When Can Children Perform Valsalva and Toynbee Maneuvers? An Exploratory Study

Abstract

Objectives Barochallenge-induced Eustachian tube dysfunction (ETD) is difficult to diagnose because the examination is often normal during clinical assessment. In adults, functional tympanometry testing, performed by asking the patient to Valsalva and Toynbee while measuring the pressure shift, can aid in the diagnosis of ETD. However, standardized values do not exist in children. We aim to determine the age at which children can perform these maneuvers and the normative values in this population. Methods Patients with a normal basic ear examination 4 years and older, presenting to the pediatric Otolaryngology clinic, were recruited. Otoscopy, baseline tympanometry, followed by Valsalva and Toynbee maneuvers were performed. Because there are no pediatric norms, we hypothesized that children would achieve the same minimum normal pressure shift as cited in the adult literature (+20 daPa or higher for Valsalva and −20 daPa or lower for Toynbee). The data were analyzed using receiver operating characteristic curves and logistic regression. Results One hundred sixty-eight children (276 ears) were assessed. Participants as young as 4 years old were able to perform a Valsalva and Toynbee. Age cut-offs at which children achieved adult norms were 12.5 years (p = 0.016) and 8.5 years (p = 0.071) for Valsalva and Toynbee maneuvers, respectively. Mean pressure shift ranged from +29 to −36 daPa, and males were 2.5 times more likely to achieve Toynbee compared with females (p = 0.006). Conclusions Functional tympanometry testing may be used to help diagnose barochallenge-induced ETD in older children.