The Valsalva maneuver is a simple technique used to equalize air pressure in the middle ear space. This procedure involves a controlled attempt to exhale forcefully against a closed airway, which helps relieve the feeling of fullness or blockage in the ears. Pressure equalization is needed when surrounding air pressure changes rapidly, such as during air travel or diving. This technique prevents discomfort and potential damage caused by an imbalance between external atmospheric pressure and internal pressure behind the eardrum.
How the Valsalva Maneuver Works
The Valsalva maneuver centers on the Eustachian tubes, which are narrow passages connecting the middle ear to the back of the throat (nasopharynx). These tubes regulate air pressure and drain fluid from the middle ear cavity. Normally, the Eustachian tubes are closed, opening briefly when a person swallows or yawns.
A pressure differential, often called barotrauma, occurs when the air pressure outside the eardrum and the air pressure inside the middle ear are unequal. When forced exhalation is performed against a closed mouth and nose, it increases the air pressure within the nasopharynx. This surge of pressure mechanically forces the Eustachian tubes open.
Air then rushes from the throat into the middle ear, instantly equalizing the pressure on both sides of the eardrum. This equalization provides relief from symptoms like muffled hearing, ear pain, or the sensation of a blocked ear.
Step-by-Step Instructions for Ear Clearing
To begin the maneuver, find a comfortable position, such as sitting upright, and take a deep breath. The upright posture helps ensure optimal airway alignment. Close your mouth completely and use your fingers to firmly pinch your nostrils shut.
The next step is to exhale gently, but with a steady effort, as if you were trying to blow up a small balloon. This forced exhalation should be a controlled push of air toward the back of the nose and throat. The goal is to generate just enough pressure to hear a slight “pop” or feel a change in pressure in your ears.
Apply gentle force for only a few seconds, as excessive straining is unnecessary and carries risks. Once the pressure is equalized, release your nose and inhale slowly. If the ears do not clear after the first attempt, you may repeat the process, but always maintain a low level of force.
Important Safety Precautions and Warning Signs
While the Valsalva maneuver is a simple technique, performing it improperly or too aggressively can cause damage to the delicate structures of the ear. The most significant risk comes from exhaling too forcefully, which can potentially lead to a ruptured eardrum. Excessive pressure can also cause internal ear damage, such as a rupture of the round window membrane, which is a serious injury requiring medical attention.
Individuals with certain pre-existing conditions should avoid the Valsalva maneuver entirely. Contraindications include a known or suspected perforated eardrum, or a history of recent ear trauma or surgery. The maneuver should also not be attempted during an active or severe ear infection or a severe cold, as this could push infected mucus into the middle ear.
If you feel sudden, sharp, or severe pain during the maneuver, stop immediately. People with certain cardiovascular conditions, like high blood pressure, heart valve diseases, or a risk for stroke, should exercise caution or consult a doctor before using the technique due to the transient changes in heart rate and blood pressure it causes. The maneuver also increases pressure in the eyes, making it inadvisable for those with retinopathy or intraocular lens implants.
Alternatives to the Valsalva Maneuver
If the Valsalva maneuver is ineffective or contraindicated, several gentler methods can help achieve pressure equalization. The simplest techniques involve stimulating the muscles that naturally open the Eustachian tubes. Swallowing, yawning, or chewing gum, which increases saliva production, often helps to pull the tubes open.
A common alternative is the Toynbee maneuver, which involves pinching the nostrils closed and then swallowing repeatedly. Using over-the-counter nasal decongestant sprays or oral medications beforehand may also reduce swelling in the nasal passages, making equalization easier. For persistent blockage, a specialized device like an Otovent can be used, which involves blowing a balloon through the nose to open the tubes.