When and How Do you Valsalva going up or down? A Guide to Ear Equalization

September 23, 2025 •

4 min read

The American Academy of Otolaryngology notes that pressure changes can lead to temporary hearing issues or pain, a common occurrence for air travelers and divers. Knowing when and how to do you Valsalva going up or down correctly can make a significant difference in comfort and safety.

Quick Summary

The Valsalva maneuver primarily works by forcing air into the Eustachian tubes, making it most effective for equalizing pressure when ascending. When descending, where external pressure is increasing, safer and more passive techniques are often recommended to manage the change in atmospheric pressure.

Key Points

Valsalva Up, Not Down: The Valsalva maneuver is most effective for equalizing ear pressure when ascending, as it helps release expanding air from the middle ear.
Gentler Techniques for Descent: When descending, it is safer and more effective to use methods like swallowing or the Toynbee maneuver to allow air to flow into the middle ear.
Never Use Excessive Force: Performing the Valsalva maneuver with too much force, especially during descent, can cause injury to the eardrum and inner ear structures.
Understand Pressure Dynamics: Ascending involves decreasing external pressure, while descending involves increasing external pressure, which dictates the appropriate equalization technique.
Seek Medical Advice if Needed: If you experience persistent ear pain, hearing changes, or dizziness after traveling, consult a doctor to rule out any serious issues.
Prevention is Key: Chewing gum, swallowing frequently, or using gentle maneuvers proactively can prevent ear discomfort before it starts.

Understanding the Pressure Problem in Your Ears

Your ears are more complex than you might think, especially when it comes to managing pressure. The Eustachian tube is a narrow passage that connects your middle ear to the back of your throat. Its primary job is to equalize pressure between the middle ear and the outside world. This is crucial during changes in altitude, such as flying in a plane, scuba diving, or even driving through mountains.

Changes in atmospheric pressure can cause a pressure imbalance, leading to that uncomfortable 'clogged' or 'popping' sensation. If not properly addressed, this can result in pain and, in extreme cases, more serious injury. That’s why understanding the right equalization technique for the right situation is so important.

The Mechanics of Ascending vs. Descending

The fundamental difference between going up and going down lies in the direction of the pressure change. When you are ascending, the external pressure (ambient pressure) decreases. This causes the air trapped in your middle ear to expand, pushing outward on your eardrum. The Valsalva maneuver helps by forcing air out of your lungs and into the Eustachian tube, assisting this outward pressure equalization. Think of it as manually helping to 'vent' the expanding air.

Conversely, when you are descending, the external pressure increases. This pushes inward on your eardrum. Forcing air out via the Valsalva can make this worse by adding more pressure from the inside, a potentially dangerous scenario that can cause damage. Instead, you need to find a way to let air passively flow into the Eustachian tube to relieve the pressure differential. This requires a softer, more subtle approach that allows your body's natural mechanisms to work.

The Correct Use of Valsalva When Going Up

During ascent, whether in an airplane or a vehicle, you can use the Valsalva maneuver safely. Here’s a simple guide:

Pinch your nose shut with your fingers.
Close your mouth completely.
Exhale gently and steadily, as if you are blowing your nose, but keep your mouth and nose closed.
You should feel a 'pop' in your ears as the Eustachian tubes open and the pressure equalizes. This is what you want.

It is crucial to do this gently and avoid excessive force. If you feel pain, stop immediately. Repeat the maneuver periodically as you continue to ascend, before you experience significant discomfort.

Safer Alternatives for Going Down

For descent, the Valsalva maneuver is generally not recommended. Instead, try one of these gentler techniques to allow air to flow into the middle ear:

Swallowing: Simply swallow frequently. Swallowing activates the muscles that open the Eustachian tube, allowing air to flow in. Sucking on a piece of candy or chewing gum can help promote swallowing.
Yawning: A big, deep yawn is one of the most effective ways to open the Eustachian tubes. The stretching of the jaw muscles helps pull the tubes open.
Toynbee Maneuver: Pinch your nose and swallow at the same time. This is more effective than Valsalva for descents because the swallowing motion helps pull the Eustachian tubes open.

A Comparison of Ear Equalization Techniques


Technique	Primary Use Case	Method	Key Feature	Safety During Descent	Ease of Use
Valsalva Maneuver	Ascent / Quick Pressure Release	Pinch nose, close mouth, exhale forcefully.	Forces air out	Not recommended; can cause injury	Moderate
Toynbee Maneuver	Descent / General Equalization	Pinch nose, swallow.	Uses swallowing muscles	Safer and more effective	Easy
Frenzel Maneuver	Diving / Advanced Equalization	Pinch nose, use tongue to force air.	Uses tongue muscles	Safe, common for diving	Difficult, requires practice
Chewing/Swallowing	General Altitude Changes	Chew gum or suck on candy.	Promotes natural swallowing	Very safe	Very easy

Potential Risks and What to Watch For

While Valsalva is generally safe when performed correctly, using it improperly, especially with too much force, can be harmful. The primary risk is a round window rupture, a rare but serious injury that can cause hearing loss and vertigo. This is why forceful Valsalva during descent is so dangerous. It can also exacerbate sinus or ear infections by forcing infected fluids into the middle ear.

Pain: If you experience sharp pain, stop immediately. Persistent pain or a blocked feeling should be evaluated by a doctor.
Dizziness: Mild dizziness can occur due to temporary blood pressure changes, but severe or lasting vertigo requires medical attention.
Bleeding: Any bleeding from the ear is a sign of serious injury and requires immediate medical help.

When to See a Doctor

For most people, ear pressure issues are a minor inconvenience that can be resolved with simple techniques. However, if you experience any of the following, you should consult a doctor, preferably an ENT (ear, nose, and throat) specialist:

Your ears remain clogged or painful for more than a few hours after landing.
You experience severe pain or hearing loss.
There is any bleeding or discharge from your ear.
You have an ongoing ear or sinus infection and need to travel.

Remember, your health is paramount. Do not risk serious injury by forcing equalization when your body is telling you something is wrong.

Conclusion

The question of do you Valsalva going up or down has a clear answer: primarily up, and with caution. Proper ear equalization is not a one-size-fits-all solution, but a nuanced approach based on the direction of travel and the pressure dynamics at play. By using the Valsalva maneuver for ascent and gentler methods like the Toynbee or simple swallowing for descent, you can protect your ears and ensure a more comfortable journey. Staying informed and knowing your body's limits is the best way to handle any pressure change, whether you are on a plane or diving deep below the surface.

For more information on vagal maneuvers and heart rate regulation, see the resources from the Cleveland Clinic.

Frequently Asked Questions

The Valsalva maneuver is generally safe for most healthy individuals when performed correctly and gently. However, people with certain eye conditions, heart issues, or recent surgeries should consult a doctor before attempting it. It is not recommended for forceful use, especially during descent.

Yes, but with caution. A gentle Valsalva can help, but if you have a severe sinus or ear infection, it can push infected fluid into the middle ear, potentially worsening the infection. Using a decongestant and gentle swallowing may be a safer approach.

The Toynbee maneuver involves pinching your nose shut and swallowing. This action creates a negative pressure in the back of the throat, pulling the Eustachian tube open to equalize pressure. It is a very safe method, especially recommended for descent.

You should perform equalization maneuvers proactively, before you feel significant discomfort. For ascent, perform Valsalva periodically as the plane climbs. For descent, start swallowing or yawning frequently as the plane begins its descent and continue until it lands.

If you cannot equalize your ears, it could be a sign of a significant pressure imbalance or blockage, possibly due to congestion or infection. Continuing to try forceful maneuvers could be harmful. Instead, try a gentler technique, and if the issue persists after your trip, see a doctor.

Yes, children also need to equalize their ears, but they may not know how. Encouraging babies to feed or use a pacifier during takeoff and landing can help, as the act of swallowing aids equalization. For older children, gum or candy can help promote swallowing.

The Valsalva maneuver uses chest and abdominal muscles to push air up and out, while the Frenzel maneuver uses the tongue as a piston to compress air and force it into the Eustachian tubes. The Frenzel technique is more controlled and used primarily by experienced divers.