Valsalva maneuver
technique for equalising pressure in the middle ears
The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air, as if blowing up a balloon. Variations of the maneuver may be used either in medical examination as a test of cardiac function and autonomic nervous control of the heart (because the maneuver raises the pressure in the lungs), or to clear the ears and sinuses (that is, to equalize pressure between them) when ambient pressure changes, as in scuba diving, hyperbaric oxygen therapy, or air travel.
A modified version is executed by expiring against a closed glottis. This will elicit the cardiovascular responses described below, but will not force air into the Eustachian tubes.
History
The technique is named after Antonio Maria Valsalva, a seventeenth-century physician and anatomist from Bologna whose principal scientific interest was the human ear. He described the eustachian tube and the maneuver to test its patency (openness).
Physiological response
The normal physiological response consists of four phases.
Initial pressure rise
On application of expiratory force, pressure rises inside the chest forcing blood out of the pulmonary circulation into the left atrium. This causes a mild rise in stroke volume during the first few seconds of the maneuver.
Reduced venous return and compensation
Return of systemic blood to the heart is impeded by the pressure inside the chest.
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