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

Area of Science:

• Pediatric Otolaryngology
• Diagnostic Audiology
• Ear, Nose, and Throat (ENT) Medicine

Background:

• Barochallenge-induced Eustachian tube dysfunction (ETD) is challenging to diagnose in children due to normal clinical findings.
• Functional tympanometry, involving Valsalva and Toynbee maneuvers, aids ETD diagnosis in adults but lacks pediatric norms.

Purpose of the Study:

• To determine the minimum age children can perform Valsalva and Toynbee maneuvers.
• To establish normative pressure shift values for functional tympanometry in children.
• To identify age cut-offs for achieving adult normative values in pediatric functional tympanometry.

Main Methods:

• Recruited 168 children (4+ years) with normal ear examinations.
• Performed otoscopy, baseline tympanometry, and Valsalva/Toynbee maneuvers.
• Analyzed data using ROC curves and logistic regression, hypothesizing adult norms (+20 daPa Valsalva, -20 daPa Toynbee).

Main Results:

• Children aged 4+ could perform Valsalva and Toynbee maneuvers.
• Age cut-offs for adult norms were 12.5 years (Valsalva) and 8.5 years (Toynbee).
• Mean pressure shifts ranged from +29 to -36 daPa; males were more likely to achieve Toynbee norms.

Conclusions:

• Functional tympanometry is a viable diagnostic tool for barochallenge-induced ETD in older children.
• Establishes a basis for normative data in pediatric functional tympanometry.
• Highlights age-related differences in maneuver performance and normative value achievement.