Chronic issue with equalization of the left ear, septoplasty surgery ?

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doronazl

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Messages
9
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Location
thailand
# of dives
100 - 199
Hi all, il try to elaborate on my situation as much as i can, please bare with me
im 34, since i started scuba diving which was 12 years ago i been having issues with eq my left ear, my right ear is a dream, so easily eq, i just move my jaw a bit and its done, my left ear though requires force and more time to slowly hear it doing its thing, it was happening during dives and during flights.
when i was scuba diving it was manageable since i could just slow down my decent, deal with it and continue, no rush.

i recently started to work on my free diving skills, with this sport it really became a nightmare
A. because im basically diving head down so its harder to eq in general this way which in my case means nearly impossible for my left ear to pop, my right one as usual working flawlessly, no matter the position im in.
B. since its time sensitive where u need to hold your breath, its a waste of time stopping and trying to eq slowly every meter or so.

this is the point where i decided enough is enough, i am determined on getting it fixed.
i went to see a ENT doctor where i live, im an expat living in PHUKET THAILAND btw, the doctor tried the flexi camera up my nose and said my left nostril has a septum deviation which makes it harder to get the camera inside there and then sent me to do an xray, he said thats probably the cause, i suggested the baloon dilation, he then said that in phuket no hospital can perform that operation and i should consult with his colleague in a hospital in bangkok.

today i went to that hospital in bangkok, did a few test which included , flexi camera, ear pressure and middle ear frequencies test and ct scan.
ct scan showed the deviation i have on my left ear, it also showed a cyst on my left bottom sinus which the doctor said is small and have no affect on my symptoms, rest of the sinuses are clear.

he also looked at my ear drums while i was equalizing and says it looks normal but of course i can feel how much force i need to use in order to pop that left ear , so he recommends as followed -
either baloon dilation or septoplasty surgery could improve the operation of the ET, he said its really up to me and he could do just one of them if i prefer.
baloon dilation - he says it is basically a very simple procedure that has a high success rate and most chances will improve the situation and have very little risk of worsening it, basically nothing to lose by doing it.
septoplastic surgery - he says it is not surely the cause for the ET issue but at the very least it will improve my situation in other ways - breathing issues of that nostril , easily getting clogged in many events(been this way always)


now honestly i am a little confused on what to do next, i talked to my diving instructor, even before i went he says that most doctors jump right away to the septoplastic solution and that its just a way from them to generate more money.

how could i know then ? if not any of those operations what else could be the fix?
any input will be greatly appreciated.
 
Hi all, il try to elaborate on my situation as much as i can, please bare with me
im 34, since i started scuba diving which was 12 years ago i been having issues with eq my left ear, my right ear is a dream, so easily eq, i just move my jaw a bit and its done, my left ear though requires force and more time to slowly hear it doing its thing, it was happening during dives and during flights.
when i was scuba diving it was manageable since i could just slow down my decent, deal with it and continue, no rush.

i recently started to work on my free diving skills, with this sport it really became a nightmare
A. because im basically diving head down so its harder to eq in general this way which in my case means nearly impossible for my left ear to pop, my right one as usual working flawlessly, no matter the position im in.
B. since its time sensitive where u need to hold your breath, its a waste of time stopping and trying to eq slowly every meter or so.

this is the point where i decided enough is enough, i am determined on getting it fixed.
i went to see a ENT doctor where i live, im an expat living in PHUKET THAILAND btw, the doctor tried the flexi camera up my nose and said my left nostril has a septum deviation which makes it harder to get the camera inside there and then sent me to do an xray, he said thats probably the cause, i suggested the baloon dilation, he then said that in phuket no hospital can perform that operation and i should consult with his colleague in a hospital in bangkok.

today i went to that hospital in bangkok, did a few test which included , flexi camera, ear pressure and middle ear frequencies test and ct scan.
ct scan showed the deviation i have on my left ear, it also showed a cyst on my left bottom sinus which the doctor said is small and have no affect on my symptoms, rest of the sinuses are clear.

he also looked at my ear drums while i was equalizing and says it looks normal but of course i can feel how much force i need to use in order to pop that left ear , so he recommends as followed -
either baloon dilation or septoplasty surgery could improve the operation of the ET, he said its really up to me and he could do just one of them if i prefer.
baloon dilation - he says it is basically a very simple procedure that has a high success rate and most chances will improve the situation and have very little risk of worsening it, basically nothing to lose by doing it.
septoplastic surgery - he says it is not surely the cause for the ET issue but at the very least it will improve my situation in other ways - breathing issues of that nostril , easily getting clogged in many events(been this way always)


now honestly i am a little confused on what to do next, i talked to my diving instructor, even before i went he says that most doctors jump right away to the septoplastic solution and that its just a way from them to generate more money.

how could i know then ? if not any of those operations what else could be the fix?
any input will be greatly appreciated.

@doctormike is the resident ENT here and he'll know way more about this than I do, but FWIW, I've had two septoplasties - the first one I had done in the Navy was not successful long-term and I had to have it repeated. They're not terrible as surgeries go, but to me, if your ENT thinks that the two procedures are equally likely to produce a favorable outcome for you, I'd go with the less invasive balloon procedure. Mike? Any wisdom to share?

Best regards,
DDM
 
My instructor insist on me ruling out POST NASAL DRIP before doing any kind of operation
 
My instructor insist on me ruling out POST NASAL DRIP before doing any kind of operation

Your diving instructor? Is he/she medically qualified? In any case, I think that you've already done this by visiting your ENT and having the rhinoscopy.

Best regards,
DDM
 
it could be but it was my mistake i didnt ask specifically about it, which i will do tomorrow morning.

i think he is just seen too many cases of doctors recommending septoplastic surgery when its not really necessary
 
My wife had terrible problems at her left tube, too.
She considered both the balloon procedure and to give up diving.
Then she switched to free diving, too, and the instructor insisted she had to learn the Frenzel equalization method, instead of Valsalva.
This solved the problem entirely, and she became able to equalize easily while speeding down with her very long Rondine Gara fins.
Then she returned to Scuba Diving. With a regulator in your mouth you cannot use Frenzel, which is done with the mouth closed (and pumping also with your cheeks, if using the Frenzel-Fattah method, which is very useful for deep free diving).
But then she did discover the Marcante-Odaglia method, a variant of Frenzel which can be done with a regulator keeping your mouth open.
So she solved all her problems without any surgery, simply learning those advanced equalization techniques (which usually are taught only in deep free diving courses and are unknown to most scuba instructors, who only teach the crap Valsalva method).
 
The nasal septum is the wall in the middle of the nose, which separate the nasal airway into right and left halves. It is far from the opening of the Eustachian tube. While fixing the septum would improve your nasal airway and your ability to breathe (especially through the side of the nose where the septum is blocking more), I'm not aware of any way that it could improve ET function.

Dilation of the ET with a balloon is a relatively new procedure that I don't do myself (I'm a pediatric ENT doc). However, there is some evidence that it may help in selected cases of difficulty equalizing during diving. Of course, most of the time it's a technique problem and not an anatomic problem. Here are some pointers on equalizing... It's actually not without some risks, so best for you to understand them and make sure that it's really necessary first.
 
I see what youre saying.
My biggest question is how can it be a technique problem when its always a problem with one particular ear? It never got better or worse, always the same situation on the same side.
I would love to avoid any type of surgery but this leads me to believe i am doing things right but unable to because something isnt right in my system.


And regarding the dilation, how does one check if it is necessary? What kind of tests are supposed to be done?
 
I see what youre saying.
My biggest question is how can it be a technique problem when its always a problem with one particular ear? It never got better or worse, always the same situation on the same side.
I would love to avoid any type of surgery but this leads me to believe i am doing things right but unable to because something isnt right in my system.


And regarding the dilation, how does one check if it is necessary? What kind of tests are supposed to be done?

I don't know if it is a technique problem in your particular case or not, I was just saying that people should confirm that they are equalizing properly before considering surgery. It's certainly possible that while both of your ETs do function to some extent - your ears are well ventilated at the surface from what you posted - maybe one works better than the other so that when they need to work in more difficult circumstances (scuba diving) you have some asymmetry.

There really is no test for the surgery as far as I know other than a good basic ENT exam (remember, I don't do balloon dilation myself, so there may be something that I'm not familiar with). If equalization with diving is a big problem for you and you have ruled out anatomic problems (like a mass pushing on the ET) with the CT, then it's something to consider.
 
i would like to first thank you for your comments, very much appreciated.
could u please further explain the first part of your comment im not sure i fully understand , from the looks and feeling of it my right tube works better than my left tube and like u said it shows when putting it to the test in a more difficult conditions, isnt that alone indicates theres something wrong with it and that i should try some sort of procedure ? whether its dilation or any other

also if its ok with you could i upload the images from the ct and xray here ? would love for you to take a look
 

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