The Valsalva maneuver is defined as "attempted exhalation against a closed airway", "The effort to breathe out forcibly while the mouth and nose are firmly closed or the vocal cords pressed together", or, colloquially, straining as if you were trying to poop. It can "pop" the eustachian tubes open, stimulate the vagus nerve, and briefly spike blood pressure, occasionally leading to people dying from a burst aneurysm on the toilet.

Some breathing practices involve pushing air out against resistance, such as ujjayi breath in yoga. This can be done by partly closing the glottis while exhaling, or by firmly exhaling through the mouth with lips slightly open, as if one were whistling. It can also happen while forcefully exhaling through a congested nose.

This seems like it should raise eustachian and thoracic pressure in the same way as the "full" Valsalva maneuver, though to a lesser extent. Are the effects of these other breathing practices similar to the Valsalva maneuver, or are there any unique effects of the Valsalva maneuver that only occur with a fully closed airway?

As a second question, would you expect any unique effects exhaling against resistance? It seems different in that the practitioner is still breathing, and that they can continue the practice indefinitely, as opposed to a breath-holding Valsalva.

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    $\begingroup$ Since commercial divers that wear diving helmets cannot pinch their nose shut with their fingers, a retractable 'nose clearing device' is provided in the helmet, or similarly a block that the nose can be pressed against. The device generally does not completely occlude the nose, but enough that if the exhaled flow rate is high enough, the middle ear can be equalized. $\endgroup$
    – docscience
    Commented May 17, 2017 at 20:15

1 Answer 1


The eustachian tubes exit into the nasal cavity superior to the glottis. Thus restricting the glottis while exhaling cannot increase pressure in the nasal cavity / eustachians. Only by closing the nostrils can that be achieved, and only while exhaling. Even a technique like circular breathing cannot maintain pressure in the nasal cavity since that's necessarily the entry point for every new breath, be it mouth or nose.

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    $\begingroup$ Please add some references to your answer. $\endgroup$ Commented Jan 14, 2017 at 3:18

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