What technique can be used to equalize middle ear pressure during ascent or descent?

• A. Yawning only
• B. Valsalva maneuver or swallow/yawn
• C. Breathing rapidly through pursed lips
• D. Holding breath until ascent ends

Answer: (B)

When you ascend or descend, external pressure changes but the middle ear needs a way to match that pressure to avoid pain or damage. The technique that reliably opens the Eustachian tube to equalize this pressure is the Valsalva maneuver or simply swallowing or yawning to trigger the opening.

The Valsalva maneuver involves gently pinching the nose and keeping the mouth closed while you exhale softly. This increases pressure in the nasopharynx, which pushes and pops open the Eustachian tube, allowing air to flow into the middle ear and balance the pressures on both sides of the tympanic membrane. Swallowing and yawning activate the muscles around the Eustachian tube (notably the tensor veli palatini), causing the tube to open briefly so air can pass through and equalize the pressure.

This is preferred because it directly targets the mechanism that equalizes ear pressure. Other options don’t reliably open the Eustachian tube: rapid pursed-lip breathing won’t open it, and holding your breath won’t relieve the pressure difference and can even increase discomfort or risk, especially if you wait too long.