The Nose and the Eustachian Tube
Normal functioning of the ear is closely related to the health status of the nose and paranasal sinuses. Pathologies of the nose, sinuses, and nasopharynx play an important role in the cause, treatment, and sequelae of ear disease. Sniffing creates negati
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Özlem Önerci Çelebi and T. Metin Önerci
Keywords
Nasal physiology • Eustachian tube • Sniffing • Nose blowing • Sneezing • Otitic barotrauma • Sinus barotrauma • Toynbee phenomenon
Core Messages
• Normal functioning of the ear is closely related to the health status of the nose and paranasal sinuses. • Pathologies of the nose, sinuses, and nasopharynx play an important role in the cause, treatment, and sequelae of ear disease. • Sniffing creates negative pressure in the nose, in the nasopharynx, and in the middle ear, causing middle ear pathologies in patients with hyperpatent eustachian tube. • Nose blowing increases intranasal propelling viscous fluid into the paranasal sinuses and middle ear.
Ö.Ö. Çelebi, MD (*) Department of ENT, Hacettepe University School of Medicine, Sihhiye, Ankara 06600, Turkey e-mail: [email protected] T.M. Önerci, MD Department of Otorhinolaryngology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
• Sneezing elevates intranasal pressure tenfold times less compared to nose blowing. However, sneezing while the nasal passages are blocked may lead to an increase in nasopharyngeal pressure, causing a failure of the valve which protects the entrance to the eustachian tube. • The positive middle ear pressures with bilateral nasal obstruction are caused by tubal openings synchronized into the positive phase of nasopharyngeal pressure generation. • Increase in the environmental pressure in the presence of nasal obstruction interferes with eustachian tube functioning; thus, the tube may remain closed and may be “locked.” Continued increase causes barotrauma. The nose is located in the middle of the face and acts as an air conditioning unit, making the air that we breathe harmless for the body. Awareness of the interrelationship between the nose, middle ear, and lower airways has increased; the respiratory tract is considered to be an integrated system, and any process that affects one part of the system affects the other parts as well.
T.M. Önerci (ed.), Nasal Physiology and Pathophysiology of Nasal Disorders, DOI 10.1007/978-3-642-37250-6_40, © Springer-Verlag Berlin Heidelberg 2013
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The middle ear is connected to the other airfilled spaces of the upper respiratory tract via the eustachian tube. Politzer first suggested abnormal function of the ET as a cause of ear pathology more than 100 years ago. The eustachian tube is closed in its resting stage. It opens periodically during swallowing, yawning, and possibly at times during normal respiration, causing frequent alterations in middle ear pressure and thus equalizing middle ear pressure to atmospheric pressure. Normal functioning of the ear is closely related to, and depends on, the health status of the nose, paranasal sinuses, and the throat. Pathologies of the nose, sinuses, and nasopharynx play a very important role in the cause, treatment, and sequelae of ear disease. Upper respiratory tract infection is the most frequent cause of otitis media (Shah 1999). In some patients with na
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