{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:49:57Z","timestamp":1791874197283,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To systematically review the literature evaluating the effects of positive airway pressure (PAP) on the middle ear and to perform a meta\u2010analysis of its impact on middle ear pressure (MEP), tympanic membrane (TM) morphology, and hearing outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>Pubmed, MEDLINE, OVID, Scopus, Web of Science, and the Cochrane Library.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was performed from database inception through November 1, 2025, following PRISMA guidelines. Studies reporting quantitative middle ear outcomes following PAP were included. Meta\u2010analyses were performed using a random\u2010effects model of MEP, TM retraction grade, and pure tone average (PTA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine studies met inclusion criteria. PAP therapy demonstrated a significant dose\u2010dependent increase in MEP (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.9516,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Meta\u2010analysis of MEP at a setting of 10\u2009cm\u2009H\n                      <jats:sub>2<\/jats:sub>\n                      0 showed a pooled mean increase of 51.4\u2009daPa (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001). Swallowing was found to be a prerequisite for significant pressure transfer to the middle ear. In patients with Eustachian tube dysfunction and TM retraction, continuous PAP use was associated with significant morphological improvement in TM retractions (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) and a mean improvement in PTA of 7.3\u2009dB HL (95% CI 3.45, 11.17,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PAP increases MEP in a dose\u2010dependent manner, a finding of interest to otologic surgeons. In addition to its role in sleep medicine, PAP therapy may serve as a noninvasive treatment for chronic Eustachian tube dysfunction and TM retraction. Further prospective studies are needed to guide management conclusions for otologic patients utilizing PAP, particularly in the postoperative setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70959","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:17:54Z","timestamp":1791872274000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effects of Positive Airway Pressure on the Middle Ear: Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8675-6890","authenticated-orcid":false,"given":"Joseph","family":"Krivda","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery Madigan Army Medical Center  Tacoma Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Lewis\u2010Cruz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery Madigan Army Medical Center  Tacoma Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Nygren","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery Madigan Army Medical Center  Tacoma Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macario","family":"Camacho","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery Tripler Army Medical Center  Honolulu Hawaii USA"},{"name":"Department of Surgery Uniformed Services University  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Ruhl","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery Madigan Army Medical Center  Tacoma Washington USA"},{"name":"Department of Surgery Uniformed Services University  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1816152"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7640"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20102600(19)30198\u20105"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13616"},{"issue":"5","key":"e_1_2_11_6_1","first-page":"120","article-title":"Obstructive Sleep Apnea and Stroke","volume":"2","author":"Jehan S.","year":"2018","journal-title":"Sleep Medicine and Disorders"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001043"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.4466"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7638"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26752"},{"issue":"2","key":"e_1_2_11_11_1","first-page":"146","article-title":"Otic Barotrauma Resulting From Continuous Positive Airway Pressure: Case Report and Literature Review","volume":"16","author":"McCormick J. 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