Müller's maneuver is a procedure used in medicine to diagnose some types of

tinnitus Tinnitus is a condition when a person hears a ringing sound or a different variety of sound when no corresponding external sound is present and other people cannot hear it. Nearly everyone experiences faint "normal tinnitus" in a completely ...

, and other medical problems.

Procedure

After a forced expiration, an attempt at inspiration is made with closed mouth and nose, whereby the negative pressure in the chest and lungs is made very subatmospheric; the reverse of a

Valsalva maneuver The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air, as if blowing up a balloon. Variations of the maneuver can be ...

. This technique is designed to look for collapsed sections of

airway The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respiratory ...

s such as the

trachea The trachea (: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from ...

and upper airways. In this maneuver, the patient attempts to inhale with their mouth closed and their nostrils plugged, which leads to a collapse of the airway. Introducing a flexible fiberoptic scope into the hypopharynx to obtain a view, the examiner may witness the collapse and identify weakened sections of the airway. Müller's maneuver is used to help determine the cause of

sleep apnea Sleep apnea (sleep apnoea or sleep apnœa in British English) is a sleep-related breathing disorder in which repetitive Apnea, pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor vent ...

. A positive test result means the site of upper airway obstruction is likely below the level of the soft palate, and the patient will probably not benefit from a

uvulopalatopharyngoplasty Uvulopalatopharyngoplasty (abbreviated as UPPP or UP3) is a type of sleep surgery, which are surgical procedures for sleep-related breathing disorders, especially obstructive sleep apnea (OSA). Uvulopalatopharyngoplasty involves removal and/or rem ...

alone. This maneuver is very helpful in doing MRI for sleep apnea, when sedation to patient can be avoided. There is some evidence that the sites of obstruction with Müller's maneuver do not represent reliably the sites of obstruction during normal sleep. Other factors such as the body's position whilst conducting the manoeuvre may well affect this. Müller's maneuver can also be used to terminate

supraventricular tachycardia Supraventricular tachycardia (SVT) is an umbrella term for fast heart rhythms arising from the upper part of the heart. This is in contrast to the other group of fast heart rhythms – ventricular tachycardia, which start within the lower cham ...

in an acute primary care setting.

References

* Textbook of Medical Physiology p784 - Arthur C. Guyton * Sleep apnea and snoring: Surgical and non-surgical therapy. M Friedman, 2009 Respiration {{med-diagnostic-stub