Straws Don't Suck: Are Straws Dangerous after Endoscopic Skull Base Surgery?

Abstract

Objective Patients undergoing endoscopic endonasal surgery have historically been restricted from using straws postoperatively, due to the concern that this activity generates negative pressure. The objective of this study is to evaluate the pressure dynamics in the sinonasal cavity associated with the use of a straw. Methods Intracranial pressure catheters were placed in the nasal cavity of 20 healthy individuals. Pressure measurements were then recorded while participants drank liquids of different viscosities from a cup and from a straw. Measurements were recorded with and without subjects occluding their nose to simulate postoperative nasal obstruction. Results The average pressure in the nasal cavity while drinking water from a cup was −0.86 cmH2O, from a straw was −1.09 cmH2O, and while occluding the nose and using a straw was −0.81 cmH2O. The average pressure in the nasal cavity while drinking a milkshake from a cup was −0.98 cmH2O, from a straw was −1.88 cmH2O, and while occluding the nose and using a straw was −1.37 cmH2O. There was no statistically significant difference in pressure measurements when comparing either task or consistency (p > 0.05). Conclusion Straw use is not associated with the generation of significant negative pressure in the nasal cavity. The pressure generated when drinking from a straw is not significantly different from that of drinking from a cup. This data suggest that straw use may be safe for patients following endoscopic skull base surgery, but further investigation is warranted.

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

“…In a series of 20 healthy subjects, Reilly et al. found that drinking from a straw did not generate a significantly greater amount of negative intranasal pressure than did drinking from a cup, regardless of fluid viscosity (e.g., water, milkshake) 102 . Similar findings were also observed in the context of nasal occlusion.…”

“…Similarly, the evidence on straw use in patients after ESBS is limited. 6,102 Straw use has a theoretical risk of increasing sinonasal negative pressure and increasing CSF leak risk, which must be considered when counseling patients postoperatively. Although a prospective series by Reilly et al recently demonstrated straw use to not be associated with significant negative pressure in the nasal cavity (i.e., no significant difference compared to drinking from a cup), 102 straw use in ESBS has not been thoroughly investigated in the clinical setting.…”

“…6,102 Straw use has a theoretical risk of increasing sinonasal negative pressure and increasing CSF leak risk, which must be considered when counseling patients postoperatively. Although a prospective series by Reilly et al recently demonstrated straw use to not be associated with significant negative pressure in the nasal cavity (i.e., no significant difference compared to drinking from a cup), 102 straw use in ESBS has not been thoroughly investigated in the clinical setting. Finally, there are limited studies on postoperative activity restriction, including, but not limited to, heavy lifting, flying, driving, and marital relations.…”

“…Future studies with higher levels of evidence are required to assess their impact on optimal skull base management. Similarly, the evidence on straw use in patients after ESBS is limited 6,102 . Straw use has a theoretical risk of increasing sinonasal negative pressure and increasing CSF leak risk, which must be considered when counseling patients postoperatively.…”