Positive Intratympanic Pressure in the Morning and Its Etiology

Shinkawa, Hideichi; Okitsu, Takuji; Yusa, T; Yamamuro, Makoto; Kaneko, Yutaka

doi:10.3109/00016488709107358

Cited by 21 publications

(8 citation statements)

References 10 publications

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“…We found that the mean MEP after 4 hours of sleep was 41 daPa, which corroborates two earlier studies measuring an average MEP of 29 and 48 daPa immediately upon waking [1,2]. These values are significantly higher than the mean awake MEP of 3 daPa in the current study.…”

Section: Discussionsupporting

confidence: 94%

“…Many organ systems have normal physiologic changes during sleep. In patients without middle ear disease, studies have shown that MEP is most commonly positive upon waking, but quickly normalizes toward zero after swallowing and chewing maneuvers [1][2][3]. These findings suggest that middle ear and ET physiology also change during sleep.…”

Section: Introductionmentioning

confidence: 96%

“…ET dysfunction resulting in chronic negative MEP has been implicated in many significant otologic conditions including hearing loss, tympanic membrane (TM) retraction, and chronic otitis media. Prior studies evaluating middle ear and ET physiology have been performed on awake patients with normal or negative MEP [1][2][3]. To the authors' knowledge, no study to date has specifically investigated MEPs during sleep despite the fact that the average individual sleeps nearly a third of their lifetime.…”

Section: Introductionmentioning

confidence: 99%

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Middle ear pressure during sleep and the effects of continuous positive airway pressure

Thom

Carlson

Driscoll

et al. 2015

American Journal of Otolaryngology

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Middle ear pressure during sleep and the effects of continuous positive airway pressure

Thom

Carlson

Driscoll

et al. 2015

American Journal of Otolaryngology

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“…However, there are still many questions. A spontaneously arising ME pressure has been reported from studies with intermittent and indirect recordings of the pressure (1,2,8). The effect occurred seemingly without contribution from the ET.…”

Section: Introductionmentioning

confidence: 94%

Middle Ear Pressure: Effect of Body Position and Sleep

Tideholm

Brattmo²,

Carlborg³

1999

Acta Oto-Laryngologica

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The aim of this study was to investigate whether a middle ear (ME) pressure rise noted during sleep is an effect of the recumbent position, the state of sleep or Eustachian tube (ET) function, respectively. Eleven subjects with no history of ear disease were subjected to continuous, 24-h, direct ME pressure measurements and tubal function tests, respectively. At the start of the measurements the subjects were in the erect position. This position was maintained for at least 2 h (during which they were permitted to conduct normal everyday activities). The subjects then rested in the recumbent position for at least 2 h, after which they again resumed the erect position with normal activities for a period of at least 2 h. Then the subjects went to sleep in the recumbent position. A mean pressure rise in the ME of 36.4 daPa was seen during sleep compared with being awake in the same position. The rise was not caused by tubal opening and active insufflation of air via the ET. The number of tubal openings was significantly fewer during sleep compared with resting awake and the erect position, respectively. The ME pressure was not significantly different in the erect position compared with the recumbent position while resting awake. Tubal function tests demonstrated results in accordance with normal tubal function for all subjects. In conclusion, the state of sleep induced a ME pressure rise, not the recumbent position per se. These findings support the significance of a two-directional gas diffusion for regulation of the ME pressure.

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“…morning pressures) [7, 8], an increase in total ME pressure after partial evacuation of ME gas volume by sniffing or swallowing at relative ME underpressures [9, 10], and an increase in total ME pressure during hypo-ventilation and a decrease during hyper-ventilation [11, 12]. All of these conditions established transMEM CO2 and/or O2 pressure gradients with the subsequent change in total ME pressure attributable to gradient-driven exchange of those gases between blood and ME [8, 12, 13]. Other studies exposed the ME to atmospheric gas partial-pressures thereby creating significant blood to ME CO2 and ME to blood O2 transMEM gradients.…”

Section: Introductionmentioning

confidence: 99%

Transmucosal O2 and CO2 exchange rates for the human middle ear

et al. 2011

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Objective-Estimate the transmucosal CO2 and O2 rate-constants for adult middle ears (MEs).Methods-Ten adults with healthy MEs had a unilateral myringotomy. A custom-fitted acrylic mold with a valved line to a Mass Spectrometer (MS) and central tube coupled to a 3-way valve and connected to a pressure transducer (the probe) was sealed with adhesive glue within the ipsilateral ear-canal. A second 3-way valve was attached to the probe valve, a flow-regulated tank gas source and paired syringes. Volumes of the ME and probe were measured. On sequential days, the probe+ME was washed for 15-minutes with 6% O2, Balance N2 and 25% O2, 6% CO2, Balance N2 to create transmucosal CO2 and O2 gradients, respectively. After washing, the probe +ME was isolated from the gas source, and baseline and 10-minute gas samples were obtained for MS analysis of gas partial-pressures. The rates of change in ME CO2 and O2 pressures were divided by their established transmucosal gradients to yield CO2 and O2 rate-constants.Results-The average (±std) transmucosal CO2 and O2 rate-constants were 0.062±0.034 (N=10, range: 0.032-0.119) and 0.011±0.009 (N=8, range: 0.002-0.032) mmHg/min/mmHg, respectively. The average half-life for the CO2 and O2 gradient was 11.1 and 61.6 minutes. The average CO2:O2 rate-constant ratio was 8.1±4.0 (N=8, range 3.6-14.6).Conclusions-For adult human MEs, transmucosal CO2 exchange is rapid and much faster than transmucosal O2 exchange. The estimated CO2/O2 rate-constant ratio for the human ME is not consistent with that predicted for diffusion-limited gas exchange across a water-based barrier.

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Positive Intratympanic Pressure in the Morning and Its Etiology

Cited by 21 publications

References 10 publications

Middle ear pressure during sleep and the effects of continuous positive airway pressure

Middle ear pressure during sleep and the effects of continuous positive airway pressure

Middle Ear Pressure: Effect of Body Position and Sleep

Transmucosal O2 and CO2 exchange rates for the human middle ear

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