Are there any side effects from a CPAP? I have had one for eight years and have started getting recurrent fluid buildup in my ears without any other signs of possible infection.

D.

For readers who are unfamiliar with this device, CPAP stands for "continuous positive airway pressure." CPAP is a mask, worn during sleep, that blows air under pressure into a person's nose. This pressurized air forms a sort of "air cushion," keeping floppy tissues (like the soft palate and uvula) from obstructing the airway during sleep. CPAP is the treatment of choice for obstructive sleep apnea. It works 100 percent of the time, assuming the patient tolerates the device.

Your ear problems may or may not be related to CPAP. I have a hard time linking the two, primarily because you've used CPAP successfully for eight years.

Before I speculate on the nature of your ear problems, let's look at the possibility of a CPAP-ear connection. Behind the nasal cavities, at the "roof of the throat" (the nasopharynx), are two muscular arches known as the tori tubarius. The tori are the openings to the eustachian tubes, which are muscular/cartilaginous tubes that link the nasopharynx to the middle ear spaces (the air pockets behind each eardrum). These are the tubes you pop when you pop your ears.

The middle ears, eustachian tubes, nasal cavities and sinuses are all lined by respiratory mucosa, a very special tissue that secretes mucus and is lined by tiny hair-like projections known as cilia. Cilia wave back and forth rhythmically, propelling the mucus "blanket" toward the throat, where it's swallowed. Mucus not only lubricates tissues, it also humidifies the air we breathe, and it traps most of the dust, pollen, smoke and so forth that we inhale.

Cilia are delicate structures. Cigarette smoke can devastate the cilia. If the cilia are injured, the mucus blanket doesn't move -- it just sits there. It continues to trap particles, including viruses, bacteria and fungal spores, which would normally be swept into the throat, swallowed and destroyed by the stomach's acid and digestive enzymes. If the mucus moves poorly, these microorganisms may get a foothold, leading to infection.

What about CPAP? While not nearly as injurious as cigarette smoke, CPAP can nevertheless dry the respiratory mucosa of the nose and nasopharynx, making the mucus blanket more difficult to swallow. The drying effects of CPAP occasionally lead to other problems, such as nosebleeds, but I would not be surprised to find an association with sinusitis or ear infections. If this is your problem, the answer would be fairly simple: CPAP can be outfitted with a humidifier.
But why is this happening to you now, after eight years of successful CPAP use? I'm not going to be able to answer that one; you'll need to see an ear, nose and throat doctor (ENT). There is a lengthy list of possible explanations for your problem. Here are a few:

1. As discussed above, anything injurious to the cilia can promote ear infections. Aside from cigarette smoke and (maybe) CPAP, cilia may be injured by smog, solvents, cleaning fluids and more.
   
2. Inhalant allergies usually target the nose and eyes, but the tori tubarius are next-door neighbors to the nasal cavities. If you have developed new allergies recently, eustachian tube dysfunction would not be unexpected and, if severe enough, could lead to ear infection or fluid buildup in the middle ears.
   
3. Do you really have fluid buildup in your ears? Unless you were told this by an ENT, I would be a little suspicious of the diagnosis. One can have a sense of pressure in one's ears without an actual fluid buildup. You may, for example, have patulous eustachian tube dysfunction, a condition in which the eustachian tubes have an unusually open conformation.
   
4. If you really are getting fluid behind your eardrums, then it is important to mention one rare but serious cause for this problem: tumor. Tumors (malignant or benign) in the nasopharynx can cause severe eustachian tube dysfunction, leading to fluid buildup in the ears.
   

In summary: Your ear problem should not be written off to your use of CPAP. This problem deserves careful attention by an ENT.