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by tahnz0

tahnz0
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Join Date: Sep 2007
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Assistance - serous otitis media, valsalva manouvre
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Hi all,

i have a few more qns, im finding all your input really great and allows me to broaden my thinking. thankyou so much!!

case 1: Ian Adamson: Impaired communictaion related to otitis media

Ian Adamson, a four year old is admitted for investigation of gradual hearing loss in both ears. A provisional diagnosis of serous otitis media is made.

QN1: How should Ian be taught to perform the Valsalva Manoevre?
a)Compress both nostrils and ask him to blow out his cheeks with mouth closed
b) Place his hands over his ears and ask him to swollow hard
c) hold a tissue over his nose and mouth and ask him to blow hard
d) hold his breath and ask to swollow at the same time

my thoughts....

Valsalva discovered a muscle for opening the Eustachian tube. he discribed the manouevre that is named after him as a method to expel pus from a tympanic cavity to the external auditory canal.

i believe that otitis media is a form of dysfunction of the Eustachian tube, which leads to negative pressure and formation of liquid in the middle ear. After a short time of negative pressure the number of mucous producing glands incresaes in the middle ear causing production of liquid as a consequence. in addition reducing hearing ability and maybe otitis media.

i have read that the valsalva's manoeuvre is performed by pressing the nostrils together, closing the mouth and by means of the diaphragm pressure and increasing the pressure of the air in the mouth and nose cavity. The increased pressure so created is transplanted through the Eustachian tube and equalised the negative pressure in themiddle ear.
so this answer i feel supports answer A. although the paper also says that many children find it difficult to learn this technique.

so then i ask myself is there other teaching strategies to perform this manoevre that children can perform and learn correctly?

another piece i have read is the valsalvas manoevre is accomlished by gently blowing air in the middle ear while holding the nose, often called 'popping the ear'
this didnt give me a technique tho, so i couldnt say which answer that fits with, i had a play around with the techniques above. and they all effected the ear. although the most effective for me was technique A.

another reading, to equalise the pressure, pinch your nose shut and gently try to exhale through it. the air you are trying to exhale will be blocked by your pinched nose so it will end up in the dead air space in your ears, which equalises the pressure. swollowing also helps.
here agian i believe this supports A. and also D. as the reading said swollowing helps.

doesnt support B. or C. as they say to blow hard.

So in conclusion by reading what i have read, i believe the most effective would be definatly A. and if a child is unable to appropriatly perform this, D. is easy and i would feel less scary for a child to forcefully try and pop there ears.

so i have a toss up between A. and D.

what does anyone else feel? sorry this post was so long

[TeleRNer]

Re: Valsalva manoevre

I'm thinking A.
Don't you find it funny when someone is about to sneeze and they pinch their nose and you wonder if their ear drums are going to blow out in the process! I thought the Valsalva manouevre was when you were bearing down to relieve yourself of an impacted stool. Oh well, what do I know?!

[donster]

Re: Valsalva manoevre

I thought the same thing; we were taught that the Valsalva maneuver was bearing down as if one was to evacuate the bowels. This is supposed to increase the internal pressure, etc. and deprive the cells of O2.

[earle58]

Re: Valsalva manoevre

i say definitely a.
this maneuver exerts a lot more neg pressure than d.

leslie

[NurseNature]

Re: Valsalva manoevre

I was taught it's bearing down to poo. Used in L&D and also to lower heart rate in certain situations.

[Christie RN2006]

Re: Valsalva manoevre

I think A

my reasoning is because this happened to me when I was little I have a lot of trouble with my inner ears and still to this day I sometimes have to take medication or do things like that to help.

And to support my reasoning, check out this link http://en.wikipedia.org/wiki/Valsalva_maneuver

Vagal maneuver is where you bear down... I just looked it up and it can be called the Valsalva Maneuver too. Under this link scroll down to where is says "physical maneuvers" and read that section http://en.wikipedia.org/wiki/Suprave...ar_tachycardia

[jojotoo]

Re: Valsalva manoevre

Why would you want a kid with otitis media to do a Valsalva Manuever?

[Christie RN2006]

Re: Valsalva manoevre

Originally Posted by jojotoo

Why would you want a kid with otitis media to do a Valsalva Manuever?

http://en.wikipedia.org/wiki/Otitis_media

Go to "treatment" and it explains why it is used.

[jojotoo]

Re: Valsalva manoevre

Christie, thanks for the link. But now that I've read it, I still want to know why you would teach a child to do this if he might end up with conjunctivitis.

I've never seen this done/ taught in any ER that I worked in. Has anyone else? Is it a new treatment?

[Christie RN2006]

Re: Valsalva manoevre

Originally Posted by jojotoo

Christie, thanks for the link. But now that I've read it, I still want to know why you would teach a child to do this if he might end up with conjunctivitis.

I've never seen this done/ taught in any ER that I worked in. Has anyone else? Is it a new treatment?

I think it is more of an older treatment... I was taught to do it when I was a child 20 years ago and started having trouble with my ears. I think it is mostly doctors offices that teach this. I never got conjunctivitis from doing it. As a kid it was absolutely awful having constant pain/pressure in my ears and I had trouble hearing... everything sounded muted like I was underwater or something. That is why they taught me how to do it, I still occasionally have to do it, but due to figuring out other ways to help I don't have to nearly as much anymore. I have figured out how to "pop" my ears by swallowing or doing a yawning motion.