A comparative study on efficiency of middle ear pressure equalization techniques in healthy volunteers

Abstract Objective To compare success rates of middle ear inflation device (Ear Popper© ), Valsalva maneuver and Toynbee maneuver in middle ear pressure equalization in healthy adults. Materials and methods Adult volunteers with otoscopically healthy ears were enrolled to the study. In a prospective setting, 60 ears of 35 volunteers were divided into two groups according to eustachian tube (ET) functions tested using the nine step inflation deflation test. Group A: good eustachian tube function at nine step inflation deflation test (30 ears), Group B: possible dysfunction of the ET at nine step inflation deflation test (30 ears). All the volunteers performed Valsalva maneuver, Toynbee maneuver and Ear Popper© application, respectively. The efficiencies of all the three techniques were statistically compared first overall, then paired-wise between the two groups. Results There was no statistical difference in success rates of middle ear pressure equalization techniques in 60 ears, regardless of ET function results (Valsalva and Toynbee maneuvers 51.7% effective, Ear Popper© 43.3% effective). There was also no statistical difference among the middle ear pressure shifts obtained by these three techniques. In almost half of the subjects in whom at least one technique was unsuccessful, the other two was effective. When the groups were separately compared; there was no significant difference between Valsalva and Toynbee maneuvers, whereas Ear Popper© was found more effective in Group A (56.7% vs. 30%, p = 0.037). Conclusion No statistical difference in equalization of the middle ear pressure was found among Valsalva maneuvers, Toynbee maneuvers and Ear Popper© in healthy adults under physiological conditions. Using alternative techniques may improve the success individually when a technique fails.