It is possible for the eardrum to be perforated by pinching and puffing. The so-called pinch nasal puff, also known as Valsalva blowing action in ENT clinics, is one of the methods of eustachian tube blowing. The purpose is to balance the pressure inside and outside the middle ear and temporarily open the eustachian tube by rushing the airflow through the eustachian tube to the tympanic chamber. However, the force should be moderate, not blindly forceful drumming, otherwise if the pressure exceeds the capacity of the eardrum, the eardrum may be perforated. It should be practiced repeatedly. In case of acute rhinitis or cold, it is forbidden to practice to avoid secondary infection.