Intraocular pressure fluctuations and the role of the Valsalva maneuver in young professional musicians

Abstract

Objective (1) To determine whether intraocular pressure (IOP) fluctuations while playing musical instruments is specific to the instrument type, (2) to investigate the role of the Valsalva maneuver as an underlying mechanism, and (3) to evaluate relationships between IOP values and demographic and environmental factors. Design Cross-sectional study. Participants Sixty-five musicians were enrolled. Of these, 2 were excluded due to glaucoma history and intolerance to IOP measurements. The final sample consisted of 63 young professional musicians (34 wind instrumentalists and 29 non-wind instrumentalists). Methods Participants underwent tonometry (ICare IC100) and otoscopy (Dino-Lite Basic EarScope) and completed a self-administered questionnaire on demographic and environmental factors. Tonometry and otoscopy procedures were performed simultaneously at four time point: before playing, while playing a low-pitched note and a high-pitched note, and after playing. Main outcome measures IOP and tympanic membrane movement. Results No differences in IOP were observed between wind and non-wind instrumentalists at baseline, during low-pitch playing, or after playing (Mann-Whitney U test, all p≥0.052). However, IOP differed while high-pitch playing (Mann-Whitney U test, p=0.007), with both high- and low-resistance wind instrumentalists showing higher IOP than non-wind instrumentalists (Mann-Whitney U test, both p≤0.041). IOP change relative to baseline (ΔIOP) similarly revealed differences during high-pitch playing and additionally detected differences during low-pitch playing (Mann-Whitney U test, both p≤0.025). Within the wind category, no differences in IOP were found between high- and low-resistance (Mann-Whitney U test, all p≥0.323), and same pattern was observed for ΔIOP (Mann-Whitney U test, all p≥0.112). The Valsalva maneuver was not detected for any instrument or under any measurement conditions. In addition, no relationships were found with demographic or environmental factors and IOP fluctuations (Pearson’s or Spearman’s correlation, all p≥0.273), although baseline IOP positively correlated with age at which wind instrumentalists began playing their instrument (Pearson’s correlation, r=0.348, p=0.048). Conclusions IOP fluctuations during musical instrument performance occur specifically in wind instrumentalists and are not attributable to involuntary Valsalva maneuvers during playing. Moreover, basal IOP correlated with age of instrument debut in wind instrumentalists, while no other demographic or environmental factors related to IOP measurements or its fluctuations.