Straws Don't Suck: Are Straws Dangerous after Endoscopic Skull Base Surgery?

 Patients undergoing endoscopic endonasal surgery have historically been restricted from using straws postoperatively, due to the concern that this activity generates negative pressure. The objective of this study is to evaluate the pressure dynamics in the sinonasal cavity associated with the use of a straw.  Intracranial pressure catheters were placed in the nasal cavity of 20 healthy individuals. Pressure measurements were then recorded while participants drank liquids of different viscosities from a cup and from a straw. Measurements were recorded with and without subjects occluding their nose to simulate postoperative nasal obstruction.  The average pressure in the nasal cavity while drinking water from a cup was -0.86 cmH O, from a straw was -1.09 cmH O, and while occluding the nose and using a straw was -0.81 cmH O. The average pressure in the nasal cavity while drinking a milkshake from a cup was -0.98 cmH O, from a straw was -1.88 cmH O, and while occluding the nose and using a straw was -1.37 cmH O. There was no statistically significant difference in pressure measurements when comparing either task or consistency ( > 0.05).  Straw use is not associated with the generation of significant negative pressure in the nasal cavity. The pressure generated when drinking from a straw is not significantly different from that of drinking from a cup. This data suggest that straw use may be safe for patients following endoscopic skull base surgery, but further investigation is warranted.