Valsalva Maneuver

Today I learned that the way that I alleviate the feeling of pressure behind my eardrum has a name. That name is the Valsalva maneuver. I learned the name because the German version of the Wikipedia page addressing endolymphatic or cochlear hydrops recommends using the Valsalva maneuver to reduce the chances that you might end up with vertigo later in life. Doctors told me for years that this thing that I had done to equalize pressure after swimming or being up in a plane had no effect on the early symptoms of Meniere’s and that it was hazardous to even attempt it. Because of this advice I stopped doing it regularly.

Little did I know that apparently the Valsalva is the thing to do in Germany. Forcing air into the middle ear should have no effect on the fluids of the inner ear; and yet for some reason, this appears to be suggested with a straight face as a treatment for early Meniere’s symptoms.

YouTubeDoc SkinnerValsalva Maneuver- what is it, how it works, how to use it for training

Just watching the video makes me think trying this could trigger vertigo, and I have gotten vertigo when straining to get the bowels working (I’ve always wondered what properly working bowels are like. I’ve never had those) which is described as being a similar effort.

Meniere’s disease is an inner ear problem. Cochlear hydrops is an inner ear problem. The German Wikipedia page refers to the disease as a middle ear problem, which it isn’t. Forcing air into the middle ear can alleviate eustachian tube blockage, but you can also rupture the eardrum doing that so it can be hazardous to perform the Valsalva. You can also pass out if you are standing up, so don’t even attempt it unless sitting down.

Hydrops is a fluid imbalance of the inner ear. As far as I know there is no way to regulate that fluid pressure using the Valsalva. There is no mention of Valsalva on the English version of both the Ménière’s disease Wikipedia page and the Cochlear hydrops page. It isn’t mentioned on the MDIC archive. It can be prescribed for atrial fibrillation, so it’s not like the English-speaking world is unaware of the maneuver, it just isn’t a thing that is mentioned in relation to treatment of Meneire’s disease anywhere other than that German Wikipedia page. Why is the German version so different?

Reading the English translation of the German is liable to turn into a drinking game (snail hole versus oval window, for example) If I could drink, that is. I can’t so I might as well be serious here. In Germany it is understood that 10% of the people who have cochlear hydrops develop Meniere’s disease later in life. In the English speaking world there doesn’t seem to be a distinction drawn between people who have the beginning stages of endolymphatic hydrops and those people who have full-blown Meniere’s disease. If you have hydrops they seem to be just diagnosing it as Meniere’s even if all the symptoms of Meniere’s disease are not present yet.

It appears that the belief that the Valsalva or the Frenzel maneuver (Working the tongue in the back of the throat can produce a similar pressure change in the middle ear. It is harder to do but can be done with less risk.) can improve the health of the inner ear by introducing oxygen-rich blood and oxygen bearing fresh air to the oxygen-starved inner ear. I don’t know if this is true or not and I lack the professional knowledge to determine if it is even plausible or not. There was a very small study conducted in Germany:

 A total of 12 patients (26%) had symptoms of vertigo, but only 4 patients (9%) developed the typical signs of full-blown Meniere’s disease with the typical inner-ear rotational vertigo over the course of 10 years. 6 of the 12 patients with vertigo (13%) suffered from psychogenic vertigo. Another patient (1%) had benign and treatable positional vertigo, and another (1%) had undergone surgery for acoustic neuroma and had postoperative gait unsteadiness.

Those results look promising, but the study isn’t large enough to be statistically significant and should be duplicated several more times before it could be ruled as reflecting something approaching a true finding.

This little stroll through alternative medical treatments for chronic illness has taught me a whole bunch of names for things that I didn’t know had names, whether or not it has informed me of valid treatments for my chronic illness. I’m going to blame my ignorance on the fact that I don’t speak German, don’t fly jet aircraft, don’t deep-sea dive or power lift. Yeah. That’s my excuse and I’m sticking with it. I sometimes inhale across the vocal cords (I think that’s what I’m doing) causing a vibration in the back of the throat that can sometimes work loose blockages in the eustachian tubes, too. Does that have a name, I wonder? I mean, other than the reaction of “gross!” or “that’s disgusting!” that making the noise generally produces. Probably not.

Author: RAnthony

I'm a freethinking, unapologetic liberal. I'm a former CAD guru with an architectural fetish. I'm a happily married father. I'm also a disabled Meniere's sufferer.

Attacks on arguments offered are appreciated and awaited. Attacks on the author will be deleted.

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