Edmonds technique
The Edmonds technique is a method of middle-ear pressure equalization described in diving and aviation medicine. It combines forward movement of the lower jaw with a pressure-generating equalization maneuver such as the Valsalva maneuver or Frenzel maneuver.[1] A systematic review of diving-related otology includes the Edmonds technique among the recognized maneuvers used to facilitate middle-ear pressure equalization.[2]
Technique and mechanism
[edit]Descriptions of the Edmonds technique involve moving the lower jaw forward, with diving-medicine texts additionally describing downward movement of the jaw similar to the beginning of a yawn, while performing a pressure-equalization maneuver.[3][4] An independent medical review describes the maneuver more generally as pushing the jaw forward while performing either the Valsalva or Frenzel maneuver.[1]
The Eustachian tube is normally closed and opens intermittently through the action of paratubal muscles, particularly during actions such as swallowing and yawning. A sufficient pressure difference between the nasopharynx and middle ear can also open the tube.[5] The Edmonds technique combines oropharyngeal movement with positive nasopharyngeal pressure to equalize pressure in the middle ear.[1][3]
During diving, active equalization of the middle ear is generally required during descent as ambient pressure increases. The Edmonds technique is one of several voluntary techniques described for this purpose.[2]
Terminology and history
[edit]The term Edmonds technique is documented in the fourth edition of Diving and Subaquatic Medicine, published in 2002 by Carl Edmonds and Christopher Lowry, which gives the technique its own subsection in the chapter on ear barotrauma.[3] The fifth edition retains the term and describes the jaw movement in conjunction with middle-ear autoinflation.[4]
See also
[edit]References
[edit]- 1 2 3 Donner, Howard J. (2017). "Is There a Doctor Onboard? Medical Emergencies at 40,000 Feet". Emergency Medicine Clinics of North America. 35 (2): 443–463. doi:10.1016/j.emc.2017.01.005. PMC 7125952. PMID 28411936.
- 1 2 Livingstone, Devon M.; Smith, Kristine A.; Lange, Beth (2017). "Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care". Diving and Hyperbaric Medicine. 47 (2): 97–109. doi:10.28920/dhm47.2.97-109. PMC 6147252. PMID 28641322.
- 1 2 3 Edmonds, Carl; Lowry, Christopher; Pennefather, John; Walker, Robyn (2002). Diving and Subaquatic Medicine (4th ed.). Arnold. p. 82. ISBN 978-0-340-80630-2.
- 1 2 Edmonds, Carl; Bennett, Michael; Lippmann, John; Mitchell, Simon (2015). Diving and Subaquatic Medicine (5th ed.). CRC Press. pp. 92–93. ISBN 978-1-4822-6012-0.
- ↑ Smith, Matthew E.; Bance, Manohar L.; Tysome, James R. (2019). "Advances in Eustachian tube function testing". World Journal of Otorhinolaryngology - Head and Neck Surgery. 5 (3): 131–136. doi:10.1016/j.wjorl.2019.08.002. PMC 6849358. PMID 31750424.