Another ear + Sudafed question

[DiverEmily]

Just got back into diving after taking multiple years off. I have always had difficulty clearing my ears, but if I went slow enough I would always be able to dive. This weekend my husband and I went to do a refresher dive before heading off to HI in two weeks for family vacation + diving. The first dive it took forever ~15minutes, but I was able to clear my ears to 30ft. It is a quarry in the midwest and the water was COLD. The second dive no matter how slowly I went I couldn't make it past 10ft and we abandoned the dive after 30 minutes. The next day I started have mild ear pain. 48hrs post dive I was at the ENT. The visual inspection and the tympanometry test came back normal. He did say that my eustachian tubes were narrower than most and mildly hyperemic. He said he saw no reason to postpone diving and recommended Sudafed to be taken 1hr prior to diving. I mentioned that I thought Sudafed wasn't recommended especially with NITROX (which is what I dive with) but he seemed undeterred. So question- Is Sudafed OK with Nitrox now? Should I plan on taking a Sudafed but using regular air? Do I need a different ENT?

 

[DiverEmily]

@doctormike You seem to be called upon a lot. I'd love your opinion if you happen to see this Thanks!

 

[inquis]

In the quarry, are you flooding your hood if you have one?

DAN just had an article about Sudafed where they said it's not an issue for recreational diving with regard to oxygen toxicity. Obviously, wearing off/reverse squeeze would be bad, so be careful about repetitive diving and timing.

 

[Marie13]

I take Zyrtec-D (same as Sudafed) daily at my doctor’s orders. I have for years. I dive weekly on nitrox. No issues.

 

[mi000ke]

I have difficulty clearing my ears due to similar problems with my Eustachian tubes. I have been taking pseudoephedrine before dives while using nitrox for several years with no problem. I use the 12 hour (not the 4) to make sure it does not wear off while diving.

 

[doctormike]

@doctormike You seem to be called upon a lot. I'd love your opinion if you happen to see this Thanks!

Hi, Emily!

I can't really give you specific advice, but I can make some general comments! Take a look at my page on these topics for more detail.

It's really not possible to examine the ET directly, although you can infer it's function by looking at the status of the middle ear. You can see one end of it if you do nasal endoscopy, but it's hard to make conclusions about the reason why you might have trouble equalizing from a regular exam.

With VERY few rare exceptions, for patients who have well ventilated, normal ears on the surface and who have trouble equalizing while diving, there aren't specific anatomic or structural problems with the ET that can be visualized or fixed. There is a bell curve for everything, and some people just have ETs that don't accommodate to changing ambient pressure as well as others. Very commonly, it's a technique issue, so it's helpful to try different types of clearing approaches.

There isn't a lot of good evidence that oral decongestants for nasal symptoms help with ET function. However, as mentioned upthread, it's unlikely that with recreational diving that you will be close to the oxygen toxicity limits, even with nitrox. There was some limited experimental animal data to suggest that these medications can lower the seizure threshold, but it's certainly not clear that that translates to a general recommendation for recreational diving.

 

[DiverEmily]

Thanks everyone! Especially @doctormike. I guess I'll try the Sudafed while on vacation and see what happens. My ENT did say that the ears are a dynamic system so it could have just been a "fluke" that they didn't want to cooperate this past weekend. I've never had to abandon a dive before! We are taking the kids out on their first dives EVER when traveling so I'm really hoping my ears behave.

In the quarry, are you flooding your hood if you have one?

DAN just had an article about Sudafed where they said it's not an issue for recreational diving with regard to oxygen toxicity. Obviously, wearing off/reverse squeeze would be bad, so be careful about repetitive diving and timing.

I did not! I did pull the hood to one side on the ear that was giving me trouble but I did not try flooding it. It has been a LONG time since I dove in cold water with a hood so If I had known about that trick I forgot it and didn't try it. Fortunately, I don't have plans to do more cold water diving in the near future, but will definitely try to remember that!

 

[Marie13]

You need to flood your hood on both sides as soon as your head is under. My OW instructor taught me this and it makes a huge difference (I always wear a hood)

 

[Centrals]

Thanks everyone! Especially @doctormike. I guess I'll try the Sudafed while on vacation and see what happens.

If you are going to travel to other countries:

Pseudoephedrine - Wikipedia

en.wikipedia.org

Read the legal status section.
Philippines is also prohibited the drug.

 

[Dark Wolf]

Do you clear your ears before you get to the dive site? I have found that clearing my ears when I get up and several times before diving helps out. Might be worth a shot.

DW