This study aimed to investigate the relationship between the use of different types of masks (N95/filtering facepiece type 2, surgical) and Eustachian tube dysfunction in healthcare workers.

The study included 37 healthcare workers using N95/filtering facepiece type 2 masks and 35 using surgical masks for at least 6 hours per day, and 42 volunteers who are not healthcare workers using surgical masks for less than 6 hours per day. Participants’ demographic features, clinical data and Eustachian Tube Dysfunction Questionnaire scores were compared.

The frequencies of autophony and aural fullness were significantly higher in the healthcare workers using N95/filtering facepiece type 2 masks. Autophony and aural fullness were significantly greater in the post-mask period than the pre-mask period. Middle-ear peak pressures and Eustachian Tube Dysfunction Questionnaire scores were higher in healthcare workers who used N95/filtering facepiece type 2 masks.

Healthcare workers who used N95/filtering facepiece type 2 masks had worsened middle-ear pressures and Eustachian Tube Dysfunction Questionnaire scores. Use of N95/filtering facepiece type 2 masks was associated with higher rates of autophony, aural fullness and higher Eustachian Tube Dysfunction Questionnaire scores in the post-mask period.

To determine whether: the N95 respirator affects nasal valve patency; placement on the bony vault improves patency; and external nasal anatomy affects the outcome.

A prospective study with 50 participants was conducted. Nasal patency was measured by the minimal cross-sectional area via acoustic rhinometry, and using the Nasal Obstruction Symptom Evaluation survey, before and after wearing the N95 respirator and after adjustment.

The minimal cross-sectional area was narrowed by 27 per cent when wearing the N95 respirator (p < 0.001), and improved by 9.2 per cent after adjustment (p = 0.003). The total Nasal Obstruction Symptom Evaluation score increased from 10.2 to 25.4 after donning the N95 respirator (p < 0.001), and decreased from 25.4 to 15.6 after adjustment (p < 0.001). There was no correlation with external nasal anatomy parameters.

Wearing the N95 respirator causes narrowing of the nasal valve, and adjustment onto the bony vault improves symptoms. The findings were not affected by external nasal anatomy.