The character and consequences of disturbing sound sensations in retraction type middle ear disease

Objective: Transient sound disturbances are common but neglected symptoms i n retraction type middle ear disease (R-MED), The aim of this study was to explore and describe their character, their individual consequences, and th eir role in the development of tympanic membrane retractions. Methods: Fift y-three subjects with manifest retractions and experiences of disturbing so und and ear sensations were interviewed. A qualitative method was used for analysis of the transcribed interviews. Results: Two different patterns eme rged from the interviews, 1. Too weak sound was the least common and most t olerable disturbance. It occurred in 45% and was eliminated by Valsalva's i nflation. 2. Sudden and transient sensations of too loud and piercing sound , and intermittent autophony frequently caused intense and intolerable disc omfort, which might in turn cause loss of control of speech and conversatio n. These types occurred in 74% and 60%, respectively, and were eliminated b y evacuating the middle ear, for example by sniffing. Subjects who describe d too loud sound or intermittent autophony commonly preferred a retracted t ympanic membrane position. This may explain why pressure equalization by sw allowing, and inflation by Valsalva's manoeuvre often elicited discomfort. Conclusions: Transient experiences of too loud sound or intermittent autoph ony may indicate a shift of sound preference towards the sound experienced at negative middle ear pressure, and an unreliable tubal function in the se nse that it fails to stay closed to protect the ear from sounds and pressur e variations in the nasopharynx. Such experiences of altered sound may trig ger evacuation of the middle ear, which eliminates the sound disturbance. I t is crucial to identify, interpret, and explain the disturbances correctly in the therapy and prevention of retractions, since habitual evacuation ex poses the tympanic membrane to strong negative pressure loads and a subsequ ent risk of developing retraction. (C) 1999 Elsevier Science Ireland Ltd. A ll rights reserved.