Otitis media with effusion (OME) is common in children but has a low prevalence in adults. There is some evidence to advocate middle ear inflation as a successful treatment for children with OME. This form of treatment is also recommended in the form of the Otovent nasal balloon, as part of conservative management of OME in children, by the National Institute for Health and Care Excellence (NICE). A South Korean team set out to do a pilot study evaluating the therapeutic effect of Valsalva manoeuvre in adults with OME with a view to planning a future prospective randomised control trial. They assessed 39 ears of 32 adult patients with OME, managed by one-week of Valsalva manoeuvre (>20/day). They measured their outcomes by means of Valsalva positivity under microscope or otoscope.

The mean duration of OME prior to intervention was 30.9 days. They found that one week of Valsalva manoeuvre was successful in 64.1% of patients. The success group had bulging of tympanic membrane on examination and improved air-bone gap on pure tone audiometry compared to the failure group.

The success of the treatment was sustained over a follow-up period of 8.2 weeks. Unfortunately, the study has several limitations. The number of cases is small, with a short follow-up period and surprisingly does not include tympanometry examination. Nevertheless, Valsalva manoeuvre, if taught properly to patients as in this study, has little morbidity and does not require a general anaesthetic as in Eustachian tuboplasty or grommet insertion. In the common clinical approach of initial conservative or medical management of OME in adults, a clinician could also consider educating patients about Valsalva manoeuvre due to its minimal morbidity but bearing in mind that there is no strong evidence to support its use.

A pilot study to investigate the therapeutic effect of Valsalva maneuver on otitis media with effusion in adults.
Han JJ, Park JM, Kim DK, et al.
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Praneta Kulloo

Lewisham and Greenwich NHS Trust, UK.

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