Rebuttal from James P. Butler, Robert L. Owens, Atul Malhotra and Andrew Wellman

摘要

We challenge the arguments presented in the 'PRO' side of this debate by our friends and colleagues, Schwartz & Smith (2013), in two important areas.(1) They claim that the effective peri-pharyngeal pressure is P_crit. We dispute this on several grounds. Pcrit itself is a construct, most often measured by extrapolation to the intraluminal pressure that would be required to effect near or complete obstruction (Gleadhill et al. 1991). The appropriate peripharyngeal pressure for a Starling resistor would be analogous to peri-bronchial pressure in intrathoracic airways, which is a relatively well denned concept (Mead et al. 1970). But absent a significant stress jump across the air/tissue interface in the pharynx, there is a continuous pressure variation in the tissues from intraluminal pressure to atmospheric pressure at the body surface (Strohl et al. 2012).