What's the latest for those with ear equalization issues?

[rick00001967]

I would recommend that you go see a good ENT doctor

i had student that was a specialist in this field. he would be able to do tests to determine the problem. you may need "tubes" in your ears. or it could be a result of any of the other advise given above. good luck to you. i hope you figure it out. scuba is fun but it isn't worth messing up your ears.

 

[1LE]

Last flight I did (first flight working on my BFR/IPC combo), even at just 3,000 feet it was rough. Ended up not doing the second flight to finish up because it seems like the problem has gotten worse (and I was perfectly clear that day, not even a hint of allergy, stuffiness, etc). So, I've decided to pause the diving and flying for now (combination of medical cost concerns plus the current state of medical science). I'll plan on checking in with an ENT a few years down the road and see what we can do then.

 

[Charles Graves]

There are a few things that will help this:

SURGICAL AS FOLLOWS-

1) Deviated septum surgery
2) Nasal valve surgery
3) Polyp removal surgery
4) Tonsil removal surgery (the eustachian tubes sit right behind the tonsils, so removing tonsils often helps widen these tubes)

NON-SURGICAL MEDICAL SOLUTIONS AS FOLLOWS (sometimes these dont work and you need surgery though):

1) Allergy shots (reduced allergies = less inflammation = less closed ears, nose and throat)
2) Corticosteroid nasal spray
3) Corticosteroid ear drops
4) Allergy medicine like benadryl or claritin
5) short term, advil will help to reduce swelling and minimize damage

METHODS IN THE WATER: (These are useful regardless of your medical situation)

1) Swallowing and then moving your jaw in a circular loose motion, including up and down, left and right
2) Gently blowing while closing nose (valsalva)
3) gently blowing nose with it open
4) swallowing in general
5) Make sure you descend and ascend VERY SLOWLY
6) Try to equalize every foot or two, for the first 10 meters down, and every 2-3 feet after that
7) Descend and ascend headfirst (upright position, head up, feet down), as you equalize easier that way. (Yeah I know, it looks much cooler to have proper trim, but taking care of your body should be priority #1 here)

I don't think there's currently surgery to widen the eustachian tubes/ear canals themselves, though. But surgical methods 1 thru 4 are all very helpful in general. I've had all of them done except the nasal valve surgery (which I still need to do) but I am equalizing much better now overall with those things done. It's really night and day! Also, allergy shots are an amazing lifesaver for people with allergies. They will help you tremendously, especially if you go 2x a week for the first 2 months, and really build up your maintenance levels quickly

 

[doctormike]

There are a few things that will help this:

SURGICAL AS FOLLOWS-

1) Deviated septum surgery
2) Nasal valve surgery
3) Polyp removal surgery
4) Tonsil removal surgery (the eustachian tubes sit right behind the tonsils, so removing tonsils often helps widen these tubes)

NON-SURGICAL MEDICAL SOLUTIONS AS FOLLOWS (sometimes these dont work and you need surgery though):

1) Allergy shots (reduced allergies = less inflammation = less closed ears, nose and throat)
2) Corticosteroid nasal spray
3) Corticosteroid ear drops
4) Allergy medicine like benadryl or claritin
5) short term, advil will help to reduce swelling and minimize damage

METHODS IN THE WATER: (These are useful regardless of your medical situation)

1) Swallowing and then moving your jaw in a circular loose motion, including up and down, left and right
2) Gently blowing while closing nose (valsalva)
3) gently blowing nose with it open
4) swallowing in general
5) Make sure you descend and ascend VERY SLOWLY
6) Try to equalize every foot or two, for the first 10 meters down, and every 2-3 feet after that
7) Descend and ascend headfirst (upright position, head up, feet down), as you equalize easier that way. (Yeah I know, it looks much cooler to have proper trim, but taking care of your body should be priority #1 here)

I don't think there's currently surgery to widen the eustachian tubes/ear canals themselves, though. But surgical methods 1 thru 4 are all very helpful in general. I've had all of them done except the nasal valve surgery (which I still need to do) but I am equalizing much better now overall with those things done. It's really night and day! Also, allergy shots are an amazing lifesaver for people with allergies. They will help you tremendously, especially if you go 2x a week for the first 2 months, and really build up your maintenance levels quickly

Hi, Charles...

I'm glad that your equalization has improved.

While it is often possible to find individual papers that support many approaches, I should just mention that there things that improve the nasal airway (like septoplasty, nasal valve surgery or nasal polyp surgery) do not affect the functioning of the Eustachian tube. They may improve the ability of a diver to avoid a sinus squeeze, but apart from the rare case of an antrochoanal polyp (that extends back into the nasopharynx), the do not address the ET region. Furthermore, tonsillectomy has no effect on ET function, the tonsils are not near the ET orifice at all. Adenoids are close to the ET orifice, and there is some evidence that adenoidectomy may improve ET function in children, but in most adults the adenoids have long since spontaneously regressed.

There is some evidence that aggressive allergy management may help with ET function, but the results are not clear. Of course, this is worth doing if you have nasal obstruction, since that can affect sinus equalization. Ear drops have nothing to do with ET function or equalization of the sinuses or the middle ear spaces.

The equalization methods that you mention are all helpful, here is another page with a good summary of the alternatives.

There actually is a procedure which - although early on in development - has shown promise in addressing ear equalization issues in divers - the balloon dilation of the ET. My clinical practice is pediatric, so I don't do this myself, but I have spoken with colleagues that have had some good results. Here is something about that procedure for freedivers.

 

[afdgf]

There is now a consensus statement that just came out.

• Format: Abstract

Send to


Otolaryngol Head Neck Surg. 2019 Jun 4:194599819848423. doi: 10.1177/0194599819848423. [Epub ahead of print]
Clinical Consensus Statement: Balloon Dilation of the Eustachian Tube.
Tucci DL1, McCoul ED2, Rosenfeld RM3, Tunkel DE4, Batra PS5, Chandrasekhar SS6, Cordes SR7, Eshraghi AA8, Kaylie D1, Lal D9, Lee J10, Setzen M11, Sindwani R12, Syms CA 3rd13, Bishop C14, Poe DS15, Corrigan M16, Lambie E16.
Author information
Abstract
OBJECTIVE:
To develop a clinical consensus statement on the use of balloon dilation of the eustachian tube (BDET).

METHODS:
An expert panel of otolaryngologists was assembled with nominated representatives of general otolaryngology and relevant subspecialty societies. The target population was adults 18 years or older who are candidates for BDET because of obstructive eustachian tube dysfunction (OETD) in 1 or both ears for 3 months or longer that significantly affects quality of life or functional health status. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus.

RESULTS:
After 3 iterative Delphi method surveys, 28 statements met the predefined criteria for consensus, while 28 statements did not. The clinical statements were grouped into 3 categories for the purposes of presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes.

CONCLUSION:
This panel reached consensus on several statements that clarify diagnosis and perioperative management of OETD. Lack of consensus on other statements likely reflects knowledge gaps regarding the role of BDET in managing OETD. Expert panel consensus may provide helpful information for the otolaryngologist considering the use of BDET for the management of patients with OETD.

KEYWORDS:
balloon dilation; consensus; eustachian tube dysfunction; nasal endoscopy; otitis media; otoscopy; tympanometry

 

[Duke Dive Medicine]

Deb Tucci is a Duke ENT and a good doc. I've seen her for my own ear issues.

 

[tndash]

https://www.eubs.org/documents/DHM Vol44 No4.pdf#page=26




Prognosis for the injured diver and returning to divingIt has been proposed that divers with IEBt are prone to further incidents that exacerbate their tinnitus and hearing loss,3 but this is not supported by others.14,24,39 One group stated; “Although the older literature clearly suggests otherwise, we believe that scuba divers who completely recover from inner (or middle) ear barotrauma may return to diving as long as they exercise caution and care”.26 However, this advice was not backed up by what these authors reported, as two of their three cases (both undergoing tympanotomy) were advised not to continue diving. Long-term follow up of IEBt cases (seven conservatively and two surgically managed) reported complete recovery of symptoms in six patients, and return to diving as early as one month post tympanotomy repair was permitted, provided that predisposing anatomical abnormalities were excluded, hearing was stable, and their balance was normal.14

 

[vastag]

The ear mask saved my diving hobby. Looks dorky, works great. Protects the ears from water and keeps them at the same air pressure as the rest of your face.
https://www.amazon.com/IST-ProEar-P...ocphy=9032783&hvtargid=pla-348895609094&psc=1

 

[Javik]

I looked around for a local ENT that knows about balloon dilation. They told me that the procedure is risky because there is a major artery to the brain that passes through the vicinity of the Eustachian tube so doc said they don't like to do dilation that unless there is no other option.

I looked into what is really involved. The actual procedure for dilation is to insert a balloon into the Eustachian tube, inflate it, and hold it there for about 10 minutes. Then deflate and remove and it is done. How this manages to do anything, I don't know. It's not a stent to hold the tube open.

Cellular structures inside the body are not exactly stretchable in a permanent manner that a 10 minute inflation is going to do anything, so as far as I can tell, they are probably applying enough pressure to the balloon to actually cause internal tearing of the Eustachian cell lining, which then heals back together with a scar that enlarges the passageway.

,

Another option that was suggested to me was to try a steroid nasal spray called Fluticasone Proprionate 50mcg, apply to each nostril once a day. It takes several weeks for this stuff to start to have any effect.

Though the spray applicator tip has to be inserted deep into the nose, have to inhale deeply while using the applicator, and try to avoid getting any of it on the bone in the front of the nose as it can cause erosion and bleeding. For that reason I have been very reluctant to try this, but I have started using it for the last week.