XV Ventilation of the Normal and Blocked Middle Ear

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Abstract
The middle ear can be ventilated by various methods. The Valsalva maneuver, currently recommended by the Air Force as a method for inflating the middle ear, is described and its shortcomings for use in modern aviation are pointed out. Although the Valsalva maneuver serves adequately to ventilate the blocked ear in most cases, its predisposition to cause syncope and its relative inefficiency warrant re-evaluation of alternate methods. It is proposed that the rather lengthy name of "nasopharyngeal positive pressure maneuver" be replaced by the shorter term, "Frenzel maneuver," placing it in its rightful category beside the Valsalva and Toynbee maneuvers. If further studies bear out its greater efficiency, it might be advantageous to the Air Force to adopt the Frenzel maneuver as a recommended means for voluntary middle ear inflation. The reason given for this proposal is 3-fold: the eustachian tube opens at a lower pressure with the Frenzel maneuver than with the Valsalva, equal or higher maximum pressures can be developed with the Frenzel maneuver, giving an additional safety factor and accomplishment of the Frenzel maneuver is entirely independent of intrathoracic pressure and phase of respiration. Thus, there is no tendency for production of syncope during performance of the Frenzel maneuver. In addition, end-expiratory performance of the Frenzel maneuver may facilitate the equilibration of gases within the middle ear with the ambient atmosphere. This is of considerable advantage in the prevention of oxygen-absorption barotitis. The Frenzel maneuver may also be of benefit in the treatment of chronic serous otitis media. The relative advantages and disadvantages of the Toynbee maneuver, politzerization, and eustachian tube catheterization are also discussed.

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