Normalizing middle-ear pressures When rapid ambient pressure increase occurs, as in
underwater diving or aircraft descent, this pressure tends to hold the eustachian tubes closed, preventing pressure equalization across the eardrum and causing pain. To avoid this painful situation, divers,
caisson workers and people in pressurized aircraft 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. 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. The Valsalva maneuver generates about 20–40 mm of Hg pressure. It is safer, if time permits, to attempt to open the eustachian tubes by swallowing a few times, or
yawning, or by using the Valsalva technique of breathing a minimal amount of air gently into nostrils held closed by the fingers as soon as mild pressure is felt before it increases to the point that its release would be painful. The effectiveness of the "yawning" method can be improved with practice; some people can achieve release or opening by moving their
jaw forward or forward and down, rather than straight down as in a classical yawn,
Pain management The Valsalva maneuver may reduce pain during
lumbar puncture. According to Kumar,
et al., performing the maneuver on an awake patient triggers predictable cardiovascular and autonomic responses that can be timed by a skilled surgeon to maximize anesthetic benefit.
Regulation of heart rhythm The Valsalva maneuver may be used to arrest episodes of
supraventricular tachycardia. Blood pressure (BP) rises at onset of straining-because the increased intrathoracic pressure (ITP) is added to the pressure in the aorta. It then falls because the ITP compresses the veins, decreasing the venous return and cardiac output. This inhibits the baroreceptors, causing tachycardia and a rise in peripheral vascular resistance (PVR). When the glottis is opened and the ITP returns to normal, cardiac output is restored, but the peripheral vessels are constricted. The blood pressure therefore rises above normal, and this stimulates the baroreceptors, causing
bradycardia and a drop in BP to a normal level.
Diagnosis Cardiology Sometimes, the maneuver may be used to diagnose heart abnormalities, especially when used in conjunction with an
echocardiogram. For example, the Valsalva maneuver (phase II) increases the intensity of
hypertrophic cardiomyopathy murmurs, namely those of dynamic subvalvular left ventricular outflow obstruction. This is due to the decreased preload in this phase, worsening the obstruction and thus accentuating the murmur. Upon performing the Valsalva maneuver, intraspinal pressure slightly increases. Thus, neuropathies or radicular pain may be felt or exacerbated, which may indicate nerve impingement by an intervertebral disc or other part of the anatomy. Headache and pain upon performing the Valsalva maneuver are also one of the main symptoms in
Arnold–Chiari malformation. The Valsalva maneuver may help check for a
dural tear following certain spinal operations, such as a microdiscectomy. An increase in intra-spinal pressure will cause
cerebral spinal fluid (CSF) to leak out of the dura, causing a headache. The Valsalva maneuver has been associated with
transient global amnesia.
Palpation of supraclavicular lymph nodes As the lymph nodes may be buried, asking the patient to perform the Valsalva maneuver may push the cupola of the lung upward, bringing deep-seated nodes to a more accessible position for palpation. Palpation may identify an enlargement of the supraclavicular lymph nodes, a diagnostic indicator of cancer. The prevalence of malignancy in the presence of supraclavicular lymphadenopathy is reported to be in the range of 54% to 85%.
Oral–antral communication A variant of the Valsalva maneuver is used to aid diagnosis of oral–antral communication, i.e., the existence of a connection between the oral cavity and the
maxillary sinus.
Urogenital medicine The Valsalva maneuver is used to aid in the diagnosis of
intrinsic sphincteric deficiency (ISD) in urodynamic tests. Valsalva leak point pressure is the minimum vesicular pressure associated with urine leakage. Although there is no consensus on the threshold value, values > 60 cm H2O are commonly considered to indicate hypermobility of the bladder neck and normal sphincter function. Also, when examining women with
pelvic organ prolapse, asking the patient to perform the Valsalva maneuver is used to demonstrate maximum pelvic organ descent. == Complications ==