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The Valsalva Maneuver: What it is and how to perform it

Last update on May, 31, 2023

If you’ve ever squirmed in your airplane seat trying to get your ears to pop with no success, you should learn about the Valsalva Maneuver. While it’s commonly used to help balance out heartbeat irregularities, it can also provide relief for the discomfort of pressure-plugged ears. Find out how it works and how you can do it safely. 

What is the Valsalva Maneuver?

From popping plugged-up ears to settling an irregular heartbeat, the Valsalva Maneuver is an effective way to treat some minor medical issues. It’s a series of breathing actions that you can perform on your own—no invasive instruments or medications needed.

It’s hard to pinpoint when humans landed on it as a solution to health issues, but it is named after Antonio Maria Valsalva (1666-1723). His 1704 work, De Aure Humana Tractatus, was the origin of the Valsalva maneuver-ear connection: He described it as a way to push air into the middle ear. Through the centuries, doctors have found it to also be an effective way to even out a fast, irregular heartbeat (known as supraventricular tachycardia or SVT) and to help diagnose the specifics of heart murmurs, vein diseases and problems with the autonomic nervous system.

The Valsalva Maneuver is also used by divers to help equalize the pressure in their ears as they go deeper into the ocean, and is a common recommendation to help relieve "airplane ear". In both situations, pressure around you changes fairly quickly, and the Eustachian tubes, which connect the middle ear to the back of the throat and help regulate pressure, can’t keep up. The Valsalva Maneuver helps with these conditions because it pushes air up through the sinuses and into the Eustachian tubes, forcing them to open.

How to perform the Valsalva Maneuver

It’s a good idea to have a doctor do a demonstration so you learn how to do the Valsalva Maneuver correctly, but these are the steps:

  • Sit down or lie down
  • Inhale deeply
  • Close your mouth and pinch your nose shut
  • Bear down as though you are trying to push the breath out, but do not let it out (Think of the feeling of blowing up a balloon)
  • Hold for 10-20 seconds
  • Open your mouth, unplug your nose and breathe out

If needed, you can repeat the maneuver. However, if you are using it to help calm an irregular heartbeat and it doesn’t work after two or three tries, you should contact a doctor right away

How to perform the modified and reverse Valsalva Maneuver

There are two modifications to the Valsalva Maneuver that you might have heard of, but they are meant to help treat supraventricular tachycardia, not ear issues. The first is the modified Valsalva Maneuver, used to treat emergency SVT:

  • Lay down on your back
  • Perform the Valsalva Maneuver as described above
  • Raise the legs immediately after straining/bearing down

For people experiencing SVT, the modified Valsalva Maneuver is sometimes more effective because raising the legs directs more blood back to the heart. There is also the reverse Valsalva Maneuver:

  • Sit upright
  • Close your mouth and pinch your nose
  • Inhale strongly enough that you feel resistance
  • Open your mouth, release your nose and breathe normally
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Advantages of the Valsalva Maneuver

Knowing how to do the Valsalva Maneuver comes in handy—you can rely on it as a quick and relatively effective way to help you deal with SVT or other issues without having to go directly to a hospital, find a special tool or wait for medication to work. And when you’re diving underwater or high in the sky on an airplane, Valsalva Maneuver ear relief is a very welcome feeling. Best of all, it can be done in seconds without assistance.

Risks and precautions when performing the Valsalva Maneuver

Learning how to do this safely is important because there is some risk involved with the Valsalva Maneuver. The maneuver causes changes in blood pressure and heart rate; in some cases, this is exactly what you need it to do, but in other cases, it can be risky.

Your blood pressure will go up as you do the straining of the Valsalva Maneuver and drops as you release. Similarly, your heart rate will go up and down. For some people, these changes might be dangerous and can lead to fainting. It can also put pressure on your eyes, which is risky for people with certain ocular conditions. 

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Who should avoid the Valsalva Maneuver?

The fluctuations in blood pressure, heart rate and pressure on the eyes mean that there is Valsalva Maneuver danger for people with conditions including:

  • Retinopathy (a condition relating to blood vessels in the retina)
  • Intraocular lens implants
  • Heart valve diseases
  • Coronary artery diseases
  • Congenital heart diseases

As noted, it’s a good idea to talk to a doctor who knows your medical history about whether the Valsalva Maneuver is safe for you to do on your own. While it can be a simple, helpful maneuver in some cases, you don’t want it to create more threatening health problems. 

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When to use the Valsalva Maneuver

The Valsalva Maneuver is useful to know because you can deploy it in all kinds of situations and settings. As noted, it can help when you feel the fast and erratic heartbeat associated with supraventricular tachycardia or other unusual heartbeat rhythms. Your doctor might also use it in-office when working on fine-tuning diagnoses of different conditions like heart murmurs, heart failure or vein-related diseases.

Though they are lower stakes than helping with heart troubles, Valsalva Maneuver ear relief techniques come in handy whether you’re on an adventure or out for a drive. That familiar ear-clogging feeling can come with deep sea diving, snorkeling, flying or even changing elevations when you’re driving through different terrain. Knowing how to deploy the Valsalva Maneuver gives you a quick way to find relief wherever you find yourself. 

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One of the best ways to care for your ears and prevent hearing loss is to get them properly examined by a hearing professional. Find your nearest Miracle-Ear store to get started on your journey to better hearing.

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