Basic Skills Review: The Valsalva Maneuver

The Valsalva Maneuver, named after 17th century anatomist Antonio Maria Valsalva, is a method that can be used to equalize pressure in the ears during a scuba diving descent. First we’ll review how to do the Valsalva maneuver and how it works, and then talk about a couple of refinements and alternatives. Although all scuba students learn this maneuver in their intro course, Divers Alert Network reports that ear injuries still account for up to one third of all of their calls for medical advice. They also publish a brochure on avoiding ear and sinus injuries that’s available at many dive shops and via their website, for free.

The human ear is normally designed to respond to very rapid pressure vibrations by sensing the movement of the eardrum, enabling us to hear sounds. Slower and longer pressure changes, such as those caused by flying or diving, can bend the eardrum or even tear it if the pressure isn’t kept equal on each side of the membrane. This equalization is accomplished by movement of air through the narrow Eustachian tube (named after 16th century anatomist Eustachius – in case you hadn’t already guessed, the tradition in medicine is to name things not based on their function, but on their discoverer, much to the chagrin of med students). The Eustachian tube system is adapted to deal best with relatively slow pressure changes over several hours or more. When we speed things up by diving to depths greater than a couple of feet, the system can often use a little help from us. Luckily, the other end of your Eustachian tube ends inside your mouth (well, pharynx), and this is where the Valsalva maneuver comes in. By closing your lips and pinching your nose, then exhaling GENTLY, you can move air into your Eustachian tube, and equalize pressure on descent. Obviously, the Valsalva maneuver is for descending to higher pressures, not ascending to lower pressures.

TIPS: In general, Eustachian tubes can be finicky, and they should be treated gently. Always perform your first Valsalva maneuver at the surface, before beginning your descent.  NEVER exhale forcefully to perform a Valsalva maneuver; if you can’t clear your ears during descent, ascend to a shallower depth and try again, even if this eventually means ascending to the surface to solve the problem. This is because increased pressure which hasn’t been equalized can pinch the tubes shut, and ascending will help them re-open. Forcing your Valsalva may also irritate the Eustachian tubes and cause swelling, which can make subsequent equalization more difficult.

A couple of other tips can also open the Eustachian tubes if the basic Valsalva maneuver isn’t working; there’s no reason not to incorporate these extras every time if they work well for you. One is to tilt your head back, so that you’re looking up at the surface of the water. Because the Valsalva is performed on descent, divers commonly automatically look down to see where they’re headed, but tilting your head up when clearing your ears works best. On this note, if your dive buddy is having trouble equalizing, don’t descend below them- it makes them look down at you, which hampers their Valsalva maneuver, and also may make them feel pressured to keep up, when they should be ascending instead if they’re having any trouble. Finally, extending your lower jaw straight out into a sort of underbite can also help a lot for some people.

CONGESTION: Eustachian tubes have an additional function: draining fluids from the inside of the eardrum, particularly in the case of ear infection or head congestion. In these situations, your ability to clear your ears is compromised, and the most prudent course is to avoid diving with any ear infections or head colds. You may be tempted to plan or begin a dive in this condition, only to have things worsen just before or during the dive, potentially leading to an ear injury. Although you may hear divers mention that some decongestants such as pseudoephedrine (Sudafed, etc.) can help to open Eustachian tubes, and they’re used for this purpose in non-diving contexts, most dive training agencies and dive operators recommend against their use for this purpose when diving, in part because even if they are effective for you, short-acting medications may wear off during a dive, and leave you back in a bad situation. Again, the safest choice is to dive again another day rather than risk injury.

OTHER METHODS: Some divers find swallowing alone is enough to open their Eustachian tubes, or sealing their tongue against the roof of their mouth and exhaling, or even stretching their jaw in a chewing motion. These methods can be gentler when effective, but are harder to teach to new divers, and are more commonly used by flight attendants and pilots, who deal with much slower pressure changes than divers. If you’re able to clear your ears this way, in addition to being gentler, it has the advantage of leaving both hands free since you don’t have to pinch your nose.

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One Response

  1. […] to pressure changes and often requires equalization (”popping your ears” with the valsalva manuever being one efficient way) to ease the discomfort and shortness of breathe due to the decreased […]

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