Playing Wind Instruments Raises Intraocular Pressure: Is Valsalva Really Responsible?

Wind-instrument performance has been associated with transient intraocular pressure (IOP) increases. Whether these changes are specific to wind instruments—and whether involuntary Valsalva is responsible—remains uncertain.

Objective: Compare IOP across wind and nonwind musicians, assess the influence of pitch and instrument resistance, and look for simultaneous tympanic membrane movement suggesting Valsalva.

Design: Cross-sectional study at the University of Minho, Portugal.

• 63 young professional musicians analyzed (65 enrolled; 2 excluded).
• 34 wind instrumentalists; 29 nonwind instrumentalists.
• Mean age approximately 21 years; musicians with glaucoma and other factors that could affect IOP were excluded.
• Among wind instrumentalists, 14 played high-resistance and 20 low-resistance instruments.

IOP: One eye per participant, iCare IC100 rebound tonometry, at four points: baseline → low-pitched note → high-pitched note → after playing. Notes were sustained for approximately 6–9 seconds.

Valsalva proxy: Simultaneous video otoscopy assessed tympanic membrane motion. Researchers analyzed absolute IOP and each person’s change from baseline (ΔIOP). Note order was fixed, and sound intensity was not objectively standardized.

Median IOP (mmHg):

• Wind: baseline 17.5; low pitch 18.0; high pitch 19.5; after 15.0.
• Nonwind: baseline 17.0; low pitch 16.0; high pitch 15.0; after 14.0.

Between-group IOP distributions differed during high-pitched performance (P = 0.007), but not at baseline (P = 0.939), low pitch (P = 0.052), or after playing (P = 0.537). The 4.5-mmHg difference between group medians at high pitch is descriptive, not a within-person increase or adjusted effect.

ΔIOP differed between wind and nonwind players during low-pitched (P = 0.025) and high-pitched (P = 0.003) performance.

Within wind players, high- versus low-resistance instruments were not significantly different for absolute IOP (all P ≥ 0.323) or ΔIOP (all P ≥ 0.112). Both wind-resistance groups nevertheless had higher IOP than nonwind musicians during high-pitched playing (both P ≤ 0.041).

No tympanic membrane movement compatible with Valsalva was detected among 50 interpretable recordings; 13 of 63 recordings were excluded because visualization was inadequate.

Video otoscopy is an indirect measure and may miss subtle or low-pressure maneuvers. Thus, the findings do not establish that Valsalva is impossible during instrument playing, nor do they identify a definitive alternative mechanism.

Age, sex, body mass index, years of experience, and weekly practice time did not significantly explain high-pitch IOP fluctuations. Baseline IOP had a weak positive association with age at starting a wind instrument (r = 0.348; P = 0.048), which the authors cautioned against overinterpreting.

Important limitations: Small, young, relatively healthy sample; cross-sectional design; fixed test order; unmeasured variation in playing loudness; 13 unusable otoscopy recordings; no long-term follow-up, optic nerve progression, visual field progression, or retinal outcomes. Findings cannot be generalized directly to glaucoma patients.

Practical relevance: Resting tonometry may miss brief performance-associated IOP changes in wind musicians. Asking about instrument playing may add useful context when assessing a patient with ocular hypertension or optic nerve vulnerability; this is a clinical inference, not an intervention validated by the study.

Bottom line: High-pitch wind playing was associated with transient higher IOP, independent of the instrument-resistance grouping used here. Valsalva was not observed by the study’s indirect test. Do not infer proven glaucoma progression, retinal injury, or a need to stop playing from these data.