Frenzel Maneuver: An Essential Technique for Middle Ear Equalization in Scuba Diving

The Frenzel maneuver, named after its developer, German physician Dr. Hermann Frenzel, is a crucial technique in scuba diving that enables divers to equalize the pressure in their middle ears as they descend and ascend underwater. This maneuver is essential to avoid the potentially damaging effects of pressure changes on the delicate structures of the middle ear. The Frenzel maneuver is performed by pinching the nose closed and moving the back of the tongue upwards, effectively increasing pressure in the nasopharynx and allowing air to flow into the Eustachian tubes, thus equalizing the middle ear pressure. In this entry, we will discuss the importance of the Frenzel maneuver, its history, physiological basis, and practical application.

Importance of Middle Ear Equalization in Scuba Diving

As divers descend into the water, the increasing pressure can cause discomfort or even injury to the middle ear, a phenomenon known as barotrauma. The middle ear is an air-filled cavity that is separated from the external environment by the eardrum and connected to the nasopharynx via the Eustachian tubes. As pressure increases, the eardrum is pushed inward, causing a sensation of fullness and discomfort. If not properly equalized, the increased pressure can lead to pain, temporary hearing loss, or even a ruptured eardrum.

To prevent barotrauma, divers must equalize the pressure in their middle ears by allowing air to flow into the Eustachian tubes, thus compensating for the increased external pressure. The Frenzel maneuver is one of several techniques that divers can use to accomplish this task.

History of the Frenzel Maneuver

Dr. Hermann Frenzel, a German physician and researcher, developed the Frenzel maneuver during World War II as an alternative to the Valsalva maneuver, a more widely known equalization technique. The Valsalva maneuver involves forcibly exhaling against a closed airway, usually by pinching the nose and attempting to exhale through it. While effective for some, this technique can strain the cardiovascular system and may be difficult to perform properly while diving.

Recognizing the need for a more efficient and safer equalization technique, Frenzel introduced his eponymous maneuver, which quickly gained popularity among divers and is now taught as a standard technique in scuba diving courses.

Physiological Basis of the Frenzel Maneuver

The Frenzel maneuver relies on the action of the tongue and the muscles of the throat to generate positive pressure in the nasopharynx. When the back of the tongue is moved upwards, it effectively closes the oral cavity, isolating the nasopharynx. With the nose pinched shut, the act of swallowing, or contracting the throat muscles, generates a pressure increase in the nasopharynx. This pressure forces air up the Eustachian tubes, allowing it to enter the middle ear and equalize the pressure.

Practical Application of the Frenzel Maneuver

To perform the Frenzel maneuver, follow these steps:

  1. Pinch your nostrils closed using your thumb and index finger.
  2. Place your tongue on the roof of your mouth, just behind your upper teeth.
  3. Move the back of your tongue upwards, as if you were trying to touch the back of your throat with the base of your tongue. This will close off the oral cavity and isolate the nasopharynx.
  4. Gently swallow or contract your throat muscles, which will create positive pressure in the nasopharynx and force air up the Eustachian tubes.
  5. Repeat the maneuver as needed while descending and ascending in the water to maintain equalized pressure in the middle ear. It is important to perform the Frenzel maneuver frequently, especially during rapid depth changes, to ensure proper equalization and avoid barotrauma.
  6. If you experience difficulty equalizing using the Frenzel maneuver, try tilting your head slightly upward, which can help to open the Eustachian tubes and facilitate the flow of air into the middle ear.

Advantages of the Frenzel Maneuver

The Frenzel maneuver offers several advantages over other equalization techniques, such as the Valsalva maneuver. These advantages include:

  1. Less strain on the cardiovascular system: The Frenzel maneuver does not require forceful exhalation against a closed airway, thus reducing the strain on the cardiovascular system and the risk of complications, such as barotrauma or a round window rupture.
  2. Greater control and precision: The Frenzel maneuver allows for better control of the pressure generated in the nasopharynx, enabling divers to equalize more gently and precisely.
  3. Easier to perform while diving: The Frenzel maneuver is less dependent on body position and can be performed more easily while maintaining a neutral buoyancy and a horizontal position in the water, which is critical for safe and efficient diving.
  4. Reduced risk of mask squeeze: The Frenzel maneuver generates less pressure in the sinuses, reducing the risk of mask squeeze, a painful condition caused by the increased pressure on the face due to an improperly fitted or tightened mask.


The Frenzel maneuver is a vital equalization technique that every scuba diver should master to ensure safe and comfortable dives. By allowing divers to equalize the pressure in their middle ears efficiently and with less strain on the body, the Frenzel maneuver helps to prevent barotrauma and other diving-related injuries. As scuba diving continues to evolve and grow in popularity, the Frenzel maneuver will remain a cornerstone of safe and responsible diving practices.