Normalizing middle-ear pressures When rapid ambient pressure increase occurs as in diving or aircraft descent, this pressure tends to hold the Eustachian tubes closed, preventing pressure equalization across the ear drum, with painful results. To avoid this painful situation, divers, caisson workers and aircrew attempt to open the Eustachian tubes by swallowing, which tends to open the tubes, allowing the ear to equalize itself. If this fails, then the<unk>  may be used. This maneuver, when used as a tool to equalize middle ear pressure, carries with it the risk of auditory damage from over pressurization of the middle ear. The<unk>  generates about 20–40 mm of Hg pressure. It is safer, if time permits, to attempt to open the Eustachian tubes by swallowing a few times, or yawning, or by using the<unk>  technique of breathing a very small amount of air gently into nostrils held closed by the fingers as soon as mild pressure is felt, before it increases to the point that its release would be painful. The effectiveness of the "yawning" method can be improved with practice; some people are able to achieve release or opening by moving their jaw forward or forward and down, rather than straight down as in a classical yawn, and some can do so without moving their jaw at all by activating the tensor tympani muscle, which is heard by the individual as a deep, rumbling sound. Opening can often be clearly heard by the practitioner, thus providing feedback that the maneuver was successful. During swallowing or yawning, several muscles in the pharynx (throat) act to elevate the soft palate and open the throat. One of these muscles, the tensor veli palatini, also acts to open the Eustachian tube. This is why swallowing or yawning is successful in equalizing middle ear pressure. Contrary to popular belief, the jaw does not pinch the tubes shut when it is closed. In fact, the Eustachian tubes are not located close enough to the mandible to be pinched off. People often recommend chewing gum during ascent/descent in aircraft, because chewing gum increases the rate of salivation, and swallowing the excess saliva opens the Eustachian tubes. In a clinical setting the<unk>  will commonly be done either against a closed glottis, or against an external pressure measuring device, thus eliminating or minimizing the pressure on the Eustachian tubes. Straining or blowing against resistance as in blowing up balloons has a<unk>  effect and the fall in blood pressure can result in dizziness and even fainting. Strength training The<unk>  is commonly believed to be the optimal breathing pattern for producing maximal force and is frequently used in powerlifting to stabilize the trunk during exercises such as the squat, deadlift, and bench press, and in both lifts of Olympic weightlifting. Additionally, competitive strongmen often use the<unk>  in things such as log press, yoke walks, and stone loading, as well as any other strongman movements. Pain management The<unk>  can be used as a means to reduce pain during lumbar puncture. Regulation of heart rhythm The<unk>  may be used to arrest episodes of supraventricular tachycardia. Blood pressure (BP) rises at onset of straining-because the increased intrathoracic pressure (ITP) is added to the pressure in the aorta. It then falls because the ITP compresses the veins, decreasing the venous return and cardiac output. This inhibits the baroreceptors causing tachycardia and a rise in peripheral vascular resistance (PVR). When the glottis is opened and the ITP returns to normal, cardiac output is restored but the peripheral vessels are constricted. The blood pressure therefore rises above normal and this stimulated the baroreceptors, causing bradycardia and a drop in BP to normal level. Medical diagnostics Cardiology The maneuver can sometimes be used to diagnose heart abnormalities, especially when used in conjunction with an echocardiogram. For example, the<unk>  (phase II) increases the intensity of hypertrophic cardiomyopathy murmurs, namely those of dynamic subvalvular left ventricular outflow obstruction. At the same time, the<unk>  (phase II) decreases the intensity of most other murmurs, including aortic stenosis and atrial septal defect. During the first few seconds of the<unk>  (phase I) the opposite findings will be the case. A UK-based randomized controlled trial (REVERT) demonstrated that in patients with cardiovascularly stable supraventricular tachycardia, a modified<unk>  started in semi-recumbent position followed by repositioning of the patient to a supine position with a passive leg raise immediately after the strain has and increased 43% success rate compared to the only 17% effectiveness of the conventional<unk>  in terminating SVT. Effect of<unk>  (phase II) Cardiac finding Decreases murmur Aortic stenosis Pulmonic stenosis Tricuspid regurgitation Increases murmur Hypertrophic cardiomyopathy Mitral valve prolapse Earlier onset of murmur Mitral valve prolapse Neurology The<unk>  is used to aid in the clinical diagnosis of problems or injury in the nerves of the cervical spine. Upon performing the<unk> , intraspinal pressure slightly increases. Thus, neuropathies or radicular pain may be felt or exacerbated, and this may indicate impingement on a nerve by an intervertebral disc or other part of the anatomy. Headache and pain upon performing the<unk>  is also one of the main symptoms in Arnold–Chiari malformation. The<unk>  may be of use in checking for a dural tear following certain spinal operations such as a microdiscectomy. An increase in intra-spinal pressure will cause cerebral spinal fluid (CSF) to leak out of the dura causing a headache. The<unk>  has been associated with transient global amnesia. Palpation of supraclavicular lymph nodes As the lymph nodes may be buried, asking the patient to perform the<unk>  can push the cupola of the lung upward bringing deep-seated nodes to a more accessible position for palpation. Palpation may identify an enlargement of the supraclavicular lymph nodes which is a diagnostic indicator of cancer. The prevalence of malignancy in the presence of supraclavicular lymphadenopathy is reported to be in the range of 54% to 85%. Oral–antral communication A variant of the<unk>  is used to aid diagnosis of oral–antral communication, i.e. the existence of a connection between the oral cavity and the maxillary sinus. Urogenital medicine The<unk>  is used to aid diagnosis of intrinsic sphincteric deficiency (ISD) in urodynamic tests.<unk>  leak point pressure is the minimum vesicular pressure that is associated with urine leakage. Although there is no consensus on the threshold value, values > 60 cm H2O are commonly considered to indicate hypermobility of the bladder neck and normal sphincter function. Also, when examining women with pelvic organ prolapse, asking the patient to perform the<unk>  is used to demonstrate maximum pelvic organ descent.
Valsalva maneuver
Phalen maneuver
Rubin maneuver
Epley maneuver
Wright's maneuver
LeCompte maneuver
Jaw-thrust maneuver
Zavanelli maneuver