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      The effect of Valsalva and Jendrassik maneuvers on acoustic reflex Translated title: El efecto de las maniobras de Valsalva y Jendrassik sobre el reflejo acústico

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          Abstract

          Abstract Aims. Studying modulation of acoustic reflex by the Valsalva and the Jendrassik manoeuvres Settings and Design. Quasi-experimental research with the pre-post testing design Methods and Material. This self-control study was conducted on 12 healthy college students aged 21.23 ± 2.02 years. They were well trained to perform the standard Valsalva manoeuvre: maintenance of a 15second expiratory pressure at 40 mmHg with open glottis. The Jendrassik manoeuver was performed by pulling clenched hands. Acoustic reflex threshold, acoustic reflex decay, middle ear pressure and compliance were measured before and after the Valsalva and the Jendrassik manoeuvres. The order of the right or the left ear recording was random. The recovery time following manoeuvres were 5 minutes. Statistical analysis usde All variables were compared using the repeated measured ANOVA. Results. There were no statistical differences in the threshold and in the decay of acoustic reflex before and after the Valsalva and the Jendrassik manoeuvres. This finding was similar in both ears and had no laterality. Conclusions. The Valsalva and the Jendrassik manoeuvres as modulator of some somatic and autonomic reflexes including the sound induced startle reflex have no effect on acoustic reflex.

          Translated abstract

          Resumen Objetivos. Estudiar la modulación del reflejo acústico mediante las maniobras de Valsalva y Jendrassik. Configuración y Diseño: Investigación cuasi experimental con el diseño de prueba previa y posterior Materiales y Métodos. Este estudio de autocontrol se realizó en 12 estudiantes universitarios sanos de 21.23 ± 2.02 años. Estaban bien entrenados para realizar la maniobra estándar de Valsalva: mantenimiento de una presión espiratoria de 15 segundos a 40 mmHg con una glotis abierta. La maniobra de Jendrassik se realizó tirando de las manos apretadas. El umbral del reflejo acústico, la disminución del reflejo acústico, la presión del oído medio y el cumplimiento se midieron antes y después de las maniobras de Valsalva y Jendrassik. El orden de la grabación del oído derecho o izquierdo fue aleatorio. El tiempo de recuperación después de las maniobras fue de 5 minutos. Análisis Estadístico utilizado. Todas las variables se compararon utilizando el ANOVA medido repetidamente Resultados. No hubo diferencias estadísticas en el umbral y en la decadencia del reflejo acústico antes y después de las maniobras de Valsalva y Jendrassik. Este hallazgo fue similar en ambos oídos y no tenía lateralidad. Conclusiones. Las maniobras de Valsalva y Jendrassik como moduladores de algunos reflejos somáticos y autónomos, incluido el reflejo de sobresalto inducido por el sonido, no tienen efecto sobre el reflejo acústico.

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          The Valsalva manoeuvre: physiology and clinical examples.

          The Valsalva manoeuvre (VM), a forced expiratory effort against a closed airway, has a wide range of applications in several medical disciplines, including diagnosing heart problems or autonomic nervous system deficiencies. The changes of the intrathoracic and intra-abdominal pressure associated with the manoeuvre result in a complex cardiovascular response with a concomitant action of several regulatory mechanisms. As the main aim of the reflex mechanisms is to control the arterial blood pressure (BP), their action is based primarily on signals from baroreceptors, although they also reflect the activity of pulmonary stretch receptors and, to a lower degree, chemoreceptors, with different mechanisms acting either in synergism or in antagonism depending on the phase of the manoeuvre. A variety of abnormal responses to the VM can be seen in patients with different conditions. Based on the arterial BP and heart rate changes during and after the manoeuvre several dysfunctions can be hence diagnosed or confirmed. The nature of the cardiovascular response to the manoeuvre depends, however, not only on the shape of the cardiovascular system and the autonomic function of the given patient, but also on a number of technical factors related to the execution of the manoeuvre including the duration and level of strain, the body position or breathing pattern. This review of the literature provides a comprehensive analysis of the physiology and pathophysiology of the VM and an overview of its applications. A number of clinical examples of normal and abnormal haemodynamic response to the manoeuvre have been also provided.
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            Amygdala and anterior cingulate cortex activation during affective startle modulation: a PET study of fear.

            The human startle response is modulated by emotional experiences, with startle potentiation associated with negative affect. We used positron emission tomography with 15O-water to study neural networks associated with startle modulation by phobic fear in a group of subjects with specific snake or spider phobia, but not both, during exposure to pictures of their feared and non-feared objects, paired and unpaired with acoustic startle stimuli. Measurement of eye electromyographic activity confirmed startle potentiation during the phobic as compared with the non-phobic condition. Employing a factorial design, we evaluated brain correlates of startle modulation as the interaction between startle and affect, using the double subtraction contrast (phobic startle vs. phobic alone) vs. (non-phobic startle vs. non-phobic alone). As a result of startle potentiation, a significant increase in regional cerebral blood flow was found in the left amygdaloid-hippocampal region, and medially in the affective division of the anterior cingulate cortex (ACC). These results provide evidence from functional brain imaging for a modulatory role of the amygdaloid complex on startle reactions in humans. They also point to the involvement of the affective ACC in the processing of startle stimuli during emotionally aversive experiences. The co-activation of these areas may reflect increased attention to fear-relevant stimuli. Thus, we suggest that the amygdaloid area and the ACC form part of a neural system dedicated to attention and orientation to danger, and that this network modulates startle during negative affect.
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              Sympathetic innervation of human muscle spindles

              The aim of the present study was to investigate the presence of sympathetic innervation in human muscle spindles, using antibodies against neuropeptide Y (NPY), NPY receptors and tyrosine hydroxylase (TH). A total of 232 muscle spindles were immunohistochemically examined. NPY and NPY receptors were found on the intrafusal fibers, on the blood vessels supplying muscle spindles and on free nerve endings in the periaxial space. TH-immunoreactivity was present mainly in the spindle nerve and vessel. This is, to our knowledge, the first morphological study concerning the sympathetic innervation of the human muscle spindles. The results provide anatomical evidence for direct sympathetic innervation of the intrafusal fibers and show that sympathetic innervation is not restricted to the blood vessels supplying spindles. Knowledge about direct sympathetic innervation of the muscle spindle might expand our understanding of motor and proprioceptive dysfunction under stress conditions, for example, chronic muscle pain syndromes.
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                Author and article information

                Journal
                jonnpr
                Journal of Negative and No Positive Results
                JONNPR
                Research and Science S.L. (Madrid, Madrid, Spain )
                2529-850X
                2020
                : 5
                : 12
                : 1504-1515
                Affiliations
                [3] Gorgan Golestan orgnameGolestan University of Medical Sciences orgdiv1School of Medicine orgdiv2Department of Physiology Iran
                [2] Gorgan Golestan orgnameGolestan University of Medical Sciences orgdiv1School of Medicine orgdiv2Department of Otolaryngology Iran
                [1] Gorgan Golestan orgnameGolestan University of Medical Sciences orgdiv1School of Medicine Iran
                Article
                S2529-850X2020001200005 S2529-850X(20)00501200005
                10.19230/jonnpr.3953
                e4b37342-ffe3-4508-b94e-b985b84e6777

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 10 August 2020
                : 06 September 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 12
                Product

                SciELO Spain

                Categories
                Original

                Acoustic reflex threshold (ART),Valsalva manoeuvre (VM),reflejo de sobresalto,decaimiento del reflejo acústico (ARD),umbral del reflejo acústico (ART),Maniobra de Valsalva (VM),Startle reflex,Acoustic reflex decay (ARD)

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