Valsalva Manoeuvre

Which effects does it have on the ear?
Last update on Feb, 18, 2022

What is the Valsalva manoeuvre?

The Valsalva manoeuvre consists of a relatively deep inhalation, followed by a forced exhalation with a closed glottis that lasts 10 seconds. This technique was first applied by the Arabs in the 11th century.

How does Valsalva affect our ear?

The Valsalva manoeuvre is used to normalize middle ear pressure, but caution is needed: in fact, there is a risk of hearing damage due to middle ear overpressure.

Valsalva manoeuvre: when is it necessary?

Used to manage hiccups, to counteract tachycardia, the Valsalva manoeuvre is also used to normalize pressure in the middle ear.  

To equalise ear pressure

The Valsalva manoeuvre is also used to equalize pressure in the ear and to cure hiccups and counteract tachycardia. The manoeuvre can be helpful when there is a rapid increase in pressure, particularly while diving (in the descent phase) or in an airplane. In these cases, the pressure keeps the Eustachian tubes closed and impedes the regulation of pressure in the middle ear. These symptomps can be avoided by swallowing repeatedly, allowing the ear to normalize pressure by opening the Eustachian tubes.

For palpitations

The Valsalva manoeuvre is especially useful in the event of tachycardia. After an initial phase of intrathoracic compression, there is a release and recovery period that allows the heart rate to decrease.
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Valsalva manoeuvre: how it should be executed

The Valsalva manoeuvre helps increase the pressure inside the chest and belly. To perform it, follow these steps: 

  • inhale deeply
  • pinch the bridge of your nose with your fingers to block your nostrils
  • perform a forced exhalation with your mouth closed
  • as you do this, make sure to contract the muscles of the abdomen

The advantages of the Valsalva manoeuvre

The technique quickly relieves the pressure inside the ear by opening the Eustachian tubes.

Is the Valsalva manoeuvre dangerous?

Risks should not be underestimated. The continuous execution of the Valsalva manoeuvre can lead to to onset of: postural problems,

  • muscle stiffness,
  • breathing problems,
  • blood system pressure problems,
  • intra-cranial pressure problems,
  • hormonal problems, due to oxygen deficiency.

In addition, over-pressurization in the inner ear can cause serious damage to the auditory system.

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Alternatives to the Valsalva Manoeuvre

The Frenzel manoeuvre (or Marcante-Odaglia Manoeuvre) can be performed as an alternative to the Valsalva Manoeuvre. This is a compensation technique used mainly in diving, performed by leveraging the closure of the lower and upper airways to avoid stressing the lungs. When this manoeuvre is performed, it is necessary to:

  1. push the tongue towards the throat and implement a movement similar to swallowing.
  2. push the tongue upwards, towards the soft palate, to exert pressure towards the middle ear.
  3. while the lower airway is closed with the tongue, the upper airway must be closed by plugging the nose.

In the event that pressure in the ear cannot be relieved with these manoeuvres, a physician should be consulted.

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