Cervical posture and nasal breathing in infancy.

Survival of infants born with bilateral choanal atresia or pyriform aperture stenosis who breathe orally, as well as experimental data, challenge the virtually axiomatic theory of 'obligatory' nose breathing of the neonate. The anatomical parameters leading to the infant's airway patency and to airway obstruction were studied on midsagittal anatomical sections of fetal and adult necks as well as in head and neck radiographs of infants. The most important anatomical parameter found to facilitate the switch from nasal to oral ventilation in human infants is a cervical extension, creating a physiological lordosis of the neck that results in an opening of the veloglossal and veloepiglottic sphincters.

Theoretic analysis of middle ear gas composition under conditions of nonphysiologic ventilation.

As gas flows in and out of the nasopharynx, the pressure in that region fluctuates. It drops below or rises above atmospheric pressure, which is itself not constant but is subject to changes in altitude and weather. Such pressure changes in the nasopharynx produce a pumping of gas into and out of the middle ear.

Transient pressure changes in the middle ear.

Transient increases in total pressure in the ear (1) during sleep, after hypoventilating in a supine position with a closed eustachian tube, and (2) after the partial pressures in middle-ear gas are lowered by a total pressure decrease and the eustachian tube is voluntarily maintained closed can be accounted for quantitatively on the basis of the standard mucosal gas exchange model and the following data: (1) partial pressures in tissue: pN2* = 573 mm Hg (7621 decaPascals [daPa]), pO2* = 40 mm Hg (532 daPa), pCO2* = 46 mm Hg (612 daPa), and pH2O* R = 47 mm Hg (625 daPa); (2) partial pressures in the nasopharynx: pN2' = 566 mm Hg (7528 daPa), pO2' = 120 mm Hg (1596 daPa), pCO2' = 27 mm Hg (359 daPa), and pH20' = 47 mm Hg (625 daPa); (3) a middle-ear gas space of 2 x 10(-5) m3; (4) an absorption rate for nitrogen, when the partial pressure difference is 1 atm, of 3 x 10(15) molecules per second; and (5) mucosal absorption rates for oxygen and carbon dioxide 1.8 and 34 times larger, respectively, than for nitrogen.