Capt. Sarah Freidel, 34th Bomb Squadron flight surgeon, performs a valsalva maneuver on Staff Sgt. Jacob Appleby, 28th Medical Operations Squadron ambulance services technician, during a physical exam in the flight medicine clinic on Ellsworth Air Force Base, S.D., May 2, 2012. During a valsalva maneuver, medical professionals watch closely as the patient exhales against a closed airway and evaluate how well the patient’s ear drum moves to better determine the patient’s ear health. (U.S. Air Force photo by Airman 1st Class Kate Thornton/Released)