What to do if the Valsava manoeuvre doesn't work?

[NW6 1TH]

Hello everybody,

I am writing to ask you something on behalf of a friend who has found a problem during her OWD course, and doesn't know what to do. The instructor (the same as that from my own OWD course) doesn't have an answer. Everything went fine for my friend during the swimming pool sessions, but on going to the sea she started having trouble with her ears. I am going to translate exactly what she says (she doesn't speak English well).

"I don't seem to be able to do the Valsava manoeuvre correctly. No matter how hard I try to blow, my ears don't pop. It's funny, because they do so all the time when I'm going up or down a mountain, whenever I swallow. In the swimming pool, I had already seen how swallowing would equalize my ears without any problem... Well, there was a problem, which was aggravated during my sea dives: I don't seem to know how to swallow when my mouth is empty, and it's difficult for me to gather enough spit when underwater. My mouth is dry, and not being able to close it and make whatever movements I need to do to produce spit because of the regulator makes it even more difficult. As a result, all my four dives were a complete disaster, as I couldn't think of anything else, I kept on going upwards and downwards, yo-yo-like, so I couldn't be certified.

I know there is no problem with my ears. Last summer, I had to go to the ENT specialist to have a wax plug removed from one ear, and on commenting that I intended to do a diving course, he checked my ears' ability to compensate by making me open my mouth and applying pressure to my ears with a device. He said I could do it correctly, so I'm not worried about that. But I'm starting to get worried about the Valsava manoeuvre. So as not to fail again my next OWD course, I'm trying to practice it at home. I cannot make my ears pop, but after trying, I get a funny feeling in my ears for some time afterwards, and I'm afraid I may end up damaging my eardrums.

I must say that even though it took ages for me to gather spit and make my ears pop while descending, so I couldn't equalize too often, I didn't feel any pain in my ears at any moment, except when ascending. This is something I had already noticed in the swimming pool: my ears hurt when I'm going upwards. It's not a terrible pain, but it's there, and in the sea, where the ascent was from much deeper, my ears started popping non-stop too, blowing a continuous raspberry, which was sort of disconcerting. After having finished the dives, there was no pain, either, though my ears kept on popping whenever I swallowed for many hours afterwards."

This is the e-mail my friend has sent to me. Is there any way to know whether you're equalizing your ears often enough? Is the simple absence of pain a good indicator?

[ebt]

Fresnel method works for me…..as does not descending head first.

[James 1976]

I had issues with one ear when starting out, found that pinching the nose while blowing it and swallowing at the same time helped the ear pop. Its a bit difficult to do but keep at it, can be done on dry land aswell.

[John63]

Equalise often and gently

If it’s starting to hurt it’s too late

If the friend has no problems in airctsft and pool but only in open water is the hood too tight. Can form a seal over the ear and prevent effective equalisation. A finger in the side of the hood to can help if this is the issue

[NW6 1TH]

@ebt, thanks for mentioning the Fresnel method, which neither of us had heard about before. I've read an explanation on how it should be done, and it seems awfully complicated, but maybe some more reading or maybe watching videos will clarify it. My friend descended feet first.

@James 1976, isn't what you describe actually the Valsava manoeuvre plus swallowing? If swallowing alone is enough, and the Valsava manoeuvre doesn't work, I suppose this is as good -for my friend- as just swallowing, which she finds difficult to do (though effective when achieved).

@John63, that's exactly what my friend thought she should do. She was worried that she wasn't equalising often enough, and that worry is what prevented her from paying attention to buoyancy, trim and everything else, which resulted in her failing to get certified. She wasn't wearing a hood during the dives, so that wasn't the problem.

Actually, she was able to equalise perfectly well when she swallowed... The problem is that she couldn't swallow as often as she would have liked to. So I suppose the solution is either finding an alternative method which isn't the Valsava manoeuvre (we'll have a look at the Fresnel method mentioned above), or finding a trick that helps her produce spit more easily.

[Chrisch]

Sometimes people try too hard. This is quite common when learning to dive. Descending reasonably slowly you can just extend your jaw forward and this is often enough to equalise. Try it as you are sat there reading and you should hear a click as your jaw gets far enough forward. Personally I find I can usually equalise by doing this and need to do nothing else. When I first started diving I would equalise far too much and have given myself ear ache from time to time.

If your friend can equalise by swallowing there is not an underlying issue IMHO. Descend a bit slower and build confidence and above all else do not concentrate on the "problem" just enjoy the dive. Anxiety is normal for new and training divers and will settle down over time.

[sim667]

I always had ear problems when I first started, I was blatantly leaving it too long and trying to hard, resulting in perforating the same ear drum first. Nowadays I use a combination of valsalva and a gurn, I also use neil med sinus flushing before a days diving and it just loosens up the ears and gets everything moving nicely.

[Energy58]

Sometimes people try too hard. This is quite common when learning to dive. Descending reasonably slowly you can just extend your jaw forward and this is often enough to equalise. Try it as you are sat there reading and you should hear a click as your jaw gets far enough forward. Personally I find I can usually equalise by doing this and need to do nothing else. When I first started diving I would equalise far too much and have given myself ear ache from time to time.

If your friend can equalise by swallowing there is not an underlying issue IMHO. Descend a bit slower and build confidence and above all else do not concentrate on the "problem" just enjoy the dive. Anxiety is normal for new and training divers and will settle down over time.

^This; dont push it and start clearing early and often - I tell people who have problems "clear as soon as your head is under water".

[Finless]

Provided it is done very gently I always had success with pressurising a little bit in advance of the descent.

Certainly something that can be practised above water, in my experience.

[Edward3c]

Is the fit of the hood too tight, can prevent the outer ear equalising? Solution ensure water is allowed to enter the outer ear. I've had a few students with this problem.

As others have said equalise often and at small depth increments, I start at about 0.5 m and have 'cleared' every meter to about 10 before now.

[NW6 1TH]

Thanks a lot for all your help!

My friend doesn't think she has any physiological problem preventing her from equalising, since it immediately happens when she swallows. But since she says she needs something like 30 seconds to gather enough spit to be able to swallow, if she descends at the rate of one swallowing per meter, by the time she's reached the desired depth, she'll almost have to ascend again.

On top of that, she was scared she'd harm her eardrums by the force she had to apply when trying to do the Valsava manoeuvre. Since no matter how hard she tried, she only succeeded in equalising once using Valsava during alll her OWD dives, it looks like the VM has more risks than advantages for her, doesn't it?

In spite of all, she didn't have any ear problems after the dives (other than, as I said, her ears popping every time she swallowed for many hours afterwards). She just says that whenever she finally managed to swallow, the pop was incredibly loud (which I suppose proves pressure behind her eardrums had built up a lot, though not enough to cause any harm).

Gurning might be a solution. I'll let her know about it. If not, is there any way she could produce more spit underwater? Anxiety won't help, for sure, but the solution a well-meaning fellow OWD student suggested, chewing gum, sounds too crazy even to consider it.

[Vanny]

Does no one just pinch their nose anymore ?

[Ihsaan]

She doesn’t need to feel a pop occurring. If she can descend without pain then her ears are equalised.

[Divemouse]

This is true, mine have never popped - one might make a slight rushing sensation if I leave it too long, the other does nothing at all.

[NW6 1TH]

She doesn’t need to feel a pop occurring. If she can descend without pain then her ears are equalised.


This is true, mine have never popped - one might make a slight rushing sensation if I leave it too long, the other does nothing at all.

Oh, this changes everything. I've already told my friend about this, and she says she always expected the Valsava manoeuvre to cause a pop, like when swallowing (in my own case, it does, so that's how I know I've equalised correctly). If it's not so, she may have been hysterically blowing with her nose pinched when there was no need for it. She's not completely sure, though, because whenever she managed to swallow, the pop was loud, which she attributed to not having done it often enough.

Now she asks, does the slight pain when ascending mean anything? Should she also try to swallow or do the Valsava manoeuvre when going upwards? Our instructor (the same both for her and me) says we needn't do anything, but she says that's when she feels some discomfort in her ears (apart from the disconcerting raspberry).

Thanks once again!

[Ihsaan]

The slight pain on ascending indicates a reverse squeeze. She needs to try wiggling her jaw side to side and swallowing on ascending and maybe slow down her ascent.

[NW6 1TH]

The slight pain on ascending indicates a reverse squeeze. She needs to try wiggling her jaw side to side and swallowing on ascending and maybe slow down her ascent.

Is it dangerous if she doesn't do it? Is the difference of pressure in one direction dangerous, but not in the other? I cannot help her there, because I don't notice anything strange when ascending.

[steelemonkey]

Is it dangerous if she doesn't do it? Is the difference of pressure in one direction dangerous, but not in the other? I cannot help her there, because I don't notice anything strange when ascending.

Pain on ascending is caused by gas in the ear that is trapped. As it expands, it hurts. It could cause damage.

[Nickpicks]

Blocked ears whilst descending, or reverse block when ascending can both cause ruptured eardrums if the pressure isn't equalised. I don't think the eardrum is stronger in one direction than the other.

Most people don't notice their ears equalising on ascent, as the equalisation usually "just sorts itself out" whereas many people have to take action whilst descending (usually valsalva).

[NW6 1TH]

Thanks a lot! My friend says that then the raspberry she heard must have been the air coming out. But probably the fact that it was so long and so loud means too much air had already been expanding there, so even if it finally managed to escape, she'd better try to swallow also on ascending. They told us not to worry about equalising during ascent, but it seems some people must still be careful about it.

Now my friend is even more worried than before. She says that if gurning solves the problem, it'll be perfect, but otherwise, descending won't be the only stressful part of the dive for her. Let's hope she can equalise by moving her jaw.

[ebt]

There's lots of techniques you can use, yawning, wiggling your jaw, swallowing, lifting your chin..... etc etc.... but ultimately the best advice is do it often and take it slowly.

Once you traumatise the middle ear/eustachian tubes you risk making it all harder, possibly for days afterwards.

[Edward3c]

Thanks a lot! My friend says that then the raspberry she heard must have been the air coming out. But probably the fact that it was so long and so loud means too much air had already been expanding there, so even if it finally managed to escape, she'd better try to swallow also on ascending. They told us not to worry about equalising during ascent, but it seems some people must still be careful about it.

Now my friend is even more worried than before. She says that if gurning solves the problem, it'll be perfect, but otherwise, descending won't be the only stressful part of the dive for her. Let's hope she can equalise by moving her jaw.

There are a very small number of people, for one reason or another, can not equalise. I’ve only come across one in nearly 40 year teaching diving.

[Neilwood]

Blocked ears whilst descending, or reverse block when ascending can both cause ruptured eardrums if the pressure isn't equalised. I don't think the eardrum is stronger in one direction than the other.

Most people don't notice their ears equalising on ascent, as the equalisation usually "just sorts itself out" whereas many people have to take action whilst descending (usually valsalva).
I think the only problem generally is the speed of ascent not matching the speed of equalising (due to physical issues or congestion).

There's lots of techniques you can use, yawning, wiggling your jaw, swallowing, lifting your chin..... etc etc.... but ultimately the best advice is do it often and take it slowly.

Once you traumatise the middle ear/eustachian tubes you risk making it all harder, possibly for days afterwards.

As you note the best advice is do it often and take it slowly. Also equalise BEFORE there is any pressure build up both ascending and descending. Done this way there should never be any pain or ear damage.