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
Scuba divers do it to equalize their ears and bubbles come out of their ears. I do it on planes a lot. It's hard to get a kid to do it b/c it kinda hurts at first and you feel like you are going to blow out your eardrums or something, but you don't. At least I haven't yet.
NurseNature
128 Posts
Scuba divers do it to equalize their ears and bubbles come out of their ears. I do it on planes a lot. It's hard to get a kid to do it b/c it kinda hurts at first and you feel like you are going to blow out your eardrums or something, but you don't. At least I haven't yet.