Auto-inflation Methods and a Proposed Classification of the Eustachian Tube Patency

The Valsalva maneuver is recommended to clear a negative middle ear pressure. We describe two methods to improve the efficacy of auto-inflation procedures. The subjects of the study comprise 134 passengers, examined after flight.

Methods: after a flight, passengers were offered an ear examination, including otoscopy and tympanometry. If the middle ear pressure after flight were negative, the passengers were asked to perform a Valsalva maneuver after which tympanometry was repeated. If still negative, an extended Valsalva maneuver was performed. If still negative, the passenger was instructed to perform auto-inflation using a nasal balloon, after which tympanometry was repeated.

Results: among the 134 ears with initial negative middle ear pressures, 19 ears (14%) normalized the middle ear pressure after Valsalva’s maneuver. In the 115 passengers with a remaining negative pressure, the pressure was equalized to zero or positive pressure in 53 ears (46%). In the 62 ears with a remaining negative middle ear pressure after both Valsalva and extended Valsalva maneuver, 43 subjects (69%) could normalize the middle ear pressure after nasal balloon inflation. Nineteen subjects out of 134, still had a negative pressure after all the autoinflation procedures.