Middle ear barotrauma

[Millemar]

Hello, we are in the Virgin Islands for 8 weeks and had planned to do a lot of diving. We did a shallow beach dive to “warm up” and I had a little trouble equalizing. Took my time but still felt a little pain on both descent and ascent. I have fluid in my middle ear. I went to a local doc and she said I could try diving again, but to stop immediately if anything hurt. I looked at the DAN website and the advice there says not to dive until the fluid goes away and ear feels normal again. That will likely take the rest of the trip or longer.

I’m 60 years old, experienced diver, only had ear problem once before in the other ear after repetitive diving in Palau on a liveaboard. It cleared up 6-8 weeks after returning home. The problem there was a reverse squeeze during ascent.

I’ll be super disappointed if I can’t dive again on this trip, but on the other hand, I’d rather skip the diving and preserve my hearing. How high risk do you think it is to try another shallow beach dive, being very careful to equalize properly and descend and ascend slowly?

 

[Searcaigh]

DAN website and the advice there says not to dive until the fluid goes away and ear feels normal again. That will likely take the rest of the trip or longer.

Sorry to hear this, but follow DAN's advice.

I'm not a doctor but had plenty of ear issues that screwed up several trips in the past. Don't push it, just accept it and find something else to do and take your mid off the problem until you feel that the issue is no longer there then consult with the doctor again before attempting another dive.

 

[Millemar]

Have you been able to continue diving once your ear clears up? It’s really depressing to think that I may not be able to. So many of the best trips are liveaboards with repetitive diving and I’m now hesitant to book these in case this happens again. How do you cope with your recurring issues?

 

[Searcaigh]

Yes I still dive every weekend.

I tend to dive no more than three days consecutively when on drive trips and take a break for a day then resume.

I wouldn't think of doing a LOB for more than three days though, and in the past 10 years all my overseas dive trips have been land based.

 

[boulderjohn]

How do you cope with your recurring issues?

When I started diving, equalizing was so difficult for me that an instructor said I might not ever be able to be a diver. Today I barely think about equalizing because it is so easy for me. The difference is the frequency of diving and the frequency of equalizing. Ears are designed to do this easily, but we have trouble because we don't do it enough. Here are some steps I took when I was a struggling beginner.

• Equalize early. On one early trip, I read a tip that said the time to begin equalizing for your first vacation dive is during the airplane flight to your vacation. That was good advice, and I started even before that. I worked on equalizing while sitting on the sofa watching TV before the trip. I equalized on the plane. I equalized in the hotel. I equalized on the boat heading for the dive site. I equalized just before we got in the water.
• Equalize often. Do not descend if you feel any pain. Period. Keep equalizing as often as it takes. Don't let peer pressure (Everyone else is already down!) cause you to have a barotrauma.
• Equalizing gets easier as the trip progresses, so start early with careful equalizing. On most trips, I would arrive, sign up for the dives starting the next day, and then go out to snorkel. While snorkeling, I would free dive down again and again and again and again, gradually finding it easier and easier and easier to equalize on the descents. I would thus find the first day of diving to be much easier, and by the second I was just fine.
• The use of decongestants is controversial, but lots of people do it. That included me in my first years. Do not dive with a cold! If you are just trying to make it easier to equalize, DAN has said that it is safe to use some decongestants, provided that you know you can take them safely. For example, many people should not take Sudafed at all, either on land or in the water, because of what it does to them. Afrin is generally considered reasonably safe, but do not use it too often. When I as on a trip to Australia, I bought a small bottle of Eucalyptus oil and took a sniff of it before diving for quite a while. It certainly opened everything up.

 

[BrackaFish]

When I started diving, equalizing was so difficult for me that an instructor said I might not ever be able to be a diver. Today I barely think about equalizing because it is so easy for me. The difference is the frequency of diving and the frequency of equalizing. Ears are designed to do this easily, but we have trouble because we don't do it enough. Here are some steps I took when I was a struggling beginner.

• Equalize early. On one early trip, I read a tip that said the time to begin equalizing for your first vacation dive is during the airplane flight to your vacation. That was good advice, and I started even before that. I worked on equalizing while sitting on the sofa watching TV before the trip. I equalized on the plane. I equalized in the hotel. I equalized on the boat heading for the dive site. I equalized just before we got in the water.
• Equalize often. Do not descend if you feel any pain. Period. Keep equalizing as often as it takes. Don't let peer pressure (Everyone else is already down!) cause you to have a barotrauma.
• Equalizing gets easier as the trip progresses, so start early with careful equalizing. On most trips, I would arrive, sign up for the dives starting the next day, and then go out to snorkel. While snorkeling, I would free dive down again and again and again and again, gradually finding it easier and easier and easier to equalize on the descents. I would thus find the first day of diving to be much easier, and by the second I was just fine.
• The use of decongestants is controversial, but lots of people do it. That included me in my first years. Do not dive with a cold! If you are just trying to make it easier to equalize, DAN has said that it is safe to use some decongestants, provided that you know you can take them safely. For example, many people should not take Sudafed at all, either on land or in the water, because of what it does to them. Afrin is generally considered reasonably safe, but do not use it too often. When I as on a trip to Australia, I bought a small bottle of Eucalyptus oil and took a sniff of it before diving for quite a while. It certainly opened everything up.

^^^This is good advice from @boulderjohn. We teach our students “early and often” when dealing with ear clearing along with not tucking your head down but extending your head forward a bit also seems to help. Several people I know use ClaritinD and have good results with it. Afrin does work very well, but can have some rebound if you are not careful. Good luck

 

[Millemar]

I’ve been reading up on equalization techniques. I was not aware there were different techniques even though I’ve been an avid diver since 1991. This may help for the future.

For the moment, I’ll have to decide whether to try another shallow beach dive or just give up on diving this trip. For the future, I sure hate to think I can’t ever do a long liveaboard again, but perhaps this is the case.

I didn’t think about waiting 2-3 days to dive after a plane ride, although in this case we landed mid-day on Wednesday and dove mid-day Friday. Even though the dive was shallow, equalization was more challenging than usual on the way down and I felt a bit of pain on our very slow ascent.

 

[100days-a-year]

I couldn't return to diving for almost two months.
Side effect of vertigo took several year to completely resolve.

I would start a day with a knock off of Afrin and possibly some guaifenesin. Neither are known for quick rebound congestion. And start clearing that morning along with gum to move the jaws a lot.
I have two different sized eustachian tubes and the right one is problematic.

 

[Duke Dive Medicine]

Hello, we are in the Virgin Islands for 8 weeks and had planned to do a lot of diving. We did a shallow beach dive to “warm up” and I had a little trouble equalizing. Took my time but still felt a little pain on both descent and ascent. I have fluid in my middle ear. I went to a local doc and she said I could try diving again, but to stop immediately if anything hurt. I looked at the DAN website and the advice there says not to dive until the fluid goes away and ear feels normal again. That will likely take the rest of the trip or longer.

I’m 60 years old, experienced diver, only had ear problem once before in the other ear after repetitive diving in Palau on a liveaboard. It cleared up 6-8 weeks after returning home. The problem there was a reverse squeeze during ascent.

I’ll be super disappointed if I can’t dive again on this trip, but on the other hand, I’d rather skip the diving and preserve my hearing. How high risk do you think it is to try another shallow beach dive, being very careful to equalize properly and descend and ascend slowly?

Is the affected ear the same one that gave you problems on Palau? Your description of your current injury sounds like another reverse middle ear squeeze.

The fact that you had pain on ascent is significant. The anatomy of the Eustachian tube is such that air exits the middle ear much more easily than it enters. Equalization on ascent is a passive event generally and doesn't require any effort on the diver's part. If you were feeling pain on ascent, that indicates that the Eustachian tube is significantly obstructed. You could do a lot of damage if you try to dive again right now with that level of swelling. I would wait at least a couple of weeks before even trying to equalize the ear on dry land.

Whatever you do, do NOT try to force the ear to clear. Doing so can result in further, possibly permanent injury. After a couple of weeks you might consider trying to gently Valsalva on the surface and seeing if you can get the ear to clear. Don't even consider diving if you can't get it to equalize easily on the surface. What follows is not a recommendation one way or the other, but if it clears easily for you, it may be reasonable to attempt another dive, following @boulderjohn 's excellent advice. Pre-load your ears before descending, stay ahead of the descent (i.e. equalize even though it doesn't feel like you have to), and stop immediately and ascend if you can't equalize. If you continue to descend without being able to equalize, you'll only close the Eustachian tube off more tightly. You should never get to the point of feeling pain on descent. If it hurts, you've already gone too far.

Some people find OTC decongestants, NSAIDs, and nasal sprays like oxymetazoline beneficial in cases like this. Of course that decision is up to you, as is ensuring that you use them safely. Be careful if you use any of these while actively diving; if they wear off on the bottom you could risk another reverse barotrauma.

Best regards,
DDM

 

[mbs]

My otologist (thanks @doctormike ) starred at me and said " what the fk is wrong with you divers" after I told her that I tried to dive the day after a vertigo incident. Apparently she hears plenty of stupid acts by us all I use alegra-d 24 hour which pretty much insures me that it will not wear off during the day. It sucks to miss out on dives on vacation, but so does lifelong tinnitus, hearing loss and vertigo.