A Few Questions About Equalization

[Seaweed Doc]

I think I mentioned decongestants first, but to be clear (in my case) this is an apres-dive activity. The decongestant (a 4-hour version) has long worn off by the next day's diving. I wouldn't recommend their use in any situation where the effects haven't completely worn off by the next day.

Depending on the issue, antihistamines may or may not help. They have a tendency to thicken mucus (at least the ones I tried), which makes it harder for me to clear the snot out of my Eustachian tubes.

 

[The_Paper_Cut]

These last several posts about decongestants have me just a touch anxious, since we're in an Intro forum. We should NOT be recommending them lightly.
Specifically, the notion of "well in advance" must prompt the reminder that diving as your decongestant is possibly wearing off may put you in a bind.
Second is the potential for rebound stuffiness issues afterward, which may lead to an infection if you have retained water in your middle ear from repeated Valsalva maneuvers.
Finally, while a one-off use to save a planned dive MIGHT be okay, any notion of saving a multi-day dream vacation by repeated, daily use of a decongestant in order to dive is probably a really bad idea.

My 2 cents.

Diving Doc

Thanks for this. I’ll probably stay away from them then. But I do have a question since you’re a dive doc and you’re here if you don’t mind. On my first dive I think I may have done something to my ears. I went to the doctor because my hearing was a little weird/muffled and I could hear fluid in my ears. The doctor said my eardrum was red/irritated and that I had water in my middle ears. How long does this usually take to clear and is there anything I can do to help it? The doctor just said to come back if it starts to hurt. But since my ears are still having pressure differences (I assume from the water or something), I keep doing the Valsalva technique on land and all. Sorry if this isn’t the right place to ask something like this, I’m just concerned as a new diver and all.

 

[Seaweed Doc]

Thanks for this. I’ll probably stay away from them then. But I do have a question since you’re a dive doc and you’re here if you don’t mind. On my first dive I think I may have done something to my ears. I went to the doctor because my hearing was a little weird/muffled and I could hear fluid in my ears. The doctor said my eardrum was red/irritated and that I had water in my middle ears. How long does this usually take to clear and is there anything I can do to help it? The doctor just said to come back if it starts to hurt. But since my ears are still having pressure differences (I assume from the water or something), I keep doing the Valsalva technique on land and all. Sorry if this isn’t the right place to ask something like this, I’m just concerned as a new diver and all.

Now is when my earlier advice applies. Take a NSAID like ibuprofen (eg, Advil), drink lots of water, and if you're not diving try pseudoephedrine. Sleep with the most affected ear up.

The goal is to open up your Eustachian tubes and get the fluid in your middle ear to drain into your throat. The ibuprofen reduces swelling, allowing passages to open up. The pseudafed loosens mucus so passages clear easily (I think). Water also softens up the mucus. Sleeping with the affected ear up gets gravity working for you.

However, I'm not a human doc. This is just what works for me.

One last trick a doc taught me, but never worked well and can only be tried once or twice: .Use a nasal spray decongestant and then lie flat on your back for a timed 5 minutes. Then roll to get the affected ear up. The goal is to get the decongestant back into your Eustachian tubes, then let them drain. The sprays cause more problems than they solve if you use them for more than a day or two, though.

As for all decongestants, including pseudafed, don't dive until the effects have passed.

 

[rsingler]

I went to the doctor because my hearing was a little weird/muffled and I could hear fluid in my ears. The doctor said my eardrum was red/irritated and that I had water in my middle ears. How long does this usually take to clear and is there anything I can do to help it?

What you describe is VERY common in new divers. The muffled sound is from fluid in your middle ear, as you have surmised. An irritated eardrum is more a sign of otitis EXTERNA from bacterial irritation of the eardrum (think retained pool or sea water), although it could be eardrum irritation from overly forceful repeated Valsalva maneuvers.

The middle ear fluid should clear on its own in 3-10 days. If you have otitis externa (key sign: pain in the side of your head when you pull back on your ear), then a little swimmers ear preparation (alcohol and glycerine) will help it clear in its own. Antibiotics for either otitis media (middle ear) or externa (ear canal) are rarely indicated. Maneuvers described by @Seaweed Doc above may indeed help. Be careful of rebound tissue swelling from repeated use of decongestants, however.

But the key is prevention. "Clear early and often" is our mantra for this very reason. Fluid in the Eustachian tube or middle ear can indeed be just water that seeps in as your body tries to equalize the lower pressure in there from late attempts to clear. But early in your diving career, it may also be serum which has seeped from the tissues because clearing was inadequate and residual negative pressure remained for awhile. Serum is much thicker and takes awhile to clear. Rarely, it can become infected, so return to your doctor if pain increases.

Practice makes perfect. Don't be too forceful. Clear early and often. The more you dive, the more this will become routine. Most of all, don't worry. This is a really frequent observation, but rarely among more experienced divers. It's just one more skill you need to master.

Welcome to the diving Brotherhood/Sisterhood! Enjoy!

Diving Doc

MOD: Perhaps extract these last three posts and move to Beginners Forum? A common issue.

 

[The_Paper_Cut]

What you describe is VERY common in new divers. The muffled sound is from fluid in your middle ear, as you have surmised. An irritated eardrum is more a sign of otitis EXTERNA from bacterial irritation of the eardrum (think retained pool or sea water), although it could be eardrum irritation from overly forceful repeated Valsalva maneuvers.

The middle ear fluid should clear on its own in 3-10 days. If you have otitis externa (key sign: pain in the side of your head when you pull back on your ear), then a little swimmers ear preparation (alcohol and glycerine) will help it clear in its own. Antibiotics for either otitis media (middle ear) or externa (ear canal) are rarely indicated. Maneuvers described by @Seaweed Doc above may indeed help. Be careful of rebound tissue swelling from repeated use of decongestants, however.

But the key is prevention. "Clear early and often" is our mantra for this very reason. Fluid in the Eustachian tube or middle ear can indeed be just water that seeps in as your body tries to equalize the lower pressure in there from late attempts to clear. But early in your diving career, it may also be serum which has seeped from the tissues because clearing was inadequate and residual negative pressure remained for awhile. Serum is much thicker and takes awhile to clear. Rarely, it can become infected, so return to your doctor if pain increases.

Practice makes perfect. Don't be too forceful. Clear early and often. The more you dive, the more this will become routine. Most of all, don't worry. This is a really frequent observation, but rarely among more experienced divers. It's just one more skill you need to master.

Welcome to the diving Brotherhood/Sisterhood! Enjoy!

Diving Doc

MOD: Perhaps extract these last three posts and move to Beginners Forum? A common issue.

Thank you so much for the response, I’ll see if it clears up shortly as its been 6 days so far. I’ll also make sure to ingrain that in my head: “early and often”. Thanks again for all the help, I really appreciate it!

 

[Seaweed Doc]

@rsingler

You've gotten me thinking, and that's dangerous.

I'd attribute my issues to allergies and dehydration: I get them when I haven't been diving at times, and I only associate them with diving because I tend to get dehydrated in the tropics and I dive when I'm in the tropics.

Would the treatment be any different whether the ear "fullness" is due to colds, allergies or slight barotrauma? (Assuming no eardrum puncture or infection in any of these cases.) I've assumed a similar cause: An inability to clear fluid or air pressure on the eardrum. Regardless of cause, opening up the Eustachian tubes is the goal, right?

Or is there something I'm missing here, and a fundamentally different approach is needed depending on cause?

OK: A couple of caveats. I'm skeptical on antihistamines generally, but for some with allergy-only symptoms I guess they might help whereas they'd exacerbate dehydration issues. And we're all skeptical of diving on decongestants though they're less of an issue above water.

 

[rsingler]

Would the treatment be any different whether the ear "fullness" is due to colds, allergies or slight barotrauma? (Assuming no eardrum puncture or infection in any of these cases.) I've assumed a similar cause: An inability to clear fluid or air pressure on the eardrum. Regardless of cause, opening up the Eustachian tubes is the goal, right?

In the case of cold or allergies, a normal Eustachian tube has impaired air passage due to mucosal inflammation. Inflammation = swelling. Swelling = impaired flow, leading to symptoms. So decongestants or antihistamines might be expected to work (temporarily), until normal tissue thickness returns, along with air flow in the Eustachian tube. Symptoms disappear.

But in diving, you have a normal Eustachian tube, not an abnormal one due to inflammation. Here, the symptoms arise from the fluid that accumulates from inadequate clearing. It is only when the result of that inadequate clearing becomes middle ear inflammation, that you have a situation similar to colds/allergies, where antihistamines/decongestants might have a role (AFTER diving).

I'm not really sure that dehydration plays much of a role.

Finally, there are those with congenital abnormalities in the Eustachian tube who might benefit from a new balloon dilation procedure to relieve symptoms or allow diving.

Hope this helps!