
Ear clearing or clearing the ears or equalization is any of various maneuvers to equalize the pressure in the
middle ear with the
outside pressure, by letting air enter along the
Eustachian tube
In anatomy, the Eustachian tube, also known as the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately long and in d ...
s, as this does not always happen automatically when the pressure in the middle ear is lower than the outside pressure. This need can arise in
scuba diving
Scuba diving is a mode of underwater diving whereby divers use breathing equipment that is completely independent of a surface air supply. The name "scuba", an acronym for "Self-Contained Underwater Breathing Apparatus", was coined by Chris ...
,
freediving
Freediving, free-diving, free diving, breath-hold diving, or skin diving is a form of underwater diving that relies on breath-holding until resurfacing rather than the use of breathing apparatus such as scuba gear.
Besides the limits of breath-h ...
/
spearfishing,
skydiving, fast descent in an
aircraft
An aircraft is a vehicle that is able to fly by gaining support from the air. It counters the force of gravity by using either static lift or by using the dynamic lift of an airfoil, or in a few cases the downward thrust from jet engines ...
, fast descent in a
mine cage
Shaft mining or shaft sinking is the action of excavating a mine shaft from the top down, where there is initially no access to the bottom. Shallow shafts, typically sunk for civil engineering projects, differ greatly in execution method from ...
, and being put into pressure in a
caisson or similar pressure-bearing structure, or sometimes even simply travelling at fast speeds in an
automobile
A car or automobile is a motor vehicle with Wheel, wheels. Most definitions of ''cars'' say that they run primarily on roads, Car seat, seat one to eight people, have four wheels, and mainly transport private transport#Personal transport, pe ...
.
People who do intense weight lifting, like squats, may experience sudden conductive hearing loss due to air pressure building up inside the ear. They are advised to engage in an ear clearing method to relieve pressure, or pain if any.
Methods
The ears can be cleared by various methods,
some of which pose a distinct risk of
barotrauma
Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or contact with, the body and the surrounding gas or liquid. The initial damage is usually due to over-stretching the tissues in tensio ...
including perforation of the eardrum:
*
Yawning which helps to open the eustachian tubes;
[
* ]Swallowing
Swallowing, sometimes called deglutition in scientific contexts, is the process in the human or animal body that allows for a substance to pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. Swallowing i ...
which helps to open the eustachian tubes;[
* The " Frenzel maneuver":] Using the rear part of the tongue and throat muscles, close the nostrils, and close the back of the throat as if straining to lift a weight. Then make the sound of the letter "K." This pushes the back of the tongue upward, compressing air into the openings of the eustachian tubes.
* "Politzerization
Politzerization, also called the Politzer maneuver or method, is a medical procedure that involves inflating the middle ear by blowing air up the nose during the act of swallowing. It is often performed to reopen the Eustachian tube and equalis ...
": a medical procedure that involves inflating the middle ear by blowing air up the nose during the act of swallowing;
* The "Toynbee maneuver Toynbee is a surname. Notable people with the surname include:
* Arnold Toynbee (1852–1883), British economic historian
* Arnold Joseph Toynbee (1889–1975), British historian
* Geoffrey Toynbee (1885–1914), English cricketer
* Henry Toynbe ...
": pinching the nose and swallowing. Swallowing pulls open the eustachian tubes while the movement of the tongue, with the nose closed, compresses air which passes through the tubes to the middle ear.[
* The "]Valsalva maneuver
The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air out as if blowing up a balloon. Variations of the maneuver can ...
": pinching the nose and closing the mouth and trying to breathe out through the nose. If the hand cannot reach the nose, it is possible to learn to pinch the nose shut by the action of two small face muscles called compressor naris
The nasalis muscle is a sphincter-like muscle of the nose. It has a transverse part and an alar part. It compresses the nasal cartilages, and can "flare" the nostrils. Some people can use it to close the nostrils to prevent entry of water when un ...
. This is the first technique normally taught, but needs to be performed gently to lessen side-effects.
* The "Lowry Technique". A combination of Valsalva and Toynbee: pinching the nose to close the nostrils, and blow and swallow at the same time.
The nose can be closed without using a hand, using the compressor naris
The nasalis muscle is a sphincter-like muscle of the nose. It has a transverse part and an alar part. It compresses the nasal cartilages, and can "flare" the nostrils. Some people can use it to close the nostrils to prevent entry of water when un ...
muscles; it can be described as "wrinkling the nose as if there was a bad smell". A hand cannot be got to the nose if using a full facemask. Many eyes-and-nose diving masks have two small pockets in their underside, or are like goggles with the soft edge extended downwards over the nose, to let two fingers reach the nose and pinch it.
* The "Edmonds Technique". While tensing the soft palate (the soft tissue at the back of the roof of the mouth) and throat muscles and pushing the jaw forward and down, do a Valsalva maneuver.[
*Voluntary opening of the eustachian tubes French: (BTV) is a method of equalising or clearing the ears described by doctor Georges Delonca and used in ]scuba diving
Scuba diving is a mode of underwater diving whereby divers use breathing equipment that is completely independent of a surface air supply. The name "scuba", an acronym for "Self-Contained Underwater Breathing Apparatus", was coined by Chris ...
and freediving. It aims to rebalance the pressure
Pressure (symbol: ''p'' or ''P'') is the force applied perpendicular to the surface of an object per unit area over which that force is distributed. Gauge pressure (also spelled ''gage'' pressure)The preferred spelling varies by country and e ...
between the external ear and middle ear.
The subject must either exercise a voluntary control of the tensor veli palatini muscles opening the eustachian tubes, or move the jaw to open the tubes when necessary. Another description of the method is to tense the muscles of the soft palate and the throat while pushing the jaw forward and down as if starting to yawn. This should pull the eustachian tubes open.
This is less easy to execute than the Valsalva maneuver
The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air out as if blowing up a balloon. Variations of the maneuver can ...
, but the BTV is the gentlest method to clear the ears. However, not all divers can perform this maneuver. It may be necessary to engage in ear training exercises to train the muscles to perform this maneuver.*: Some people are able to voluntarily hold their Eustachian tubes open continuously for a period of several seconds to minutes. The 'clicking your ears' can actually be heard if one puts one's ear to another person's ear for them to hear the clicking sound. Those that are borderline on learning this voluntary control first discover this via yawning or swallowing or other means; which after practice can be done deliberately without force even when there are no pressure issues involved. When the Eustachian Tubes are deliberately held open, one's voice sounds louder in one's head than when they are closed.
No single method is considered safest or most successful in equalization of the middle ear pressure. Using alternative techniques may improve the success individually when a technique fails.
Precautions
The pressure difference between the middle ear and the outside, if not released, can result in a burst eardrum
In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear
The outer ear, external ear, or auris externa is the extern ...
. This damages hearing, and if this occurs underwater, cold water in the middle ear chills the inner ear
The inner ear (internal ear, auris interna) is the innermost part of the vertebrate ear. In vertebrates, the inner ear is mainly responsible for sound detection and balance. In mammals, it consists of the bony labyrinth, a hollow cavity in the ...
, causing vertigo. The pressure difference can also cause damage to other body air spaces, such as the paranasal sinus
Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the ethmoidal sinuses are between the eyes and the sphenoid ...
es. This can also be caused by damaged sinus ducts.
To allow successful equalization when diving, it is important that the diving suit hood not make an airtight seal over the outside ear hole, and that earplugs not be worn.[ Diving is proscribed when a eustachian tube is congested or blocked, such as can occur with the ]common cold
The common cold or the cold is a viral infectious disease of the upper respiratory tract that primarily affects the respiratory mucosa of the nose, throat, sinuses, and larynx. Signs and symptoms may appear fewer than two days after exposu ...
, as this may cause what is known as a ''reverse block'', whereby descent is uninhibited as the Valsalva maneuver may still clear the eustachian tubes temporarily by force, but during ascent a blockage may stop the air in the middle ear (which is now at depth pressure) from escaping as the diver ascends. The eardrum then bursts outwards, causing the same hazards as with an ordinary burst eardrum, such as cold water in the middle ear deranging the working of the sense organs of balance in the inner ear.
Decongestants
Nasal congestion may affect the sinus openings and the eustachian tubes and may lead to difficulty or inability to clear the ears.
To prevent congestion, allergies can be treated by the use of antihistamine
Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides re ...
s, decongestants and nasal spray
Nasal sprays are used to deliver medications locally in the nasal cavities or systemically. They are used locally for conditions such as nasal congestion and allergic rhinitis. In some situations, the nasal delivery route is preferred for syste ...
s, and allergy desensitization
Allergen immunotherapy, also known as desensitization or hypo-sensitization, is a medical treatment for environmental allergies, such as insect bites, and asthma. Immunotherapy involves exposing people to larger and larger amounts of allergen in ...
. Recently developed antihistamines do not cross the blood–brain barrier
The blood–brain barrier (BBB) is a highly selective semipermeable membrane, semipermeable border of endothelium, endothelial cells that prevents solutes in the circulating blood from ''non-selectively'' crossing into the extracellular fluid of ...
and do not produce drowsiness, but may only be available by prescription.
Decongestants can have side effects such as speeding up heart rate which may have adverse effects in cases where there is underlying cardiovascular disease. Over-the-counter nasal sprays can produce a rebound effect causing greater congestion when the effect wears off, which can lead to reversed ear blockage on ascent. Some steroid nasal sprays do not have this side effect and can be very effective, but may also only be available by prescription.
Combinations of the same drugs are useful in non-allergic rhinitis. These medications can be very useful in controlling the nasal congestion problem.
Training
Divers get training in clearing the ears before being allowed to dive.[ Because of the potential for side effects of the valsalva maneuver, scuba divers and free-divers may train to exercise the muscles that open the Eustachian tubes in a gentler manner. The French underwater association (]Fédération Française d'Études et de Sports Sous-Marins
The (FFESSM) is a French sports federation specialized in recreational and competition underwater sports, like scuba diving and freediving. It is the main diver training organization in France.
The historical ancestor of the federation was cre ...
) has produced a series of exercises using the tongue and soft palate
The soft palate (also known as the velum, palatal velum, or muscular palate) is, in mammals, the soft tissue constituting the back of the roof of the mouth. The soft palate is part of the palate of the mouth; the other part is the hard palate. ...
to assist a diver in clearing their ears by these techniques. These recommendations were based on work done at the Médecine du sport, Bd st Marcel, Paris.
With practice it is possible for some people to close the nostrils hands-free by contracting the compressor naris
The nasalis muscle is a sphincter-like muscle of the nose. It has a transverse part and an alar part. It compresses the nasal cartilages, and can "flare" the nostrils. Some people can use it to close the nostrils to prevent entry of water when un ...
muscles.
See also
*
References
{{Authority control
Ear procedures
Otorhinolaryngology
Aviation medicine
Diving medicine
Underwater diving safety
Underwater diving procedures