Incidence of sniff-related cholesteatomas.

High negative middle ear pressure created by habitual sniffing in patients with insufficient closure of the Eustachian tube has been claimed by Magnuson and colleagues to be an important causative factor of acquired cholesteatomas. The present study was conducted to ascertain the rate and types of cholesteatomas in which habitual sniffing is involved. Among 105 consecutive patients with acquired cholesteatomas (112 ears: 93 flaccida type, 15 tensa type, 4 extensive type), 27 patients (31 ears) were diagnosed as having a habitual sniff in response to aural discomfort resulting from insufficient closure of the Eustachian tube. This corresponds to 25.7% of the patients, which is significantly higher than the prevalence of habitual sniffing in normal subjects, being 2 out of 130 (1.5%) (p < 0.005: chi2-test). Habitual sniffing was found to be statistically more common in flaccida-type than in the tensa-type cholesteatomas. Habitual sniffing in response to aural discomfort was thus found to be an important risk factor for cholesteatomas. However, investigations into other pathogeneses of cholesteatomas should be continued, since the sniff-related cases reported here were limited to one-fourth of the cases of acquired cholesteatomas studied.