Middle ear pressures were assessed by tympanometry in a group of 56 children with concurrent or recent middle ear effusions, prior to myringotomy and tympanostomy tube insertion. Following myringotomy, the ventilatory function of the Eustachian tube was studied. Of the 104 ears tested, 76 (73%) had measured premyringotomy middle ear pressure between −100 and −400 mm H2O, or indeterminate middle ear pressure. Following myringotomy, most of the Eustachian tubes of children with prior otitis appeared to be more “floppy,” when compared with tubes of patients with traumatic perforations and an otherwise negative otologic history. Certain hypotheses have been presented regarding the mechanics of the system constituted by the nasal cavity, nasopharynx, Eustachian tube, middle ear and mastoid air cells as they influence susceptibility to, and persistence of, middle ear effusions.

A prospective study was carried out which tested three hypotheses: 1) certain tumors of the head and neck that originate in sites other than the nasopharynx may cause middle ear effusion; 2) middle ear effusion is a predictable sequela of radical maxillectomy as well as total or partial resection of the soft palate; and 3) middle ear effusions that follow surgery to remove head and neck lesions are due to disturbances in palatal function, specifically to tensor veli palatini muscle dysfunction. Our results indicate that one fourth of all subjects had some evidence of middle ear abnormality prior to entering into treatment although they were asymptomatic. The treatment process influenced the function of the middle ear, as 79% of the subjects experienced middle ear-eustachian tube dysfunction following treatment, and 23% were found to have developed a perforation of the tympanic membrane or required myringotomy and tube insertion to relieve middle ear effusion. The results of these studies indicate that surgery that is adequate to remove cancer of the maxilla, tonsil, or palate in most cases interferes with the function of the tensor veli palatini muscle, resulting in functional eustachian tube obstruction. The need for attention to and the treatment of middle ear effusion in such patients is emphasized in light of other sensory deficits in this patient population.