Otovent Versus Valsalva: Physiological Insights for Diagnostic and Therapeutic Autoinflation in Eustachian Tube Dysfunction

Objectives Autoinflation aids assessment of Eustachian tube function, or as a conservative treatment for obstructive Eustachian tube dysfunction. This study compares the physiological characteristics of 2 autoinflation techniques, the Otovent® device and the Valsalva manoeuvre, to inform clinical application for both diagnosis and therapy. Study Design Prospective physiological study. Setting Tertiary academic teaching hospital. Methods Twenty‐one healthy adult volunteers performed 3 trials of both the Otovent and Valsalva manoeuvres. A linear mixed‐effects model (LMM) was used as the primary analysis to compare the mean maximum and plateau nasopharyngeal pressures. Intra‐subject repeatability was assessed using the intraclass correlation coefficient (ICC), while inter‐subject consistency was evaluated by comparing standard deviations. Eustachian tube (ET) opening rates were measured via tubo‐tympano‐aerodynamic‐graphy, otoscopy, and participant report. Results The Valsalva manoeuvre generated significantly higher nasopharyngeal pressures. Mean maximum NP pressure for Valsalva (597.5 daPa) was greater than for Otovent (482.3 daPa) ( F (1, 104) = 18.82, P < .001). This difference was more pronounced for plateau pressures (Valsalva: 486.0 daPa vs Otovent: 278.0 daPa; F (1, 104) = 126.42, P < .001). Conversely, the Otovent demonstrated markedly superior consistency, showing higher intra‐subject repeatability for plateau pressure (ICC = 0.872 vs 0.572) and substantially less intersubject variability (SD ± 39.8 daPa vs ±144 daPa). ET opening rates were comparable between the 2 techniques. Conclusions Otovent facilitates autoinflation at lower but significantly more consistent pressures than Valsalva. Thus, Otovent may offer greater clinical value when a controlled, repeatable insufflation pressure is required for diagnostic or therapeutic purposes.