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Lowry technique

The Eustachian tube connects the middle ear to the nasopharynx and permits regulation of middle-ear pressure.

The Lowry technique is a method of middle-ear pressure equalization used in diving and other situations involving changes in ambient pressure. It combines the Valsalva maneuver with the Toynbee maneuver, coordinating increased nasopharyngeal pressure with swallowing.[1][2] A systematic review of diving-related otology includes the Lowry technique among the recognized maneuvers used to facilitate middle-ear pressure equalization.[3]

Technique and mechanism

The Eustachian tube is normally closed and opens intermittently, including during swallowing, through the action of muscles surrounding its cartilaginous portion. It can also be opened by a sufficient pressure difference between the nasopharynx and middle ear.[4]

The Lowry technique combines two established approaches to opening the Eustachian tube. In the Toynbee maneuver, swallowing is performed while the nostrils are occluded. In the Valsalva maneuver, expiratory effort against an occluded nose raises pressure in the nasopharynx. In the Lowry technique, the Valsalva maneuver is performed in conjunction with the initiation of swallowing.[1] An independent review of pressure-related medical problems in aviation similarly describes the technique as attempting to raise nasal pressure while swallowing with the nostrils occluded.[2]

During diving, equalization of the middle ear through the Eustachian tube is generally active during descent and passive during ascent. The Lowry technique is one of several methods described for active equalization, alongside the Valsalva, Frenzel, Toynbee and Edmonds techniques and voluntary tubal opening.[3]

Terminology and history

The name Lowry technique is documented in the fourth edition of the diving-medicine textbook Diving and Subaquatic Medicine, published in 2002 by Christopher Lowry and Carl Edmonds, where it is described as a combination of the Toynbee and Valsalva maneuvers.[5] The same name and basic description are retained in the fifth edition.[6]

See also

References

  1. ^ a b Mallen, Jonathan R.; Roberts, Daniel S. (2020). "SCUBA Medicine for otolaryngologists: Part I. Diving into SCUBA physiology and injury prevention". The Laryngoscope. 130 (1): 52–58. doi:10.1002/lary.27867. PMID 30776099.
  2. ^ a b 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.
  3. ^ a b 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.
  4. ^ 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.
  5. ^ Edmonds, Carl; Lowry, Christopher; Pennefather, John; Walker, Robyn (2002). Diving and Subaquatic Medicine (4th ed.). Arnold. p. 82. ISBN 978-0-340-80630-2.
  6. ^ 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.

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