The Valsalva maneuver is a coordinated muscular movement that increases pressure in the Eustachian tubes and middle ears. The maneuver produces a bilateral increase in pressure on both the left and right middle ears. The maneuver was first described by Italian anatomist Antonio Maria Valsalva (1666-1723). The Valsalva maneuver may occur as a result of natural muscle movements during defecation, coughing, or gagging, or as an induced maneuver.

The natural Valsalva maneuver occurs when exhaled air is blocked by a closed glottis. In addition to causing pressure changes in the Eustachian tubes, the Valsalva maneuver has a number of physiological side effects. The maneuver causes a decrease in the return of venous blood to the heart and decrease in blood pressure. When the airway is reopened, blood pressure increases and the heart race increases until slowed by a reflex slowing (brachycardia).

The artificial maneuver requires that...