Could oxygen consumption by bacteria in the middle ear cavity be the cause for negative pressure in patients with otitis media?

Negative middle ear pressure is commonly seen in patients with otitis media. This space is invariably occupied by secretions causing middle ear effusion.

Probable causes of negative middle ear pressure in these patients:

1. Eustachean tube dysfunction: Hydrops ex vacuuo theroy proposed by Politzer about 100 years ago is still valid. This theory suggests that vacuum in the middle ear cavity is replaced by fluid. This is caused by transudation of fluid from the middle ear mucosa into the middle ear cavity.
2. Sniffing
3. Failure of clearance of effusion by the eustachean tube
4. Toyenbee's phenomenon: Stuffed nose causes Negative pressure in the middle ear cavity
5. Oxygen consumption by middle ear bacteria