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In medicine, the Valsalva maneuver is performed by forcibly exhaling against closed lips and pinched nose, forcing air into the middle ear if the Eustachian tube is open. This maneuver with slight modifications can be used as a test of cardiac function and autonomic nervous control of the heart or to ‘clear’ the ears and sinuses (equalize pressure) when ambient pressure changes, as in diving or aviation.
The technique is named for Antonio Maria Valsalva, the 17th 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.
Additional recommended knowledge
The normal physiological response consists of 4 phases, which are marked on the figure at right:
Deviation from this response pattern signifies either abnormal heart function or abnormal autonomic nervous control of the heart.
Valsalva in normalizing middle ear pressures
When rapid ambient pressure increase occurs as in diving or aircraft descent, this pressure tends to hold the Eustachian tubes closed, preventing pressure equalization across the ear drum, with painful results. To avoid this painful situation, divers, caisson workers and aircrew attempt to open the Eustachian tubes by swallowing, which tends to open the tubes, allowing the ear to equalize itself.
If this fails, then the Valsalva maneuver may be used. It should be noted this maneuver, when used as a tool to equalize middle ear pressure, carries with it the risk of auditory damage from over pressurization of the middle ear. It is safer, if time permits, to attempt to open the Eustachian tubes by swallowing a few times, or yawning. The effectiveness of the "yawning" method can be improved with practise; some people are able to achieve release or opening by moving their jaws forward or forward and down, rather than straight down as in a classical yawn. Opening can often be clearly heard by the practitioner, thus providing feedback that the maneuver was successful.
Note that in a clinical setting the Valsalva maneuver will be done either against a closed glottis, or against an external pressure measuring device, in each case either eliminating or minimizing the pressure on the Eustachian tubes. Straining, blowing against resistance as in blowing up balloons has a Valsalva effect and the fall in blood pressure can result in dizziness and even fainting.
Valsalva in cardiology
The Valsalva maneuver may be used to arrest episodes of supraventricular tachycardia. The maneuver can sometimes be used to diagnose heart abnormalities, especially when used in conjunction with echocardiogram. For example, the Valsalva maneuver classically increases the intensity of hypertrophic cardiomyopathy murmurs, viz those of dynamic subvalvular left ventricular outflow obstruction; whereas it decreases the intensity all other murmurs, including aortic stenosis and atrial septal defect.
Valsalva in neurology
The Valsalva maneuver is used to aid in the clinical diagnosis of problems or injury in the nerves of the cervical spine. Upon the exertion of pressure, neuropathies or radicular pain may be felt, and may indicate impingement on a nerve by an intervertebral disc or other part of the anatomy.
 Definitions of various clinical tests for neuropathy.
A pathologic syndrome associated with the Valsalva maneuver is Valsalva retinopathy. It presents as preretinal hemorrhage (bleeding in front of the retina) in people with a history of transient increase in the intrathoracic pressure. The bleeding may be associated with a history of heavy lifting, forceful coughing, straining on the toilet, or vomiting. The bleeding may cause a reduction of vision if it obstructs the visual axis. Patients may also note floaters in their vision. Usually a full recovery of vision is made.
 More on the topic of Valsalva retinopathy
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Valsalva_maneuver". A list of authors is available in Wikipedia.|