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

[doctormike]

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

Sure, always happy to help when I can, but I can't really make a diagnosis or give you a specific recommendation over the Internet. So I won't be able to comment on the scan.

What I was saying was that your left and right ET have to work to some degree, or your ears would not be normal in the doctor's office at sea level. But you said that you had problems equalizing the left ear when scuba diving, although you can do it eventually. So for whatever reason, it sounds as if your left ear doesn't equalize as well underwater as the right side.

If this is only a problem with diving, and if you can deal with it when scuba diving (as you have been for years) but not when free diving (due to the need for more rapid equalization). the simplest and safest solution would be to not free dive. If for some reason you feel that you must free dive and you can't figure out how to equalize rapidly on your own, then the ET balloon dilation might help with that. But whether to do it or not is going to be your own decision based on discussing the risks with the surgeon. If it was me, I would probably just stick to scuba diving, but it's not me...!

 

[doronazl]

Thank you for elaborating, i see what u mean now.
Im quite stubborn when it comes to those things, when i was training for scuba diving, i ended up at the doctor office which flat out told me i should not dive.
I dont know why but i didnt want to give it up, i kept trying and found the way i can do it that was possible for me and i finally did and i couldn't be happier with it.
Agreeably this is far more extreme but honestly free diving is just part of the reason im willing to take the extra mile, my left nostril has always been so easily clogged and whenever i had just a little bit of nose congestion or a sign of common cold, my left ear would be the first thing that gets screwed, i can immediately start hearing popping sounds during the first couple of days right before it gets completely clogged for the entire duration of the common cold, needless to say i cant do any kind of diving or flying and my hearing gets weird when that happen, i dont really know the technical part of what im describing to you, if its the ET that gets clogged during that time, hoping you could shed some light on it.

So even if i were to give up free diving, i still fly a lot, im sort of a digital nomad so its part of my lifestyle, flying isnt a picnic as well, far from easy going and always on the left ear as well.

 

[Angelo Farina]

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 ?

It is entirely normal that one tube is more easily opened than the other. I did see this happening to the majority of my students. One ear clears, the other has problems. When you learn a proper advanced equalization technique (as Frenzel and its derivatives - but in the link posted by @doctormike you see many others, including my favourite one, BTV), the problem disappears. The fact is that most students are lazy, and do not take seriously the effort required for getting complete voluntary control of the valves and muscles inside their head.
My wife did need a couple of months, going in the swimming pool twice per week and in the sea one per week, for learning Frenzel properly, and under the strict guidance of an expert free diving instructor (as said, most scuba instructors do not have the knowledge and the expertise for teaching properly these advanced equalization methods).

 

[doctormike]

Thank you for elaborating, i see what u mean now.
Im quite stubborn when it comes to those things, when i was training for scuba diving, i ended up at the doctor office which flat out told me i should not dive.
I dont know why but i didnt want to give it up, i kept trying and found the way i can do it that was possible for me and i finally did and i couldn't be happier with it.
Agreeably this is far more extreme but honestly free diving is just part of the reason im willing to take the extra mile, my left nostril has always been so easily clogged and whenever i had just a little bit of nose congestion or a sign of common cold, my left ear would be the first thing that gets screwed, i can immediately start hearing popping sounds during the first couple of days right before it gets completely clogged for the entire duration of the common cold, needless to say i cant do any kind of diving or flying and my hearing gets weird when that happen, i dont really know the technical part of what im describing to you, if its the ET that gets clogged during that time, hoping you could shed some light on it.

So even if i were to give up free diving, i still fly a lot, im sort of a digital nomad so its part of my lifestyle, flying isnt a picnic as well, far from easy going and always on the left ear as well.

I don't know exactly what is going on in your case, but imagine these three issues:

1) Deviated nasal septum - causes blockage of airflow in and out of one nostril

2) Eustachian tube dysfunction (ETD) - one ET works better than the other. With any sort of increased demand to the ear ventilation system (flying, scuba diving or free diving), this difference becomes more noticeable and ear pain results from the inability to equalize the pressure gradient across the eardrum.

3) Upper respiratory tract infection. This causes swelling of the mucosa, the lining of the nose, throat and ET. So whatever problems were caused by 1 and 2 are now worse...

ETD is thought to be a problem with the muscles that open and close the ET, or narrowing of the ET itself (sometimes an intrinsic problem, sometimes related to external things like radiation therapy. The balloon dilation stretches the ET and makes it larger, hopefully improving ETD. The deviated septum does not affect your ability to equalize the ears, since even if you had 100% blockage of the nasal airway, to do a valsalva you have to pinch the nose closed anyway, to raise pressure in the nasopharynx, well behind the septum.

 

[doronazl]

so youre basically saying if im to focus on the equalization problem i should only opt for the dilation if anything yes ?
i am also considering that since the doctor explained today its a relatively easy procedure with quick recovery.
i of course want to sort out my other problems but could also do that in stages

 

[doctormike]

so youre basically saying if im to focus on the equalization problem i should only opt for the dilation if anything yes ?
i am also considering that since the doctor explained today its a relatively easy procedure with quick recovery.
i of course want to sort out my other problems but could also do that in stages

I'm saying that if you (1) find the problem with equalizing that ear such a quality of life issue that you would consider surgery, and (2) have really tried the various methods for equalization (like the ones outlined in that document that I linked to) and have not succeeded, then you should have a conversation with the surgeon about the risks and benefits of balloon dilation and decide if you want to do it. As I said, I don't do them myself, so you are better off discussing that with your surgeon.

Not sure what other symptoms or procedures you are considering, but if you find the nasal obstruction a problem you could also ask about septoplasty. As I mentioned, these two things are unrelated.

 

[doronazl]

Thank you very much dr. mike , really helpful

 

[doctormike]

Thank you very much dr. mike , really helpful

Sure! Sorry I can't be more specific, but from what I hear the dilation procedure does help, especially with freedivers who don't have the luxury of time... Here is an article.

 

[doronazl]

Dr. Mike, one more question please.
I asked the doctor yesterday if he knows more information about the left ET, for example how big is the diameter comparing to the right one.
He says its not possible to know that in anyway.
So my question how does one normally decides to dialte the tube?
I know you said youre not doing that, im just curious if you know

 

[doctormike]

Dr. Mike, one more question please.
I asked the doctor yesterday if he knows more information about the left ET, for example how big is the diameter comparing to the right one.
He says its not possible to know that in anyway.
So my question how does one normally decides to dialte the tube?
I know you said youre not doing that, im just curious if you know

It's not as simple as that, the ETs aren't like pipes of varying diameter. They are potential space - except for unusual situations they are closed with no open lumen. They open by the action of muscles and then close passively due to the spring action of the cartilage that partially forms the walls of the tube.

So you really can't judge the function of the ET by any sort of measurement. And even in patients like yourself, they can't be totally non-functional. If they were, then your middle ear spaces would just collapse over time. The issue is that one of them doesn't work so well, in terms of the process of opening to ventilate the ear when there is a gradient between the middle ear pressure and ambient pressure (i.e. diving or flying).

So tube dilation would be offered based on the symptom history.