Otovent Versus Valsalva: Physiological Insights for Diagnostic and Therapeutic Autoinflation in Eustachian Tube Dysfunction.

Abstract

Autoinflation aids assessment of Eustachian tube function, or as a conservative treatment for obstructive Eustachian tube dysfunction. This study compares the physiological characteristics of 2 autoinflation techniques, the Otovent® device and the Valsalva manoeuvre, to inform clinical application for both diagnosis and therapy. Prospective physiological study. Tertiary academic teaching hospital. Twenty-one healthy adult volunteers performed 3 trials of both the Otovent and Valsalva manoeuvres. A linear mixed-effects model (LMM) was used as the primary analysis to compare the mean maximum and plateau nasopharyngeal pressures. Intra-subject repeatability was assessed using the intraclass correlation coefficient (ICC), while inter-subject consistency was evaluated by comparing standard deviations. Eustachian tube (ET) opening rates were measured via tubo-tympano-aerodynamic-graphy, otoscopy, and participant report. The Valsalva manoeuvre generated significantly higher nasopharyngeal pressures. Mean maximum NP pressure for Valsalva (597.5 daPa) was greater than for Otovent (482.3 daPa) (F(1, 104) = 18.82, P < .001). This difference was more pronounced for plateau pressures (Valsalva: 486.0 daPa vs Otovent: 278.0 daPa; F(1, 104) = 126.42, P < .001). Conversely, the Otovent demonstrated markedly superior consistency, showing higher intra-subject repeatability for plateau pressure (ICC = 0.872 vs 0.572) and substantially less intersubject variability (SD ± 39.8 daPa vs ±144 daPa). ET opening rates were comparable between the 2 techniques. Otovent facilitates autoinflation at lower but significantly more consistent pressures than Valsalva. Thus, Otovent may offer greater clinical value when a controlled, repeatable insufflation pressure is required for diagnostic or therapeutic purposes.