What Are Valsalva Maneuvers, and Are They Safe

What Is Valsalva Maneuver?

Valsalva maneuver (also called “the Vals” or “The Valse”) is a medical term describing the involuntary contraction of the diaphragm during inspiration and expiration. During inspiration, air enters the lungs through the mouth while it leaves them through the nose. When breathing becomes difficult due to coughing, sneezing, laughing or other causes, this natural mechanism automatically contracts to prevent suffocation.

In normal circumstances, the diaphragm relaxes when inhaling and expands when exhaling. However, if there is a blockage in the respiratory tract such as a blocked or narrowed airway, then the diaphragm will not contract properly. This condition known as “ventricular fibrillation.” If left untreated, ventricular fibrillation can lead to cardiac arrest.

When Does Ventricular Fibrillation Occur?

If ventricular fibrillation occurs suddenly, it may cause no symptoms at all. But if the heart beats too slowly, or if there are other conditions that affect the heart’s rhythm, then sudden death can occur.

A person with ventricular fibrillation is considered to have a resting heart rate of less than 60 beats per minute (bpm). A resting heart rate is defined as the average number of times each minute your body goes from rest to activity.

During exercise or other activity, the heart can beat much faster. While a normal resting heart rate is 60 to 100 bpm, it can increase to more than 100 bpm in athletes and individuals who are physically fit.

A person with ventricular fibrillation will feel like they are about to die because their heart is beating so fast and so impossibly weakly. If they do not receive immediate medical treatment—including defibrillation, drugs, and CPR—they will.

Valsalva Maneuver: What Is The Valsalva Maneuver Used For?

The valsalva maneuver (VM) is a term that describes an attempt to exhale against a closed airway. This is done by closing the glottis (happens automatically when you yawn) and then trying to exhale.

The valsalva maneuver can be used to check if there is a blockage in your ears or nose, or if there is fluid in your inner ear. Some people use the valsalva maneveur to try to relieve themselves of some of their symptoms of Ménière’s disease.

The valsalva maneuver is sometimes also used to prevent oneself from passing out during a medical test or procedure.

Why Is Valsalva Maneuver Used During Dental Work?

In general, the valsalva maneuver is used as a diagnostic tool during ear and nose related medical procedures.

The valsalva maneuver is used during a dental visit to check whether one or more of your sinuses is blocked. Normally, if all of your sinuses are clear, this would cause air to travel into your ears and equalize the pressure. If, however, you have a blockage in one or more of your sinuses, this will prevent the air from traveling into your ear and equalizing the pressure.

The valsalva maneuver is done by gently blowing air out of your nose, and then trying to gently sniff in. If you are unable to sniff in, then there is a blockage in one or more of your sinuses. In this case, the doctor will usually prescribe decongestants or suggest that you have your sinuses drained by an ear, nose, and throat (ENT) doctor.

If the valsalva maneuver is done during ear-related medical procedures, then it allows the doctor to see if there is fluid in your ear. If you can gently sniff air into your ear, then this indicates that there is fluid in your ear. Doctors will usually perform a procedure called an acoustic myringotomy to drain this fluid. These are two small holes made in the eardrum to drain the fluid from the middle ear.

How Is It Done?

The valsalva maneuver is done by closing off your nose and gently trying to exhale or sniff air in. This is a conscious effort and is not the same as holding your breath while coughing or sneezing.

Who Can And Can’t Do It?

Anyone can do the valsalva maneuver as long as they are able to gently close off their nose. There are a few people who should not do the maneuver, though. These people are those who:

Have recent ear surgery

Have a hole in their eardrum (perforated eardrum)

Have tubes in their ears

Have fluid or infection in their ear

Have recently hit their head and have symptoms of a concussion

Pregnant women should not do the maneuver, as it may harm the fetus.

Who Is The Valsalva Maneuver Not Used On?

The valsalva maneuver can be used on most patients. There are, however, some people who should not use it. These people include:

Anyone with a hole in their eardrum

Those who have had recent ear surgery

Those who have tubes placed in their ears

Those who have fluid or an infection in their ear

Those who have had a head injury or concussion within the past four weeks, as this may cause a problem with equilibrium and balance

Pregnant women

What Are The Alternatives?

If you can’t do the valsalva maneuver, then your doctor will usually use other ways to examine your ears.

Ear Wax:

If you have a buildup of earwax in your ears, then you may experience some hearing loss. Earwax is naturally produced by our bodies to protect and clean out the ear canal. However, for some people, earwax production is higher than normal, causing a clogging of the ear canal. This clogging can prevent sound waves from traveling into the ear properly.

Earwax is softer than earplugs and can be removed by using over the counter drops that soften the wax. After several uses, the wax should come out freely with little effort. These ear drops are not able to be purchased in stores and must be prescribed by a physician.

Cerumen Impaction:

If there is no earwax buildup, then your physician may suspect cerumen impaction. This means that the earwax has actually become so impacted that it is pushing inward on the eardrum. This blockage of the ear canal causes difficulty in hearing and should be treated right away, as it may lead to a perforated eardrum. The physician will be able to easily treat this by irrigating your ear with warm water to soften the wax, which can then be removed manually using an instrument called an ear curette.

Swimmer’s Ear:

This is a fungal or bacterial infection of the outer ear canal. It can be treated with an anti-fungal or antibacterial ear drop to clear up the infection and prevent it from spreading. After the infection has cleared up, your physician may also recommend an over the counter ear drying agent to dry out the moisture and prevent the infection from returning.

How Should I Prepare?

There isn’t too much that you need to do to prepare for your appointment. However, it may be a good idea to write down any symptoms you are experiencing or medications you are currently taking to help your doctor.

What Should I Bring?

You should bring any medications you are taking to your appointment. If you are supposed to irrigate your ears at home, then you will also need to bring the ear drops that your physician gave you.

Sources & references used in this article:

Intraluminal colon pressure dynamics with Valsalva maneuver during air enema study. by RT Bramson, WE Shiels 2nd, CJ Eskey, SY Hu – Radiology, 1997 – pubs.rsna.org

Comparing the success rates of standard and modified Valsalva maneuvers to terminate PSVT: A randomized controlled trial by ŞK Çorbacıoğlu, E Akıncı, Y Çevik, H Aytar… – The American Journal of …, 2017 – Elsevier

Changes in tracheal cross-sectional area during Mueller and Valsalva maneuvers in humans by IG Brown, PM Webster, N Zamel… – Journal of Applied …, 1986 – journals.physiology.org

Continuous ambulatory right heart pressure measurements with an implantable hemodynamic monitor: a multicenter, 12-month follow-up study of patients with chronic … by A Magalski, P Adamson, F Gadler, M Böehm… – Journal of cardiac …, 2002 – Elsevier

The Valsalva maneuver: its effect on intra-abdominal pressure and safety issues during resistance exercise by DA Hackett, CM Chow – The Journal of Strength & …, 2013 – cdn.journals.lww.com