Tubal Closing Failure in Retraction Type Cholesteatoma and Adhesive Middle Ear Lesions

In cases of retraction type cholesteatoma and related conditions it has been observed that the Eustachian tube may show a reduced ability to withstand respiratory pressure variations. The reduced resistance of the tube may play an important role in the development and course of middle ear disease. In the present study 42 subjects who had middle ear disease of this type and confirmed habitual sniffing behaviour were examined for symptoms and signs that would indicate a patulous tube. Different degrees of malfunction were recognized: in the presence of total closing failure, with an intermittently free transfer of respiratory pressures to the middle ear, the sniffing procedure maintains a negative intratympanic pressure. The condition is identical to the patulous tube state in the classical sense. In relative closing failure there is no free pressure transfer, and no patulous tube symptoms. Sniffing may however cause a repeated evacuation of the middle ear space. The results of this study cast doubt upon the conventional views on tubal malfunction in middle ear disease, and indicate a need for reconsidering the etiology of these lesions.