In Reply.—I have no reason to doubt that in a certain percentage of normal persons a large change in pressure in the middle ear could lead to a vestibular reaction. Tjernstrom1 found that the prerequisite for a vestibular reaction was an "overpressure" of 60 cm of water in the middle ear and that about 7% of normal subjects demonstrated this pressure before spontaneous equilibration via passive opening of the Eustachian tube. He furthermore showed that "underpressure" or negative pressure, applied to the middle ear, did not induce any vestibular reaction. Drs Becker and Clemis found nystagmus that was induced in six of 15 normal persons, as recorded with eyes closed with the use of electronystagmographic (ENG) monitoring. In my study, the standard Politzer bag with an olive tip was used to exert both positive and negative pressures, and certainly this technique is capable of pressure changes in the
NADOL JB. Positive Fistula Test-Reply. Arch Otolaryngol. 1979;105(5):301. doi:10.1001/archotol.1979.00790170071026
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