To the Editor:—
Dr. Alvan L. Barach's superb and erudite answer in the Questions and Answers section, on page 398 of The Journal of April 29, 1961, on asthma and wind instruments is fine as far as it goes. However, one important aspect is not mentioned. This is that in the presence of infection the performance of the Valsalva maneuver or any other experiment which increases the pressures in the upper respiratory tract is quite conducive of otitis media. This can be likened to descent from high altitude, in which patients with upper respiratory infections have more trouble than on the ascent with decreasing pressures.