Attempting to exhale forcefully while closing your mouth and pinching your nostrils is a common physical action used to relieve ear pressure. This deliberate maneuver rapidly increases the air pressure within your nasal and throat cavities. The immediate goal is to alleviate the uncomfortable feeling of fullness or blockage that often occurs during changes in altitude. This straining action also influences the body’s entire circulatory system in a predictable, four-phase process.
How This Action Clears Your Ears
The physical act of attempting to exhale against a closed airway is formally known as the Valsalva maneuver, named after the 17th-century physician Antonio Maria Valsalva. This technique is highly effective for normalizing middle ear pressure imbalances, a condition known as barotrauma, which commonly occurs during airplane descent or scuba diving. The maneuver works by forcing compressed air from the throat upward into the narrow passageways of the Eustachian tubes.
The Eustachian tubes are small canals connecting the middle ear to the back of the nasopharynx. These tubes are normally closed, but they open briefly when you swallow, yawn, or perform the Valsalva maneuver to allow air to pass and regulate pressure. When atmospheric pressure changes rapidly, the air pressure in the middle ear often lags, causing the eardrum to bulge inward or outward, resulting in the sensation of a “clogged” ear.
The sudden increase in pressure created by the forced exhalation pushes air through the Eustachian tubes to equalize the pressure on both sides of the eardrum. This equalization process relieves the physical stress on the eardrum. For the maneuver to be effective, the exhalation must be strong enough to overcome the resistance of the closed Eustachian tubes, but gentle enough to avoid causing injury.
Hidden Effects on Circulation and Heart Rate
The Valsalva maneuver’s forceful exhalation significantly increases the pressure inside the chest cavity, known as intrathoracic pressure. This increase directly affects the major veins returning blood to the heart, leading to a predictable sequence of cardiovascular changes divided into four phases. In the initial phase, sudden chest compression forces blood out of the lungs into the left side of the heart, causing a transient spike in blood pressure.
As the straining continues into the second phase, the sustained high intrathoracic pressure compresses the large veins, severely impeding the flow of venous blood returning to the heart. This decreased venous return leads to a rapid fall in the heart’s output and a corresponding drop in blood pressure. The autonomic nervous system detects this drop and compensates by causing blood vessels to constrict and the heart rate to accelerate, attempting to restore blood pressure.
The third phase begins the moment the forced exhalation is released, and the pressure in the chest instantly returns to normal. Blood pressure continues to dip momentarily because the venous reservoir is temporarily depleted. Finally, in the fourth phase, the venous blood rushes back to the heart, leading to a rapid surge in heart output. This sudden increase in blood flow causes the blood pressure to temporarily overshoot its starting level, which then triggers a reflex slowing of the heart rate, returning the system to its baseline.
When Not to Use This Technique
While the maneuver is widely used for pressure equalization, performing it too forcefully carries a risk of damage to the delicate structures of the ear. Excessive pressure can potentially rupture the eardrum or cause inner ear damage, especially if the Eustachian tube is completely blocked. Therefore, a gentle, sustained exhalation is always recommended over a violent one.
Individuals with certain pre-existing medical conditions should avoid the Valsalva maneuver entirely due to its significant effect on blood pressure and heart rate. People with specific heart conditions, such as coronary artery disease, heart valve disease, or certain arrhythmias, should not perform the technique without medical consultation. The maneuver is also contraindicated for those who have recently had eye surgery or suffer from conditions like glaucoma or retinopathy, as the increased internal pressure can put undue stress on the eyes.
If you are experiencing a severe cold, sinus congestion, or an active ear infection, the maneuver should be avoided. Forcing air into an already inflamed or fluid-filled middle ear can push infection into other areas or worsen the existing inflammation. Safer alternatives for ear clearing include swallowing or yawning, or techniques like the Toynbee maneuver, which involves swallowing while pinching the nose.