Splenic constriction during isometric handgrip exercise in humans

During the first minute of a moderate-intensity isometric handgrip (HG) exercise, there is an increase in stroke volume and cardiac output that occurs without any change in systemic vascular conductance. Although the mechanism of increased venous return is not yet known, current focus has been placed on the constriction of visceral organs. The human spleen represents a compliant organ with high perfusion that constricts during the rather severe stresses of maximal exercise, a diving reflex, or prolonged apnea. This study tested the hypothesis that spleen constriction occurs during isometric HG exercise. Eight participants performed a 1 min isometric HG test at 40% maximum voluntary contraction. Splenic length and width were measured (with ultrasound imaging) after 1 min of exercise, and volume was calculated. To investigate the reflex specificity of this response, spleen dimensions were also measured during 4 min of lower-body negative pressure (LBNP; –20 mm Hg). To test the additional impact of altered breathing and intra-abdominal pressures during the HG, measures were also taken during Valsalva’s manoeuvre (VM) at 30 mm Hg. Compared with baseline, both length and width of the spleen were reduced by 0.20 to 0.55 cm (or 4.44%–6.09%; p < 0.05) during each test. This resulted in relative reductions in splenic volume of 13 ± 1% (HG), 9% ± 7% (LBNP) and 18% ± 7% (VM) (p < 0.05; all mean ± SD). It was concluded that the spleen can constrict during the first minute of isometric HG exercise.

Internal jugular vein ectasia – a rare cause for paroxysmal cough

Internal jugular vein ectasia (dilatation of the internal jugular vein) is a rare clinical entity, often undiagnosed. Usually it presents as an asymptomatic, soft, compressible neck swelling that increases in size on Valsalva's manoeuvre. Our report describes right internal jugular vein ectasia in a 15-year-old girl who presented to us with intractable paroxysmal cough. The entity was suspected on ultrasound imaging and confirmed by computed tomography scan and Doppler. Ligation and excision of the dilated vein almost immediately cured her cough. The probable reason for the cough was the pressure exerted by the dilated vein on the vagus nerve.

Sympathetic Responses to Valsalva's Manoeuvre Following Bed Rest

The purpose of this study was to examine whether 14 days of head-down tilt bed rest (HDBR) alters autonomic regulation during Valsalva's manoeuvre (VM) and if this would predict blood pressure control during a 60° head-up tilt (HUT) test. To examine autonomic control of blood pressure, we measured the changes in systolic (ΔSBP) and diastolic (ΔDBP) blood pressure between baseline and the early straining (Phase IIE) period of VM (20 sec straining to 40 mmHg; N = 7) in conjunction with changes in muscle sympathetic nerve activity (MSNA; microneurography) burst frequency (B/min) and total activity (%Δ) from baseline over the 20-sec straining period. MSNA data were successfully recorded from 6 of the 7 individuals. The averaged responses from three repeated VMs performed in the supine position were compared between the pre- and post-HDBR tests. Compared with the pre-HDBR test, a greater reduction in SBP, DBP, and MAP was observed during Phase IIE following HDBR, p < 0.05. The increase in MSNA burst frequency during straining was augmented in the post- compared with the pre-HDBR test, p < 0.0001, as was the Phase IV blood pressure overshoot, p < 0.05. Although all subjects completed the 20-min pre-HDBR tilt test without evidence of hypotension or orthostatic intolerance, the post-HDBR test was stopped early in 5 of the 7 subjects due to systolic hypotension. The responses during the VM suggest that acute autonomic adjustments to rapid blood pressure changes are preserved after bed rest. Furthermore, MSNA and blood pressure responses during VM did not predict blood pressure control during orthostasis following HDBR. Key words: muscle sympathetic nerve activity, blood pressure, orthostatic tolerance, head-up tilt

Extensive and symptomatic cranial pneumatization: caused by frequent performance of Valsalva's manoeuvre?

Pneumocranium and spontaneous pneumocephalus are very rare disorders. We report a case in which the patient had suffered for some time from neck pain and neurological symptoms which originated from an extensively pneumatized cranium. The symptoms and the abnormal bone pneumatization disappeared after normalization of a high middle-ear pressure. The history and the findings suggest that the pathological pneumatization was caused by the patient's habit of frequently performing Valsalva's manoeuvre, in combination with the Eustachian tube functioning as a valve.

Thyroplasty for functional rehabilitation of the incompetent larynx

Type I thyroplasty was performed in 12 patients with unilateral paralysis of the vocal fold. Subjective as well as objective improvement in vocal performance was reported in 11 patients. Aspiration was improved in six out of eight patients. Effort closure was evaluated by the ability of the patient to voluntarily raise his intra-abdominal pressure during Valsalva's manoeuvre. A comparison of pre- and post-thyroplasty measures, showed a statistically significant improvement in the efficacy of effort glottic closure (p < 0.05), indicating a better physical performance. We had one case of wound sepsis and another case of implant extrusion.

Barotitis in children after aviation; prevalence and treatment with Otovent®

Barotitis is an acute or chronic inflammation caused by environmental pressure changes. The most common cause is the pressure change during descent in civil aviation. To prevent barotitis the middle ear pressure has to be equalised several times during descent. This can be achieved by performing the Valsalva manoeuvre, but for children, many of whom have a dysfunction of the Eustachian tube, this is difficult to perform and they are therefore at high risk of developing barotitis during flight. The traditional treatment modalities of barotitis are inflation by a Politzer balloon, myringotomy or prophylactic grommet insertion. An alternative treatment or prophylactic measure is autoinflation using the Otovent® treatment set. This prophylaxis/treatment can be performed by the child with assistance from its parents as soon as possible or rather before the descent has started. The prevalence of barotitis amongst transit passengers was found to be highest in young children, 25 per cent, compared with adults, five per cent. Only 21 percent of the youngest children with negative middle ear pressure after flight managed a successful Valsalva's manoeuvre, whereas 82 per cent could increase the middle ear pressure inflating the Otovent® set. In conclusion we recommend autoinflation using the Otovent® set by children and adults with problems clearing the ears during flight.

Fluctuating hearing loss in presbyacusis

Thirty-six patients with bilateral symmetrical presbyacusis who reported a temporary improvement in the hearing of one ear following a Valsalva's manoeuvre were further investigated. Bone conduction and air conduction thresholds, middle ear pressure and middle ear compliance were measured before and after Valsalva's manoeuvre in the ears which had a subjective improvement in hearing following auto-inflation. Bone conduction thresholds remained unaltered in 66 per cent of ears while average air conduction thresholds varied by less than 5 decibels. Middle ear pressure was unchanged in over half the ears tested and in 81 per cent of the ears there was no change in middle ear compliance. There appears to be no simple explanation for the temporary subjective fluctuation in hearing reported by patients with presbyacusis.