I'm not a doctor or a freediver, and I'm barely a scuba diver at this point, but I witnessed an interesting exchange on this subject during my OW class. While we were taking the written final exam, a man walked into the dive shop, and my instructor got up to help him. (There was another employee in the back filling tanks, but we didn't really need our instructor at the moment.) I was kind of half-listening as the man talked at my instructor for what seemed like a long time about equalizing techniques and how she should be teaching us the Frenzel instead of the Valsalva maneuver. I wondered if he might be an instructor from another certification agency, but then I heard him talking about how he'd taught his 9-year-old daughter to freedive. After he'd finished his lecture and we finished our exam, I asked my instructor about it. She told me he wasn't an instructor or a scuba diver at all, just a freediver who was kind enough to take time out of his busy schedule to mansplain equalizing techniques to the local lady dive instructor. She also explained to us that freedivers usually descend more quickly and in a head-down position, which makes the Valsalva maneuver less effective, but without regulators in their mouths, some of the other equalizing techniques become a little easier. So perhaps that's the difference.