Is this the most difficult skill for new scuba divers?

[boulderjohn]

I may add to give it a big blast from your nose so it pretty much clears it in one shot.

I disagree.

I saw enough students blast the air out so fast that the water remained behind that I made NOT doing a big blast a part of my briefing. A long, steady exhale easily removes all the water.

 

[Scraps]

The problem with the mask flooded by water is caused by the neo-natal glottis reflex.
This is the reflex that any human has at birth, and is triggered by the contact of water to some neural receptors located around our nostrils. When they detect water, the reflex automatically closes the epiglottis valve, impeding to breath (but also to drown).
It is called "neo-natal" reflex because you can easily detect it in very young babies, but this reflex usually disappears spontaneously after a few months, and most people do not have it at the age they start diving.
However, approximately 1 every 10 adults still has this reflex: so in a class it is quite common to have one or two subjects which are in serious trouble as soon as their mask is flooded: they cannot breath anymore, as the glottis is closed. They cannot exhale from the nose, for evacuating the mask. And after a few seconds impeded to breath, they swim to the surface, suffering a serous risk of lung over-expansion, as they cannot exhale during the ascent.
It is not "all in their brains", as this reflex does not affect the brains, but their automatic reflex system, which is mostly out of voluntary control.
With a lot of patience and training, these subjects can become capable of counter-effecting the glottis closure by voluntary control, reopening it after the reflex is triggered: there is no way to avoid the reflex, indeed, but staying calm, usually after 10-30 s of apnoea, and exerting strong voluntary control, the glottis opens again, and the subject can breath, and exhale through the nose, evacuating the mask.
These subjects are indeed exposed to troubles in their diving career, as any event causing the mask flooding or being removed will impede them to breath for a while.
Nowadays, with a patient instructor who understands the problem, these people can still be certified and can afford some moderate diving experiences. In the past, when I was working as an instructor, we were told that those subjects were not allowed to become divers, and they were simply expelled from the course, as physically not fit.
So, for people not suffering of the neonatal reflex, evacuating the mask looks like a trivial task. For people suffering of this problem, the mask evacuation is an almost unsurmountable problem.

Angelo,
Thanks for this comment.

Do you know of a way for a non-physician to help someone determine if the reflex is still intact?

Do you have any particular drills or techniques for helping someone learn how to overcome this condition?

I had a confined water student last week simply who could not clear his mask, despite being a good swimmer and quick to learn most other skills he tried. Retaining this reflex would explain his problems. He couldn't exhale through his nose, and he had a strong urge to return to the surface as soon as he started trying to clear his mask.

I'm very glad we did the partial clearing in shallow water. He couldn't resist the urge to surface once he failed to exhale. It could have been very bad if he had tried to do this at any kind of depth.

We didn't have time in the group setting to go over this possible explanation. We're talking about it now. He needs to find out if he has the reflex and if he's willing to put in the effort to overcome it. And if he does have it and is willing to resume training, I need to know what medical clearance or other precautions should be in place before he tries to dive again.

 

[ssssnake529]

I have trouble clearing my mask. For some reason, it's really hard for me to exhale through just my nose. Even when I'm concentrating hard, I still tend to exhale through my mouth.

As a solution, I've found that if I need to get a lot of water out of my mask, it's easier for me to do if I remove my regulator from my mouth when I blow out. Then, it's easy to do my exhale through my nose and not my mouth.

My wife ribs me about it, but at least I have a work around.

The other skills I have trouble with are navigation and situational awareness. I have a pretty bad sense of direction on the surface and it seems like it gets even worse under water. Similarly, I often get so focused on whatever I am looking at that I lose track of all the other things around me. I will be looking at a tiny sea horse in front of me and won't even notice the huge nurse shark right beside me.

 

[eelnoraa]

Controlled ascents is the most difficult for a new diver, IMO. Hell even for some experienced divers.

I don't do a lot of charters, but the ones I have done I have been a bit shocked to see everyone climbing the anchor line, despite skill level and no current.

Navigation is probably a tie with ascents. Without a guide many divers would simply be lost.

Getting neutral might be at the top, but a good instructor can usually train a new diver within the first couple dives to have a fair amount of control.

Mask clearing isn't a difficult skill. There's usually one out of a group that find it challenging and most of the time it's just in their head. How hard is it to put hand pressure on the top of the mask and exhale through the nose? Not hard at all. The new diver is more mentally concerned about the fact there's water in their mask versus the actual task of expelling it.

Controller ascend in cold water, 400g drysuit, carrying double plus other bottle (meaning there is substantial amount of gas in wing and suit), add without visual reference like in murky water, it is the most difficult skill. Something we encounter in NorCal diving often. Even after 10+ years of diving, I cannot say I master. On the other hand, warm water, single tank, 3mm wet or even DUI30/30, even without visual reference, piece of cake by now.

 

[Angelo Farina]

Angelo,
Thanks for this comment.

Do you know of a way for a non-physician to help someone determine if the reflex is still intact?

Do you have any particular drills or techniques for helping someone learn how to overcome this condition?

I had a confined water student last week simply who could not clear his mask, despite being a good swimmer and quick to learn most other skills he tried. Retaining this reflex would explain his problems. He couldn't exhale through his nose, and he had a strong urge to return to the surface as soon as he started trying to clear his mask.

I'm very glad we did the partial clearing in shallow water. He couldn't resist the urge to surface once he failed to exhale. It could have been very bad if he had tried to do this at any kind of depth.

We didn't have time in the group setting to go over this possible explanation. We're talking about it now. He needs to find out if he has the reflex and if he's willing to put in the effort to overcome it. And if he does have it and is willing to resume training, I need to know what medical clearance or other precautions should be in place before he tries to dive again.

It appears a typical case of epiglottis reflex. The student should practice with the snorkel, swimming at surface without mask, and breathing from the snorkel. If the reflex is there, he initially will be unable both to exhale and to inspire, as the glottis is closed. Being at the surface and with no equipment, and being a good swimmer, he probably will be in a relaxed mood, so, he can wait some 20-30 seconds before needing to raise the face from water. Staying calm and relaxed, after a while the reflex attenuates, and he will be able to breath. Once reached this point, he should continue swimming with the face submerged, and breathing from the snorkel. Practicing this for some 3-4 weeks, twice per week, should bring progressively the reflex under control.
He can also do the same excercise at home, in a basin, placing the face underwater and breathing from the snorkel. It is very important to keep the eyes open, and for facilitating the reflex to disappear, he can rub around the nostrils with his fingers, for overstimulating the neural receptors and de-triggering the reflex.
Regarding medical advice, I know that there are substances which inhibit, at least partially, the activity of these neurotransmitters. But we are talking of powerful anesthetic drugs, which can only be medically prescribed, and taking them makes swimming or diving much more dangerous: these reflexes are there for protecting from drowning, assuming anesthetic substances, even locally (there are anesthetic creams to be applied around the nostrils, for example) increases significantly the risk of inhaling water from the nose and having it entering the lungs.
So I do not recommend to search for a medical solution...
This reflex is not pathologic, it is perfectly natural, so who has it should simply learn to manage it.

 

[Angelo Farina]

I have trouble clearing my mask. For some reason, it's really hard for me to exhale through just my nose. Even when I'm concentrating hard, I still tend to exhale through my mouth.

As a solution, I've found that if I need to get a lot of water out of my mask, it's easier for me to do if I remove my regulator from my mouth when I blow out. Then, it's easy to do my exhale through my nose and not my mouth.

My wife ribs me about it, but at least I have a work around.

The other skills I have trouble with are navigation and situational awareness. I have a pretty bad sense of direction on the surface and it seems like it gets even worse under water. Similarly, I often get so focused on whatever I am looking at that I lose track of all the other things around me. I will be looking at a tiny sea horse in front of me and won't even notice the huge nurse shark right beside me.

It is a typical case of lack of control of the internal valves inside your head. In particular the soft palate, which is the three-way valve connecting the throat with either mouth and nose. When open, air can flow freely between mouth, nose and throat.
But the valve can be closed partially or totally. In case of partial closure, the throat is left communicating just with the mouth (as when you are filling a rubber balloon) or just with the nose (as when you clear the nose in a tissue).
There are several exercises you can do at home, out of water, for learning how to get proper control of this valve system. There is also a device, called the Otovent, a small inflatable balloon designed to be filled with your nostrils, for practicing these exercises. Here a video illustrating how to use this device for removing stagnating fluids in the middle ear:

However the Otovent can also be used for practicing control of your soft palate. You need to inflate it with your nose, and with the mouth open!

 

[DiveProKoko]

.....The other skills I have trouble with are navigation and situational awareness. I have a pretty bad sense of direction on the surface and it seems like it gets even worse under water. Similarly, I often get so focused on whatever I am looking at that I lose track of all the other things around me. I will be looking at a tiny sea horse in front of me and won't even notice the huge nurse shark right beside me.

This is normal. You have to learn to trust the compass....as far as missing a nurse shark due to focusing on a seahorse? That's not a problem, my friend, that's a win! Nurse sharks are a dime a dozen....seahorses, not so much!

 

[DiveProKoko]

Controlled ascents is the most difficult for a new diver, IMO. Hell even for some experienced divers.....

Navigation is probably a tie with ascents. Without a guide many divers would simply be lost.

This