Antihistamines, Decongestants and Diving

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Walt Stearns

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I'm a Fish!
Antihistamines, Decongestants and Diving
Is this a good combination?

The sun is shining and the water looks inviting, but as you prepare for your dives you’re congested, sneezing and your watery eyes are so bad they’re threatening to flood your mask. Some divers in this situation might choose to ignore these symptoms or try to dive with over-the counter decongestants or antihistamines, because let’s face it, no one wants to stay topside, particularly on a trip dedicated to diving. Before you take that giant stride and descend, check out the DAN Corner on page 67 of the latest issue - #20 - of The Underwater Journal.

Do you typically choose to dive with decongestants or antihistamines? I don't know, I'm coming off a two week trip to the Philippines and I had to forfeit a whole lot of dives due to congestion and a subsequent ear infection. I've taking decongestants and antibiotics. While it made me sick to miss out I'm still glad I did.

Once you've read the article, what are your thoughts?
 
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Here's the gist, ya gotta use common sense.:doh: I have been diving for over 8 years successfully using Sudafed...due to inner ear issues caused by chronic congestion from sinus issues dealing with allergies.

If I don't use Sudafed,,. I usually can-only get one dive in before I have issues equalizing. However, I am very cautions about its usage and I always super hydrate when I am taking it. I don't take it to minimize the effects of a cold and there have been many times I have halted a dive because I was too fatigued from travel etc and if I have not felt well, I did not dive. Does not matter how much money I spent or how far I traveled either. Is it risky to use in this fashion....yes. However, diving is inherently risky too. I minimize the risks as best I can and stay cognizant of the dosage and time I am diving. :cool2:
 
Several years ago an excellent dry chamber study was published that showed that the side effects of decongestants like "Sudafed" cancelled each other out so that there was no net adverse effect on diving. The same group of researchers showed that antihistamines caused problems with drowsiness.

It is true that one has to be very careful with the half life of the decongestant to avoid rebound congestion that could result in a reverse block and ruptured ear drum during ascent. That's why I used 12 hours generic "Sudafed" instead of immediate release in the past.

However, for a number of years I have used high volume positive pressure buffered saline nasal-sinus irrigation using the NeilMed adult squeeze bottle and have not needed decongestants for diving. In earlier posts I have written about a study I did with divers for NeilMed and have presented the data at several meetings, most recently at Our World Underwater in Chicago this winter when I talked about natural ways to equalize your ears.

In my opinion, if you need decongestants and antihistamines, then maybe you need to address the cause and not the symptoms. Nasal irrigation can be a very effective natural approach with very little potential for adverse events when done correctly and has already saved many dive vacations for me and others.

These days I also carry a preventive remedy for swimmer's ear (otitis externa) containing 49% acetic acid (distilled white vinegar) to kill the pseudomonas that causes the infection and inflammation, 49% isopropyl alcohol to help remove water from the ear, and 2% glycerol to keep the sensitive lining of the external ear canal from drying out. Just using alcohol to dry the ear is a sure way to end up with a painful ear as it removes the natural oil and wax and may not kill the pseudomonas.

Financial Disclosure: I have been a paid medical consultant to NeilMed Pharmaceuticals in the past.
 
I endorse divepsych's entry and appreciate his financial disclosure. I happen to use Neilmed whenever I have sinus problems and it is an effective natural treatment. Neilmed is essential a variant on the Neeti-pot which has been used for natural healing for centuries, if not millenia. However, I have also had to use pseudoephedrine, and recognize the cautions mentioned by other posters: super-hydrate and make sure you time the dosage so that you don't have a rebound effect in the middle of your dive. Also, I do not dive if I don't feel well. Common sense should always rule. Remember, we are on life support while diving.
 
Have you blokes never heard of Hopi Ear Candles -I have been diving for twn years and used to use Suda Fed and other decoongestants until a girl on our Red Sea liveaboard ear candles my ears after a bout of reverse squeeze and i did not have a problem for the rst of the trip. I know it a bit girlie and it reminds me of a bob Newhart sketch to stick a tube in your ear and light it but the Hopi Indians have been doing it for humdreds of years - they clear out the crap in your eardrums and release pressure in your sinus tubes - if you havent used the before it will take a couple of go's for it to really take effect - seriously try them - i always take some on trips in case other people have ear problems and without fail they always work and it is better than takeing drugs - Trevor:)
 
Decongestants can affect a person's blood pressure. If you have high blood pressure, i suggest consulting a doctor before taking them, particularly for prolonged periods.
 
I never leave home without some version of 12-hour Sudafed, usually a generic. Even if I'm only planning a two-tank trip I use the 12-hour version. If it's going to be an all-day affair with a night dive I will tack on a dose of regular Sudafed before the night dive. I have dived nitrox almost exclusively for more than 10 years, frequently in the 1.1 to 1.4 po2 range, and have never had a problem with the Sudafed.
 
According to my otolaryngeologist, I have extremely narrow eustacean tubes. This makes equalizing a very slow, and sometimes painful, experience, especially on the second and later dives of the day. If I get ANY pain, I am certain to develop hyperbaric trauma and lose 80% of my hearing within a few days. This condition lasts from 2-4 weeks.

The Doc recommended Afrin: two snorts in each nostril before my first dive of the day and one snort/nostril on subsequent dives. I sill wind up with HBT to some degree, because I tend to hurry the equalization process. However, without the Afrin I couldn't dive at all.
 
Great topic and lots of mis-information among the diving community. Thanks for your analysis/expertise.

As for the ear candling it's ironic that I was doing research on medical benefits/mis-information of different massage therapies and came across ear candling. It seems any benefit from this is a placebo and has more potential for complications and harm... Buyer beware!

Here's the article
Why Ear Candling Is Not a Good Idea
 
A few thoughts on the subject. While typical diver training often warns against the use of decongestants (and sometimes antihistamines), most trained sources I've consulted agree that if you take these meds regularly, it's a mistake to discontinue suddenly them before diving. Obviously, you have to be cautious in terms of the medication wearing off during a dive, but it seems somewhat safe if you use the 12+ hour versions, and take them on a regular schedule. Certainly in the case of antihistamines, it would be a mistake to stop taking them immediately prior to a dive, as it makes the possibility of a sudden reaction to an allergen more likely and less predictable, so you would still have a strong chance of your sinus status changing unexpectedly. Changing the pattern is often more dangerous than any procedure or med you can take. The second consideration is that with any treatment, natural or otherwise (even with a Neti Pot or similar), there can be a rebound type effect. The sinuses are initially cleared out during the treatment, but the same sources that caused them to block in the first place (e.g. allergies, infection, etc.) are just as likely to re-clog them, and since the cleansing has no ongoing effect, such techniques can be just as dangerous, if not more so, than the use of medications. So while flushing techniques (NeilMed, Neti) are effective and "natural", they're not really much safer from a diving perspective than meds, as you don't know when their effects are going to wear off.
 

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