向瓦尔萨尔瓦动作引起的反复气压伤似乎是复发性中耳积液以及包括粘连性中耳炎和胆脂瘤在内的慢性中耳疾病发展的一个基本诱发因素。
