The Frenzel Ear Pressure Equalization Maneuver in Operatic Singers: A Qualitative Pilot Study

The goal of this study was to investigate the reported use and effects of an ear pressure equalization maneuver among professional operatic singers, including an assessment of whether the technique aligns with the Frenzel or Valsalva maneuver.

Semistructured interviews were conducted with six internationally recognized opera singers (five male, one female). Participants were classified using the Bunch/Chapman taxonomy (Level 1 or 2). Interview transcripts were subjected to member checking and analyzed thematically using Braun and Clarke's framework. The functional basis of the mechanism was determined by otolaryngologic analysis (RTS), based on comprehensive descriptions of the applied technique.

The participants, none of whom were familiar with the medical terms for this practice, had all independently developed techniques for equalizing ear pressure. Typically, they had discovered these maneuvers during high-altitude exposure or air travel, subsequently recognizing their utility during singing. Participants described using the technique to equalize middle-ear pressure and enhance auditory self-perception during singing, particularly in challenging acoustic or altitude conditions. The functional basis of the mechanism was judged to represent the Frenzel rather than the Valsalva mechanism. Perceived benefits included enhanced perception of high-frequency voice resonance, greater performance confidence, and improved auditory clarity. Reported risks included habitual use, potential for under-singing when relying on enhanced internal feedback, mild ear discomfort when the maneuver was performed forcefully, and visible distraction of the audience during performance. Frequency of use increased with age for several participants.

Ear pressure equalization using the Frenzel maneuver is a strategy used by several elite opera singers to enhance auditory self-perception during performance. While participants reported subjective benefits related to resonance perception and confidence, the relationship between pressure equalization and acoustic output requires investigation. Further research with physiological monitoring, acoustic analysis, and larger samples is encouraged.