Valsalva Maneuver and Tympanic Membrane Movement Video

Eardrum Retraction and Treatment

The above maneuver can be used in the diagnosis and treatment of eardrum retraction. The controversial issue here is that when there is an upper respiratory tract infection and there is an inflammatory discharge in the nose, if this maneuver is performed, it may cause reflux of the inflammatory contents in the nasal cavity into the Eustachian tube. There are balloon-shaped apparatuses that are placed in the nose and provide increasing intranasal positive pressure. In this system, when nasal discharge and inflammatory nasal discharge are present, increasing the intranasal pressure and pushing air into the middle ear may cause microorganisms to be pushed into the Eustachian tube.

Ear Equalization Technique With Valsalva Maneuvering

As can be seen in the case of pressure trauma to the eardrum during upper respiratory tract infections, diving and air travel; can also be seen in the case of eustachian tube insufficiency in which middle ear ventilation is affected. In children, adenoid hypertrophy, middle ear fluid (serous otitis media) and adult patients may be present in cases of nasal obstruction.

After the mouth is inhaled, unclogging or pressure equalization is called "Valsalva Maneuver" by closing the nose and blowing air through the ear.

Valsalva During the maneuver, the pressure in the head is increased and it should not be done without consulting a doctor. A patient who has undergone ear surgery, nose surgery or any other surgical intervention must make this maneuver by consulting a physician.

Using the Valsalva Maneuver in Vagal Stimulation

Valsalva maneuver can be used in clinical practice as a vagal stimulation technique, in the diagnosis and treatment of SVT (supraventricular tachycardia) while performing Doppler USG, in the evaluation of heart failure and left ventricular dysfunction, and in the evaluation of venous return. The modified valsalva maneuver is defined as the simultaneous raising of the legs of the patient lying on his back at least 45 degrees during the valsalva maneuver. It is not used in this way in the otolaryngology area. Patients with heart rhythm disorders should not apply this method on their own. It should not be done without consulting a doctor.

The valsalva maneuver performed with the wrong technique can be dangerous!

Valsalva maneuver that is not performed properly (increasing pressure excessively, pushing too much air at a time, continuing to increase the pressure despite pain in the ears) can cause serious problems by causing severe pressure increase in the middle ear, creating barotrauma in the middle ear. It can cause damage and rupture to both the eardrum and the membranes of the inner ear. In such a case, perilymph and endolymph fluid leaks of the inner ear can cause tinnitus and hearing loss. It should not be done when there is otitis media, acute sinusitis and intranasal inflammation secreton. Again, it may be appropriate for patients with intracranial vascular aneurysms and heart rhythm disturbances, people who use anticoagulants or have diseases that prevent blood clotting, to consult a physician before performing this maneuver.

The Valsalva maneuver may also be inconvenient during pregnancy. It is not appropriate for pregnant patients to do this maneuver without consulting a doctor.

The Valsalva Maneuver is not effective in all tympanic retractions!

This maneuver can be applied in case of temporary retraction of the eardrum and negative pressure in the middle ear. It should be done within the recommendation and treatment scheme of an otolaryngologist. It is inconvenient to do in the presence of active middle ear infection and acute sinusitis. A healthy person can provide pressure equalization with the valsalva maneuver during the flight in case of aircraft descent. In patients with advanced tympanic retraction, this maneuver is not effective.

In patients with Ear Ventilation tube, Valsalva Maneuver has no effect on the eardrum and middle ear!

The Valsalva maneuver has no effect on the middle ear or eardrum in patients with a previously placed ear ventilation tube and the ventilation tube open, in situ, and functioning normally. Already, the ear ventilation tube equalizes the middle ear and external pressure. If the tube is clogged with dirt or crusts, collapse of the membrane or negative pressure in the middle ear may occur, as in the normal eardrum, and the pressure can be equalized with this maneuver. However, if this maneuver is performed too quickly and harshly, the ventilation tube may displace outward.

In those who have eardrum surgery, this maneuver is risky in the early period!

After eardrum surgery, recovery is largely completed within the first 6 months. Especially in the first 2 months, movements such as Valsalva Maneuver, sneezing with mouth closed, blowing, which may cause severe pressure changes in the middle ear, may cause separation of the graft placed in the eardrum and the re-emergence of the hole in the membrane. Do not do this maneuver without consulting your doctor who performed your eardrum surgery.

Patients with brain aneurysm and using blood thinners, do not do this maneuver!

Because it may cause an increase in intracranial blood pressure, patients with aneurysms in the brain and using blood thinners should avoid performing the Valsalva Maneuver, due to the risk of cerebral hemorrhage.

The Valsalva maneuver can be used in clinical practice, in the field of cardiology

In the diagnosis and treatment of paroxysmal supraventricular tachycardias, in the evaluation of heart failure and left ventricular dysfunction. There is no "gold standard" for proper Valsalva maneuver technique, but it is generally intended to increase intrathoracic pressure to at least 30-40 mm Hg for 10-30 seconds against the closed glottis. With the increase in intrathoracic pressure, vagotonic baroreceptors located in the aortic arch and sinus caroticum are stimulated. The vagal nerve is stimulated as a result of the impulses reaching the medulla oblongata via the Hering nerve and the glossopharyngeal nerve. The sinoatrial node is stimulated via the right vagus nerve, and the AV node is stimulated via the left, and SVT is terminated with a bradycardia response (source >> Valsalva manevrası ve Taşikardilerin Tanısı 2020 | MEtokondri).

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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