Efficacy of Middle Ear Inflation with the Head Tilted Fully Forward for the Treatment of Otitis Media with Effusion

If the head is tilted fully forward during middle ear (ME) inflation, the tympanic opening of the eustachian tube will be positioned below the ME, and the injected air is expected to be able to drain the intratympanic effusion. To investigate this hypothesis, serial pure-tone audiometries were performed prior to ME inflation, after inflation with the head straight up as usual, and with the head tilted forward. Eight ears (six patients aged between 14 and 87 years) with middle-ear effusion and an air-bone gap of more than 20 dB were included. The mean improvement in air conduction across all seven frequencies was 10.2 dBHL in the upright position of the head, and 18.2 dBHL with the head tilted forward during ME inflation (P<0.001), and in all cases, the air-bone gap almost disappeared. In one case, high-resolution computed tomography was performed, which revealed an effusion-free middle ear after ME inflation with the head tilted forward. We concluded that tympanic effusion can be efficiently drained if ME inflation is performed with the head tilted fully forward.