The Valsalva manoeuvre involves forcibly breathing out against a closed airway. It is a method of equalising pressure in the middle ear, but may also be used in certain medical examinations. It may be performed by pinching the nose and closing the mouth, while trying to breathe out, though there are other techninques. Care should be taken when performing this technique to avoid using too much force. The pressure created by the cheek and throat muscle should be sufficient.