Fred Y. Lin, MD and Richard K. Gurgel, MD, contributed equally to the article, and both are considered first authors.
Article first published online: 17 JAN 2012
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 3, pages 688–690, March 2012
How to Cite
Lin, F. Y., Gurgel, R. K., Popelka, G. R. and Capasso, R. (2012), The effect of continuous positive airway pressure on middle ear pressure. The Laryngoscope, 122: 688–690. doi: 10.1002/lary.22442
Presented at the Scientific Research Poster Session of the American Academy of Otolaryngology–Head and Neck Surgery Foundation Annual Meeting, San Francisco, California, U.S.A., September 11–14, 2011.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 21 FEB 2012
- Article first published online: 17 JAN 2012
- Accepted manuscript online: 7 NOV 2011 11:01AM EST
- Manuscript Accepted: 13 OCT 2011
- Manuscript Revised: 11 OCT 2011
- Manuscript Received: 14 SEP 2011
- obstructive sleep apnea;
- continuous positive airway pressure;
- middle ear pressure;
- eustachian tube;
- sleep medicine;
- Level of Evidence: 2b.
While continuous positive airway pressure (CPAP) is commonly used for obstructive sleep apnea treatment, its effect on middle ear pressure is unknown. The purpose of this study was to measure the effect of CPAP on middle ear pressure and describe the correlation between CPAP levels and middle ear pressures.
Retrospective review of normal tympanometry values and a prospective cohort evaluation of subjects' tympanometric values while using CPAP at distinct pressure levels.
A total of 3,066 tympanograms were evaluated to determine the normal range of middle ear pressures. Ten subjects with no known history of eustachian tube dysfunction or obstructive sleep apnea had standard tympanometry measurements while wearing a CPAP device. Measurements were taken at baseline and with CPAP air pressures of 0, 5, 10, and 15 cm H2O.
The percentage of normal control patients with middle ear pressures above 40 daPa was 0.03%. In the study population, prior to a swallowing maneuver to open the eustachian tube, average middle ear pressures were 21.67 daPa, 22.63 daPa, 20.42, daPa, and 21.58 daPa with CPAP pressures of 0, 5, 10, and 15 cm H20, respectively. After swallowing, average middle ear air pressures were 18.83 daPa, 46.75 daPa, 82.17 daPa, and 129.17 daPa with CPAP pressures of 0, 5, 10, and 15 cm H20, respectively. The postswallow Pearson correlation coefficient correlating CPAP and middle ear pressures was 0.783 (P < 0.001).
Middle ear air pressure is directly proportional to CPAP air pressure in subjects with normal eustachian tube function. Middle ear pressure reaches supraphysiologic levels at even minimal CPAP levels. Although further investigation is necessary, there may be otologic implications for patients who are chronically CPAP dependent. These findings may also influence the perioperative practice of otologic and skull base surgeons.