The exercises that are proposed in this section constitute a new approach to the activity of compensation. They are aimed at training all the structures of the nasalpharyngeal-tubular area that are directly or indirectly involved in the mechanics of the Eustachian tube, with the goal of creating a smooth and efficient system, ready to confront compensation at depth. We have divided these exercises into two categories: muscular exercises that reinforce and synchronise the structures of the nasal-pharyngeal-tubular area: and maneuvres of autoinsufflation that specifically train the Eustachian tubes. These exercises must be executed out of the water.

The exercises that we propose in these pages are helpful to: 1. reinforce and synchronise the structures of the nasal-pharingeal-tubular area; 2. impart an awareness and competency aimed at obtaining an effective and appropriate compensation; 3. protect the auditory structures from lesions of any kind, safeguarding their auditory function; 4. allow anyone to discover, and be able to apply the best technique of compensation, tailored to suit personal capacity and objectives.

Each time you perform one of the proposed exercises try to achieve a better coordination, without forcing the structure.

Tubular exercises, like all muscular training, should be executed daily for the first 20-30 days. During this period perform all the proposed exercises and manoeuvres for at least 10-15 minutes per day, sitting comfortably in front of the mirror and automating the proper movements without following them blindly, which won't bring the results desired. Subsequently, it is enough to maintain exercises once a week and to intensify the activity the day before diving, in order to prepare the structures.

towards the chin. if one or the other of the ears contains mucous in the middle ear cavity it is quite likely that the subject will hear noise like paper tearing. as the muscles of the soft palate play a primary role in the dynamics of the tubes. so no air should escape from the nose at all. without contracting the lips. Using a tongue depressor or a spoon. inflate baloons. Trace the perimeter of the lips with the tongue. In the same fashion pronounce successive series of /ee/. Breathing exercises Blow out a candle from an increasing distance. /eh/. from right to left and back again. Move the jaw latteraly. Rotate the jaw on the frontal plane. Pronounce a series of three quich and powerful /ah/ sounds. If possible watch and analyse the quality of movement of the soft palate in a mirror. Soft palate exercises These exercises are very important. /eek/. /ok/. rotating clockwise then anticlockwise. clockwise then anticlockwise. keeping the tip of the tongue on the floor of the mouth. Brush the roof of the mouth with the tongue. If the middle ear is free the only possible noise will be the sound of mandibular articulation. . then retract it and force it all the way back. making the movements imperceptible. you can touch the soft palate and stimulate a reflex contraction. Emit vowel sounds with varying intensity and pitch. The pause is recommended because a longer series can cause an uninterrupted contraction of the palate. During the execution of these exercises. if this does not occur then it is necessary to continue with this type of exercise until successful. This exercise involves displacements of the larynx and soft palate.Tongue exercises Bring the tongue as far as possible out of the mouth. Contract the soft palate without emmiting a sound (this corresponds to the enunciation of a silent /ah/ sound). then close the mouth for a few seconds and recommence. The correct execution of this exercise is often accompanied by a vomit reflex. /ak/. keeping it on a transverse plane. /ook/. /oh/. moving from front to back and trying to reach the soft palate. and exhale through a straw into a container of water. These vocalisations provoke a firm and complete contraction of the soft palate. For some people this exercise is not appropriate. as it stimulates the vomit reflex. /oo/. Repeatedly protrude and retract the jaw. Jaw exercises Repeatedly open and close the mouth. Breathing exercises assume a perfect closure of the soft palate.

The swallowing exercise can be peformed using any type of drink (fruit juice. closing the nose at the moment when air rises back up. • Retract the tongue. and protects the airway. This position sends the air displaced by the liquid towards the tubes. followed by a 2-3 second apnea. • Nasal inspiration and oral expiration • Calm and comfortable inspiration and expiration • Short and forced inspiration followed by a calm expiration • Calm inspiration followed by a short and forced expiration • Short and forced inspiration and expiration . • Emit an /ah/ sound. Swallowing exercise Take a gulp of water into the mouth. producing a characteristic clicking sound. brushing the palate from front to back. • Push the tongue out of the mouth as far as possible towards the chin. and at the same time contract the soft palate. Tongue-jaw-soft palate exercises Try to induce a yawn by means of a deep oral inhalation. Usually we tend to produce this sound by striking the tip of the tongue quickly and repeatedly on the back of the bottom teeth. keeping the mouth open. fruit shake etc). so it is also possible to use fizzy drinks. without emmiting a sound. milk. then release the air with an oral exhalation. Single and double airway expiration exercise This exercise favours nasal respiration. avoiding inhalation of water and coughing. The tubes are also opened by belching.Tongue-soft palate exercises Slide the tongue over the palate from front to back. aeration of the nasopharynx and nasal cavities and stimulation of movements of the soft palate. Keeping the mouth open. • Close the mouth and gently retract the jaw. keeping it well in contact until it falls. whils lowering the head. and the tip falls further backwards. during which the mouth is kept open and the palate contracted without making a sound. move the tongue like a piston towards the soft palate. Yawning is an important physiological mechanism as it involves many muscles and causes an active opening of the Eustachian tubes. At first one nostril is used at a time – the second is closed with the simple pressure of a finger – but subsequently both nostrils are used together. opening of the tubes (due to the pressure changes created during this type of respiration). note that the correct exercise instead involves the top surface of the tongue. Execute the following succession of movements: • Extend and lower the jaw. pinch the nose closed and swallow. The greater the volume and density of the water in the mouth. the more air will be mobilised. The tip of the tongue is kept in contact with the floor of the mouth.

the Valsava and Marcante-Odaglia manoeuvres can be substituted by movements targeted at single muscles. The tubular exercises must always be performed in the way indicated in the following pages. these exercises are aimed at allowing anyone to obtain maximum mastery of the structures involved in compensation. . Compensatory manoeuvres can protect ethe ear and make a dive more pleasurable. and when the physical and surrounding conditions allow. Their success is based on a correct and constantly stimulated activity of the Eustachian tubes. In doing so it can happen that. as they favour the aeration and cleaning of an inflamed ear. Instead. However if the annoyance becomes painful it is advisable to discontinue autoinsufflation and receive an otoscopy exam in order to prevent the acute. As we have emphasised. but this is not cause for concern. Whether diving or training out of the water. WARNING The opening of the Eustachian tubes during autoinsufflation manoeuvres is evidenced in most people by a 'click' inside the ear.AUTOINSUFFLATION The term 'autoinsufflation manoeuvre' is used to identify an exercise useful for the training of the Eustachian tube. There may be a bothersome sensation during the initial session of autoinsufflation manoeuvres and in first exercises with the baloon and nosepiece. but with a lesser expense of air and energy. In this section we will examine in detail several exercises of autoinsufflation: these are basically compensatory manoeuvres performed 'dry'. Optimal condition of the Eustachian tube – critical for compensation – is based on a continued and balanced muscular training. It is caused by the repeated introflexion and extroflexion (due to the movement of air) of a hypo-mobile eardrum. however during immersion they can be modified according to freedom of movement and requirements of the individual. This is to avoid pathogenic agents climbing the tube and the movement of air and liquid in the middle ear that could cause pain and damage to the structure. possibly during training in a pool. and will dissapear as soon as the condition of hyper-pressure is interrupted. obtaining the same result. light or initial phase of middle ear inflammation. in these cases the muscular exercises are very helpful. it is necessary to remember that these manoeuvres should never be performed if the ear is inflamed or in cases of bad colds. provided that they are perfectly understood and executed at the right time and place.

after the oral inspiration and before proceeding to autoinsufflation. There is a reduced amount of pressure required to open the tubes with respect to that required by the Valsalva manoeuvre. Place the base of the tongue against the soft palate. the palm on the mouth and the fingers on the other cheek. and push lightly bacwards. Marcante-Odaglia manoeuvre. The Mysuria manoeuvre combines the hyper-pressure of the nasopharynx with a contraction of the entire pharyngeal zone. Mysuria manoeuvre 1. Free the nose. Place the thumb of the second hand on one cheek. 5. but it will help to be reminded that this manoeuvre requires the most coordination. allowing the air to exit.Valsalva manoeuvre 1. 4. if a more elevated pressure is required then a possible sudden opening could cause great damage. Draw air up into the oral cavity by a pumping action of the base of the tongue. Execute a moderately deep oral inspiration. so as to avoid hyperventilation. and gently pinch the nose with two fingers. In fact. To reduce the thoracic hyper-pressure that is created during the manoeuvre. lower the head. 3. 1. or Frenzel The nasopharynx is turned into a closed cavity full of pressurised air that is easily forced towards the middle ear through the Eustachian tube. The manoeuvre must be short and it is advisable to allow a moment's relaxation between one execution and the next. it is a good idea to pronounce two vowel sounds in succession. inflate the cheeks with the inspired air and pinch the nose closed with two fingers of a hand. The Valsalva manoeuvre is effective if the momentary state of hyperpressure created in the nasopharynx during the exercise is sufficient to cause the opening of the tubes. 3. caused by the act of swallowing. Squash the cheeks with a light pressure of the fingers. 4. and at the same time lower the head and swallow. Breathe out powerfully into the closed nose. 2. We have discussed this at length in the preceeding section. Close the mouth. Execute a moderately deep oral inspiration. During the exercise the soft palate must be repeatedly contracted. 2. 2. . Maintain both the nostrils closed and epiglottis closed for the entire duration of the exercise. without inflating the cheeks or opening the mouth. without allowing the air to escape from the mouth. 5. 3. Maintain this condition for 3-4 seconds.

They are used as follows: 1. guaranteeing proper function of the transmission system of the eardrum and ossicles and a suitable ventilation of the cavity behind the eardrum. Swallow. Don't forget that for a complete execution the exercises should be performed through both nostrils! Exercise A 1. 3. Most autoinsufflation instruments consist of a plastic toggle that is inserted into nostril and connected to balloon. Breathe the air from the balloon into the nose. tomcat. this combination allows an optimal aeration of the middle ear and an effective tubular cleansing.. allow for the compensation of the middle ear. air may be injected through the nostrils towards the cavity of the nasopharynx. Coupled with the constant airflow. "The geese with golden galoshes" "This gelato is gustatory" "Alana bred a jaguar and a llama" "A pyjama rotter" "Frodo's dodo got in a grotto" "A duo of rude two-timing ghouls" "Catch the cadet" "Two teens guard an apartment" "Claire ate an iguana" "Tomcat. Inflate the balloon to the required dimensions. The swallowing exercise associates the active opening of the tubes caused by the swallowing to a passive mechanism of opening created by the air from the balloon. and close the other nostril with a finger. With these instruments. on the basis of which the instruments were designed. Perform a deep oral inspiration and close the mouth. We now suggest seceral exercises with this instrument. then for a complete and specific treatment it is necessary to precede the exercise with a program of 'tubular aerobics'. where the orifices of the Eustachian tubes are located. if used correctly. and the pressure alterations and functional problems of the middle ear derived from a prolonged state of insufficient activity or inactivity of the tubes. The success of the exercise is only guaranteed under normal anatomic and physiological conditions of the tube. 2. tomcat. Inflate the balloon to the required dimensions. articulating and stressing each phoneme. Place the round part of the toggle in contact with a nostril. 3. These are then continued while the autoinsufflation exercises are gradually introduced.. Pronounce the following phrases with sustained intensity. If these conditions are not present. Breathe air out through the nose to inflate the balloon. Exercise B 1. 2. 2.Using an instrument of autoinsufflation There are instruments available that." "The gang joked with a go-go girl" .

ga/goh/geh/ghi/goo" "Kee.. ghi. ka/koh/ke/kee/koo" "Glug. of confusion or feeling dazed. . At the same time as the vocal emission you may have a sensation of open ears. glug! When air rises into the nasopharynx cavity and the trunk of the Eustachian tube the voice acquires a distinctive tone. The phonation exercise has the same aim as those preceding: to open the Eustachian tube by means of the production of precise phonic sequences. monotonous.. the phenomena that cause the tubes to open are those in which correct articulation requires distinct movements of the soft palate. of air moving or rising towards the ears. glug. or of cleanness and freshness. Generally. kee. but eceryone should find the most effective phrases for themselves. 'course'. and resonant.3. aug. pronounce: "Aug. With the jaw lightly protruded." (like an Indian) "Ghi. It can be defined as intermittent. aug.

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