Straws Don’t Suck

Educational Objective: There exists a belief that straws should not be used after endoscopic cranial base surgery. The warning against straws has made its way into discharge instructions for sinus precautions despite a lack of evidence and literature. It has been hypothesized that the negative pressure created within the nasal cavity while drinking from a straw has a potential unfavorable effect on the operative site, especially in patients who have undergone dural repair. The goal of this study is to show that straws do not actually alter the pressure within the nose compared with normal deglutition.

Methods: A previously validated cadaveric model using intracranial sensor catheters has proved to be a reliable technique for measuring sinonasal pressures. Sensors were placed in the midnasal cavity of 20 healthy individuals. Pressures within the nose were recorded while participants drank water and a milkshake from a cup and from a straw. Measurements were taken both with and without the soft part of the nose pinched closed to simulate postoperative nasal obstruction.

Results: The average pressure in the nasal cavity while drinking water from a cup was −0.86 cm H₂O, while drinking water from a straw was −1.09 cm H₂O, and while pinching the nose and using a straw was −0.81 cm H₂O. The average pressure in the nasal cavity while drinking a milkshake from a cup was −0.98 cm H₂O, while drinking a milkshake from a straw was −1.88 cm H₂O, and while pinching the nose and using a straw was −1.37 cm H₂O. There was no statistically significant difference in pressure when comparing any of these tasks and consistencies (p > 0.05).

Conclusion: The pressure within the nasal cavity while drinking from a straw is not statistically different from the pressure generated while drinking from a cup. We propose that it is likely safe for patients to use straws after sinus and skull base surgery.