New contributions to the theory of air pressure regulation mechanisms in the middle ear: The Eustachian tube resting ventilation and mastoid core hypotheses

• A Novel Perspective on the Mechanisms of Eustachian Tube (ET) Dysfunction. • New hypotheses on Middle Ear Pressure: ET Resting Ventilation and Mastoid Core. • A clearer explanation of the associations between types of otitis media. The mechanism underlying middle ear air pressure regulation remains unclear, and the intrinsic links between related middle ear disorders such as acute otitis media (AOM), chronic suppurative otitis media (CSOM), and otitis media with effusion (OME) have not been adequately elucidated. The possibility of mucus blanket bubble formation and connection in the Eustachian tube (ET) lumen, inflammation that can alter gas exchange in the middle ear fissure, potential presence of bacteria in OME, and the unique role of the mastoid in the treatment of CSOM support our hypothesis regarding resting ET ventilation and the mastoid core. We aimed to refine the current theory of middle ear air pressure regulation. The intrinsic connections between middle ear disorders, such as AOM, CSOM, and OME, can be more rationally explained through this hypothesis. Further, it also clarifies how inflammation, the mastoid, middle ear, and ET interact in these disorders.