A pilot study to investigate the therapeutic effect of Valsalva maneuver on otitis media with effusion in adults

The birth of experimental physiology

The year 2023 marks the 300th anniversary of the death of Antonio Maria Valsalva (1666-1723). Valsalva was a leading physician across the 17th and 18th centuries, specifically for his focus on experimental physiology, the science dealing with the normal functioning of bodily organs as a basis for a better understanding of diseases, symptoms, and care. He used a top-down systematic approach typical of the Enlightenment, rather than a heuristic one ("trial-and-error"), which became feasible after the long-lasting ban on dissecting human corpses was lifted. Valsalva's main interest was exploring the complex structure of the human ear, to which he dedicated a specific treatise, De Aure Humana. He understood the issues inherent in the imbalance in pressure between the outer and inner ear and found ways to exploit it to get rid of purulent fluid by deliberately raising the inside pressure with his maneuver. Time was however not yet ripe to see the broader importance that the Valsalva maneuver would achieve, not just in otorhinolaryngology, but also in cardiology and other fields of medicine. Although Valsalva's name is usually associated with his maneuver, his contributions to the history of medicine were broader: he discovered several anatomical parts (i.e., the sinuses of Valsalva), built the basis for the development of pathological anatomy, introduced advances in surgery, and promoted compassionate care of patients affected by mental diseases.NEW & NOTEWORTHY Antonio Maria Valsalva (1666-1723) was a pioneer in experimental physiology between the 17th and 18th centuries. The Valsalva maneuver is still a popular academic topic and has broad applications not only in physiology research, but also in the diagnosis and therapy of various diseases. The celebration of 300 years from his death could be a timely occasion to commemorate the scientific works of this illustrious scientist.

Medical Management for Eustachian Tube Dysfunction in Adults: A Systematic Review and Meta-Analysis

OBJECTIVE

Medical treatment for eustachian tube dysfunction (ETD) is varied, with physician preference driving treatment choice and limited guidance for these options. An evaluation of the efficacy of medical management (MM) for ETD is warranted.

METHODS

A systematic review of three databases (PubMed, Scopus, and Embase) was performed through December 2020. Adults treated nonsurgically for ETD were included. Exclusion criteria were as follows: patulous ETD, ETD deriving from craniofacial anomalies, or surgical treatment. Data were extracted independently by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis of continuous measures, proportions, and risk ratio was conducted.

RESULTS

Twelve articles were identified by systematic review, with either level 2 or 3 evidence. A meta-analysis of available data was performed on nine studies. A pooled cohort found 50.3% (95% confidence interval [CI], 41.7-59.0) of patients experienced symptomatic improvement with MM. ETDQ-7 scores improved in a clinically nonsignificant manner by -0.88 (95% CI, -1.12 to -0.64) following medical treatment. Further, MM benefited from subacute and chronic symptoms in 30% to 64% and 11% to 50% of cases, respectively. Intranasal corticosteroids (INCS) were not efficacious, improving only 11% to 18% of chronic cases. Therapies such as Politzer devices and Valsalva therapy had minimally beneficial results.

CONCLUSION

Our review did not find any level 1 evidence for MM of ETD in adults. Available evidence indicates INCS are ineffective for chronic symptoms and the efficacy of nonsurgical options for subacute ETD has yet to be determined. Further randomized controlled trials are needed to discern efficacy of single-agent medical therapies. Laryngoscope, 2021.