Avoid the Valsalva Maneuver for Equalizing!

Please register or login

Welcome to ScubaBoard, the world's largest scuba diving community. Registration is not required to read the forums, but we encourage you to join. Joining has its benefits and enables you to participate in the discussions.

Benefits of registering include

  • Ability to post and comment on topics and discussions.
  • A Free photo gallery to share your dive photos with the world.
  • You can make this box go away

Joining is quick and easy. Log in or Register now!

After seeing this thread, I asked my son's Ear, Nose & Throat (ENT) doctor -- who is also a diver -- about this. He said that he uses the Valsalva method, and that it is generally unlikely that someone would create enough pressure to damage their ears that way. He did say that problems might arise if you both inhaled and exhaled that way (which would flex the eardrum both in and out) but as long as you only exhaled it should usually not be a concern. Disclaimer: I'm not a medical doctor, consult your own ENT.
 
it is generally unlikely that someone would create enough pressure to damage their ears that way.
Interesting. I wonder about all those posts on SB that the new diver blew too hard and damaged his ears?
And so on....
 
Interesting. I wonder about all those posts on SB that the new diver blew too hard and damaged his ears?
And so on....
I haven't read all of those, but a couple of things: (1) he didn't say it was impossible, but unlikely if a person was being reasonable; (2) from a quick look it's not clear whether any of those both inhaled and exhaled, and some of those are just asking if possible, not saying it was clearly connected (and some admitted to doing it unreasonably hard); and (3) even if all of those cases were caused by Valsalva that is a bit anecdotal considering hundreds of thousands (or more?) are taught to use the Valsalva method. As I said, consult your own ENT.
 
How do you do Marcante-Odaglia? I'm not finding any good resources online that do a good job of clearly demonstrating how to execute this technique?
Marcante-Odaglia was the "secret" method employed during WW2 by Italian Gamma men (and one woman).
The method was formalized after the end of war by Duilio Marcante, one of pioneers of formalised scuba training, which possibly was introduced to him by Luigi Ferraro, the most successful Gamma man during the war, and the first scuba instructor for recreational diving courses, started by Ferraro in 1949.
For understanding the physiology of this equalization method Duilio Marcante asked for help to one of his friends and diving pioneer, prof. Odaglia, one of the first specialists in hyperbaric medicine.
They published a paper around 1952 describing the method (in Italian).
Some years later, when this method was largely employed here by the community of recreational scuba divers who were using the ARO CC pure-oxygen rebreathers, an alternative method emerged in the community of spearfish free divers, the Frenzel method, also developed during WW2 for aircraft pilots.
The two methods share some common points:
1) pinch your nose
2) create internal pressure without using lungs.
But the two methods differ about how this pressure is created.
In Frenzel the pressure comes by the tongue, which is arched up, compressing the soft tissue separating the mouth from the nose. Hence Frenzel is done usually with the mouth closed and without breathing. The three main valves of our airways (lips, soft palate and epiglottis) are held closed.
Instead people using the ARO did not like to remove the mouthpiece for practicing the pure Frenzel, they preferred to keep the mouth and the epiglottis open, and being able to continue the very slow respiratory cycle required by the ARO without interruption.
So in the Marcante-Odaglia method the tongue is not used. The tongue is a powerful muscle: without it, the pressure generated is much smaller than with pure Frenzel (or Valsalva).
The only muscle available for the Marcante-Odaglia is the palatine muscle, the one which raises the soft palate and closes the passage of air between mouth and nose.
Almost all people can control voluntarily this muscle: for example when you blow through a pipe making bubbles in the water in a glass, or when you fill a balloon with your mouth.
So, learning to shut close your soft palate is easy. The problem is that doing just this, with the nostrils closed, causes just a modest overpressure inside the naval cavity, which could not be enough for opening the tubes, if they are congested.
Hence Marcante Odaglia is very easy to teach and practice, but unfortunately is not as powerful and effective as Valsalva or Frenzel. The latter, indeed, is much more complex, as it requires to coordinate the motion of the tongue against the soft palate in a quite unnatural way, which can cause vomit to some people, and generally is not so easy to teach and to learn.
Hence I consider the pure Frenzel, and the even more complex (but more powerful) Frenzel-Fattah methods as advanced methods which are only advisable for deep free divers or competitive spearfish hunters.
For us, normal rec divers, the Marcante-Odaglia is a good option, if our tubes can be opened easily. When they can't, you have to resort to good old Valsalva (or to BTV if you are lucky, having voluntary control of the small muscles which act directly on the tubes, with no involvment of tongue, glottis, jaw or soft palate).
Back to Marcante-Odaglia: despite the advantages of this method, it started to fade out also here in Italy, after Duilio Marcante passed away, in 1985. Previously almost all Italian diving instructors were trained by him in the Federal Didactical Center in Nervi (near Genoa).
I was there twice, in 1978 and 1982, so I learned this method (and its history) directly from him.
Instructors trained elsewhere did not learn this method, and of course they did not teach it to their students. Furthermore, many people got the erroneous understanding that Marcante-Odaglia and Frenzel are basically the same.
So I can understand how nowadays it is difficult to have proper information about the Marcante-Odaglia method. It is clearly described in his books, which indeed were never translated.
Hence I fear that this method will progressively disappear. I am probably one of the very last instructors who were so lucky to be trained directly by Duilio Marcante (and so unlucky to having been a patient of prof. Odaglia, but this is another story).
 
I haven't read all of those, but a couple of things: (1) he didn't say it was impossible, but unlikely if a person was being reasonable; (2) from a quick look it's not clear whether any of those both inhaled and exhaled, and some of those are just asking if possible, not saying it was clearly connected (and some admitted to doing it unreasonably hard); and (3) even if all of those cases were caused by Valsalva that is a bit anecdotal considering hundreds of thousands (or more?) are taught to use the Valsalva method. As I said, consult your own ENT.
@doctormike
 
Wow. I was unaware there were so many people named after clearing techniques. Seems like anyone can chalk up their name to equalizing!

Short of an actual physiological reason for difficulty with EQ'ing, I've been surprised over two decades how many people I've run into who don't know "popping your ears" (as in equalizing, not rupturing, for the verbiage police.) Once you describe altitude changes, plane rides, etc., people tend to get it.

Round window ruptures I assume are covered across all agencies for initial certification, although, don't hold me to that. If it isn't, it should be. PADI goes into good detail regarding EQ'ing, the results of not doing it or doing it improperly, and what reverse squeezes are about.

Can't say I've run into anyone that had a reverse. If I have, they didn't mention it. There have been two occasions, maybe three, where I've had a student who seemed to have sniffles who have said "oh I'm good to go, I took (insert random OTC antihistamines) this morning!" Nnnnnnnoope. Not even pool.
 
Yep, I equalise before I descend.
I also stretch my Eustachian tubes the night before. Maybe these things could assist in prevent injury.
How do you do that? Stretch your tubes I mean
 
I never thought of actually blowing. Trying it now I can't get the pressure up. I think I've always done variations of soft pallet/k sound plus pinching. I can't do it with just my jaw as I really need to move my jaw a lot. I'd spit my reg out!
 
I agree, but it is a matter of priority. To my students I always presented a number of equalization methos, including Valsalva. But the order I always used is:
1) BTV, as this is what I did always use, and I think is the best. 1/5 of the students are done with it.
2) Marcante-Odaglia. A lot of people already use it, mostly thinking it is Valsalva (possibly even you). Some other think it is Frenzel. But it does not have the drawbacks of Valsalva, nor those of pure Frenzel. Let say that another 1/5 of the students can perform easily this method. All the others could (as it is much easier than Frenzel), but it requires doing exercises, so let's leave the remaining 3/5 for now.
3) Toynbee. Swallowing is easy and effective for a small number of students. We can assume a third 1/5 of the students are done immediately with Toynbee.
4) Valsalva. Here we are addressing the remaining 2/5 of students, those with more problems, who cannot manage any of the previous 3 methods without some specific training. Valsalva is simple, and is immediately succesfull for half of these remaining students.
5) the last group of 1/5 of students still have problems equalizing, due to a combination of factors.These include narrow tubes, chronical inflammation (smokers), anxiety, lack of control, etc.
These students are not done in one lesson, they require specific training lasting as much as 10 one-hour lessons in a deep swimming pool. For these students often it is necessary to resort to some of the most advanced techniques, which combine a basic Valsalva with something else (Lowry, for example).
As you see I did not include Frenzel in the list. I think Frenzel is worth to be taught only to deep free divers, no need of Frenzel for scuba divers, who have plenty of time descending slowly and equalizing at will.
In conclusion, Valsalva is one of the many methods available. It should never be the first choice, in my opinion, as several other methods are available, which are both easier and safer for a minority of students.
Valsalva should not be demonised, indeed: it can be the right method for the largest group of students.
But I find barely stupid to ask a student who can succesfully equalise using BTV, Marcante-Odaglia or Toynbee to use Valsalva.
Of course a Valsalva done properly is just marginally more dangerous than other methods, and definitely less dangerous than not getting proper equalization.
So it is just matter of presenting the various methods in a reasonable order, and then let each student to become proficient in the method which works better for him/her, including Valsalva.
What I do not like is presenting Valsalva as the first, better method for everyone.
Your priority list is different than mine, because this is all subjective based on biased personal opinions. I prioritize based on probability of success, if you rate BTV success rate as 1/5, I would not put it on top.
Anyone can pinch their noses and blow or swallow, there is no barrier for learning Valsalva and Toynbee like ability to control muscles that you did not know otherwise existed.
You can not verify how a student is able to equlize, you just depend on what they say. So, I assume they have no special talent or case and start from most simple to learn: Valsalva and Toynbee. If they can succeed, they can safely try other, more advanced techniques as well. If we start scaremongering Valsalva, we will create an environment where beginners will be worried to do most basic technique, this is potentially more dangerous as we want them to equilize timely and correctly and whichever technique they might be using.
 
If we start scaremongering Valsalva, we will create an environment where beginners will be worried to do most basic technique, this is potentially more dangerous as we want them to equilize timely and correctly and whichever technique they might be using.
So facts are scaremongering? LOL.
Yes, of course we want beginners to equalize timely and correctly, but the problem is when we ASSUME all students can successfully do a proper Valsalva. That is demonstrably untrue. They need to understand the point is to equalize, not to do a Valsalva, and there are several ways to equalize, each with pros and cons. The cons of Valsalva are insufficiently mentioned, and the pros of other simple methods are rarely mentioned. There is a broad spectrum between Valsalva and something requiring being able to wiggle your ears; it is a false dichotomy to say that anything other than Valsalva is too hard to teach and too hard to do.
 

Back
Top Bottom