Autophony: A normal middle ear contains air so that the eardrum can vibrate and efficiently transfer sound to the inner ear. Air enters the middle ear through the eustachian tube (tube that runs from the back of the nose to the front of the middle ear space). If the eustachian tube gets blocked then air cannot get into the middle ear, and negative pressure (vacuum) develops. This can result in fluid being drawn into the middle ear space, which then may become infected with bacteria, producing a middle ear infection (otitis media). In some patients, middle ear fluid can be relieved by “popping” the ears. This can be done by holding the nostrils and blowing air out to force air into the ears through the eustachian tubes, or by using a Mathes inflation bulb while swallowing. If the fluid is infected, antibiotics may help clear it up. When this is not successful, a myringotomy (tiny lancing incision in the ear drum) may be performed to drain the fluid from the middle ear. This usually results in immediate improvement in symptoms.