Mastoid and Tympanic Membrane as Pressure Buffers: A Quantitative Study in a Middle Ear Cleft Model

The tympanic membrane (TM) and mastoid air cells are measurable pressure buffers of the middle ear (ME).Pressure homeostasis of the ME is maintained approximately atmospheric by mechanisms that neutralize (buffer) pressure fluctuations, two of which are the TM and mastoid.Negative pressures were induced by volume changes in an artificial ME model. Those were recorded directly while using a rigid or a flexible TM with "mastoids" of various sizes.In the rigid TM model, the volume changes correlated linearly with the induced pressures and were confirmed to fit Boyle's law. In the flexible TM model, the pressure/volume correlation was nonlinear up to -50 mmH2O, where the TM was maximally displaced (approximately 25 mm3), became rigid, and constituted 75%, 41%, and 33% of the buffering gained in tandem with the "mastoid" in a model having a "mastoid" of 0, 5, and 10 mL, respectively. Altogether, a large "mastoid" required a greater volume change than a small one to induce the same pressure.The mastoid air volume "dilutes" pressure changes relatively to its size: the volume change required to alter a given pressure in an average (6 mL) mastoid is six-fold that which is needed in a small (1 mL) mastoid. ME volume reduction by TM retraction buffer negative ME pressures. This maximal ME volume change is constant for a "normal" TM. Therefore, it is the ME with the small mastoid that is most vulnerable to pressure changes and may develop compensatory buffering mechanisms, e.g., additional TM retraction (atelectasis) and/or ME volume reduction by fluid accumulation.