The Nose and the Eustachian Tube

Normal functioning of the ear is closely related to the health status of the nose and paranasal sinuses. Pathologies of the nose, sinuses, and nasopharynx play an important role in the cause, treatment, and sequelae of ear disease. Sniffing creates negative pressure in the nose, in the nasopharynx, and in the middle ear, causing middle ear pathologies in patients with hyperpatent eustachian tube. Nose blowing increases intranasal propelling viscous fluid into the paranasal sinuses and middle ear. Sneezing elevates intranasal pressure tenfold times less compared to nose blowing. However, sneezing while the nasal passages are blocked may lead to an increase in nasopharyngeal pressure, causing a failure of the valve which protects the entrance to the eustachian tube. The positive middle ear pressures with bilateral nasal obstruction are caused by tubal openings synchronized into the positive phase of nasopharyngeal pressure generation. Increase in the environmental pressure in the presence of nasal obstruction interferes with eustachian tube functioning; thus, the tube may remain closed and may be “locked.” Continued increase causes barotrauma.