Barotrauma on my open water dive.

[phil8diver]

As soon as my head goes under water I equalize immediately and continuously but lightly during my dive so that I will never have any problems. Hope this helps.

 

[Davemohio]

Yep..my first post or reply. Excuse any errors! After 10 years of diving, I guess it was bound to happen. I experienced it in Cozumel at 65 feet. Good safe dive..with very minor pressure going down. As the dive progressed, it got worse. When I did my extra long safety stop I could not wait to get on the boat. I saw a physican in Mexico within 90 minutes and he diagnosed middle ear barotrauma. He gave me the steroid and a pain reliever. When I got home I called my ENTand he prescribed an antibiotic. The pain is incredible and will try to get in to see him today. He is taking appts for January now! I always use Afrin before a dive and sometimes sudafed. No sudafed on this dive. I see my ENT several times a year for ear cleaning and check ups. It feels like an incredible headache and my right ear is plugged. I consider myself a very safe and conservative diver. I assume I had the beginnings of a cold and perhaps the usual symptoms had not appeared yet. The next day I started sneezing and had other cold symptoms.

 

[stadevene]

A tip one of my instructors gave me (TSandM please wade in here if this is a myth) is on the ride out to the site to clear your ears a few times before you go in the water. Basically every few minutes give your nose a gentle blow. He felt this I dunno "loosened up" your ears and made it easier to equalize. I've tried it and it seems to help.

I've also found Pro-Plugs help keep my ears more open which allows for better equalizing.

To Davemohio, I'm wondering if the use of Afrin was a detriment in your recent issue. I'm wonder (again, TSandM is the one I defer to) if Afrin doesn't have too short of an affect and as a result part way in your dive it wore off causing you to have issues? Sudafed or other tablets seem to have a much more consistent and long term release. In any event, hope you start feeling better soon.

 

[Bronson]

Thanks for this post. Weight is a problem for many divers and paying attention to your training is worthwhile to avoid such a painful experience. I am glad that you are ok.

 

[TSandM]

Afrin is a fairly long-acting medication when you use the first dose. The big issue with Afrin comes with multiple-day use. The medication works by causing vasoconstriction, or narrowing of the blood vessels. When it wears off, the tissue which has been limited in blood flow while the drug was working has been sending out all kinds of signals to get MORE blood, so the vessels dilate even more than before, making the swelling worse. The patient then tends to reuse the drug before the 12 hour period has elapsed. The effectiveness gets shorter and shorter as a result. This CAN end up with what's termed rhinitis medicamentosa, which is persistent, severe nasal congestion CAUSED by the medication, and it can take steroids to get somebody off the Afrin.

In my opinion, if you require Afrin and Sudafed routinely to execute a dive, you should be evaluated by an ENT doc.

 

[paulvay]

A tip one of my instructors gave me (TSandM please wade in here if this is a myth) is on the ride out to the site to clear your ears a few times before you go in the water. Basically every few minutes give your nose a gentle blow. He felt this I dunno "loosened up" your ears and made it easier to equalize. I've tried it and it seems to help.

I have also found it easier, especially for new/certifying divers to "pre-equalize"; I ask them to equalize before they begin their descent, seems to make things go smoother on OW dives.

I have never tried getting them to practice it a few times to lossen up the ear drum, but I suppose that it is plausible (MythBusters time)

Paul.

 

[paulvay]

Afrin is a fairly long-acting medication when you use the first dose. The big issue with Afrin comes with multiple-day use. The medication works by causing vasoconstriction, or narrowing of the blood vessels. When it wears off, the tissue which has been limited in blood flow while the drug was working has been sending out all kinds of signals to get MORE blood, so the vessels dilate even more than before, making the swelling worse. The patient then tends to reuse the drug before the 12 hour period has elapsed. The effectiveness gets shorter and shorter as a result. This CAN end up with what's termed rhinitis medicamentosa, which is persistent, severe nasal congestion CAUSED by the medication, and it can take steroids to get somebody off the Afrin.

In my opinion, if you require Afrin and Sudafed routinely to execute a dive, you should be evaluated by an ENT doc.

Thanks for that insight, very helpful. Is there something that is recommended for weekend dive training? I'm going to be teaching OW classes this summer and can imagine a scheduling nightmare if I have congestion in the morning. I would need something that would get me through two long days of diving??? I have used behind the counter sudafed, but is there something better/different?

 

[Davemohio]

Thanks for the follow up posts. I have been reviewing the accident for the past 5 days in my Lazboy and I don't think Afrin was the culprit. I use the sudafed when I can remember, prior to the dive. I do not overuse it..it affects my sleep. And If I don't get decent sleep, I don't dive. I believe I just got sloppy/lazy with my equalizations. Been diving alot(for me) this year...3 times in MX alone. The diving and decents had gotten easier. Before my dive last week, I had some minor discomfort below my ear and proceeded with the dive anyway. The pain/discomfort did not feel largely out of the ordinary. If I could go back in time, I would have aborted the dive. This has been a wake up call for me. I am seeing my ENT for a follow up again in January. TSandM...I appreciate your posts and insight and might PM you next week with a couple questions. THX..Dave

 

[franks402]

This is great information - I found this thread because I, too, had barotrauma during certification training, causing a disruption in the schedule, then suffered it again during our checkout dive. I have an awful time clearing and a history of allergies, so I visited an ENT for advice. He prescribed treatment for the allergies, but even when my sinuses are not congested my ears still do not clear well, so he said I likely have narrow eustacian tubes.
TSandM's remarks about Afrin are exactly what the ENT said - no more than a couple of days' consecutive use, or one suffers worse consequences than the allergies.
TSandM - the links to Dr. Kay's lectures are SO helpful - thank you, thank you, thank you from a new diver with Ear Fear from previous trauma. We are planning our first scuba trip and I feel so much more comfortable now, knowing that my inadequate eustacian tubes may not spoil the trip afterall! I hope this helps other divers, too!

 

[EGad]

I'm former US Air Force aircrew and I used to carry a bottle of Afrin in my flight bag because descending from altitude can sometimes cause barotrauma in the same way as a reverse block. It's only used as a last resort, when the valsalva maneuver doesn't work and bouncing the aircraft altitude (when possible) doesn't work. We had to check that we could equalize every time we saw the flight doc to get/stay/return to flying status. That being said, the only time I needed my "get me down bottle" was when I was overseas for an exercise and it had fallen out of my bag at some point. No one else was carrying one in my crew section so I had one of my nasal sinuses inflate. It was a novel feeling, like someone was blowing up a balloon in my face. It was also rather painful. Fortunately, it was a relatively minor block that cleared right about the time we landed, but I still took myself off of the rest of the sorties for that deployment. I had no lasting damage, but after that, I definitely checked that I had Afrin before pretty much every mission I flew.

I can say that Afrin or the like does work very well when you need it, but diving with a cold or the like is a bad idea. If you find that you need it when you're feeling healthy more than once in a long while. (Your health changes a lot less in a 60 minute dive than a 18 hour sortie.) Then I would suggest you see your friendly unit flight doc. If you're not on flight status, see an ENT, preferably one who has hyperbaric experience. (DAN can help you there.) Not diving sucks, but not diving due to barotrauma or a rupture sucks a lot more and for a lot longer.

Stay safe, Keep diving.

Eric