Developing reverse block

[Hank49]

This is free diving related but I hope I can get some good advice.
I've never had a problem equalizing in the 17 years since I started scuba diving.
I've been free dive spearfishing almost every week for the last 7 years and up until recently, still had no problems.
But in the last couple months I've started to get a very slow equalization in my left ear while ascending. I don't have any allergies and no lingering colds or sinus infection. The mucous is clear.
For the first 15-20 dives of the day, I'm fine. After that it gets a little harder going up.... and there is a little more resistance while going down also, but only in one ear.

After getting out of the water, within 2-3 hours I can equalize fine again.
Thanks

 

[Duke Dive Medicine]

Hank,
Having one ear clear more easily than the other is pretty common. You may be irritating the Eustachian tube of the more difficult ear with repeated valsalva maneuvers. This would make the difference in the ears more pronounced. Also, if salt water comes into contact with the nasopharynx (the upper part of the back of the throat, where the openings for the Eustachian tubes are located), it can cause inflammation and make it more difficult to equalize.
An over-the-counter, non-drowsy decongestant can sometimes be beneficial. Also, being mindful of your ear clearing can help. Start performing your equalization maneuvers before you feel the need to clear. If you wait to clear until too much of a pressure differential develops, it can collapse the fleshy opening of the Eustachian tube and make it more difficult to equalize. Someone here (I think it was DocVikingo) has a great link to a page with more ear equalization methods than you can shake a stick at. I looked all over for it but couldn't find it. Doc, if this was you, can you share it again so I can bookmark it? At any rate, you might also try a different equalization method - one that works well for our chamber patients is pinching the nose and swallowing. It takes some coordination but tends to work well.
Cheers,
DDM

 

[Lopaka]

Having one ear clear more easily than the other is pretty common. You may be irritating the Eustachian tube of the more difficult ear with repeated valsalva maneuvers.

I hear what you are saying DDM, but the man has been diving for 17 years. His issues are new, and are associated with reverse blockage. I do recall ascending during certification dives, and hearing a long squueeeek from one ear as the surface came near and the tube vented. Creepy sounding, did not actually block, and never had any indication of reverse blockage since then. My understanding is there is not a helluva lot you can do but wait with a reverse block, not really an option when freediving.

I am interested in his case, as a similar sort of thing happened to me years after I had started diving: suddenly my sinuses did not want to clear, icepicks in the forehead, and the joy of blood in the mask. Ears cleared fine. Far as I can tell in my case, allergies got more severe as I got older, so now I nuke myself with Claritin a day or so before diving, just in case.

Stuff happening long after getting a handle on equalizing and diving is very interesting, and should be to most divers as time goes on. You never know when a new kink might get entered into your diving.

 

[Bubbletrubble]

I am interested in his case, as a similar sort of thing happened to me years after I had started diving: suddenly my sinuses did not want to clear, icepicks in the forehead, and the joy of blood in the mask. Ears cleared fine. Far as I can tell in my case, allergies got more severe as I got older, so now I nuke myself with Claritin a day or so before diving, just in case.

@Lopaka: If your sinus pain occurred during descent, it would seem to be consistent with sinus squeeze. Strictly speaking, that's different from a reverse block which occurs during ascent.

 

[Duke Dive Medicine]

Greetings Lopaka,

I hear what you are saying DDM, but the man has been diving for 17 years. His issues are new, and are associated with reverse blockage.

Diving and free diving are two different animals. Typically, when diving, you actively equalize on the way down, maybe adjust a little with your profile on the bottom, and your ears pretty much clear themselves on the way up. Free diving like Hank was ("For the first 15-20 dives of the day, I'm fine...") involves a lot more active equalization and thus more potential for irritating the Eustachian tubes. Also, when free diving, there's more of a potential for salt water to come into contact with the nasopharynx - it doesn't take much to cause irritation.

I am interested in his case, as a similar sort of thing happened to me years after I had started diving: suddenly my sinuses did not want to clear, icepicks in the forehead, and the joy of blood in the mask.

Ditto what the previous poster said. You had a sinus squeeze, not a reverse block. This caused extravasation of blood into your sinuses.

Stuff happening long after getting a handle on equalizing and diving is very interesting, and should be to most divers as time goes on. You never know when a new kink might get entered into your diving.

True, and this may very well be what's going on with the OP. It's hard to tell without a more complete history.

Regards,
DDM

 

[Hank49]

Greetings Lopaka,


Diving and free diving are two different animals. Typically, when diving, you actively equalize on the way down, maybe adjust a little with your profile on the bottom, and your ears pretty much clear themselves on the way up. Free diving like Hank was ("For the first 15-20 dives of the day, I'm fine...") involves a lot more active equalization and thus more potential for irritating the Eustachian tubes. Also, when free diving, there's more of a potential for salt water to come into contact with the nasopharynx - it doesn't take much to cause irritation.


Ditto what the previous poster said. You had a sinus squeeze, not a reverse block. This caused extravasation of blood into your sinuses.


True, and this may very well be what's going on with the OP. It's hard to tell without a more complete history.

Regards,
DDM

Ask away. I'll give you all the answers on my history that you want, Doc. Except for that time I was ......never mind.

Like I said, I've been free diving a long time every week. No problems. I don't think I'm doing anything different now than I was last year. I do get salt water in my mask which may get back in my throat and into my Eustachian tubes. But I would guess that it's been happening ever since. Unless it's just that I'm getting older.
I've read that improper hydration could be a factor? I am careful about what I drink and eat on dive days. If I'm in the water for 3 hours, come out and gulp down a lot of fluids and a peanut butter sandwich, it really cuts my dive times short when I get back in the water.
I'll try the pinching and swallowing. Never done that before. I swallow a lot while on the bottom. It lengthens my breath hold a bit.

 

[Lopaka]

@Lopaka: If your sinus pain occurred during descent, it would seem to be consistent with sinus squeeze. Strictly speaking, that's different from a reverse block which occurs during ascent.

Understand that very well.

My point (I guess it was too obtuse) was that after diving for quite some time, ear issues seem to suddenly pop for some of us, whether during descent or ascent. That is what concerns me.

 

[Duke Dive Medicine]

Hank and Lopaka,
Your questions got us interested in the possibility of age-related degenerative changes in the anatomy of the middle ear that might cause increased difficulty equalizing. None of us were aware of anything like that, so our medical director, Dr. Moon, emailed Dr. Allen Dekelboum, a retired ENT physician who's also a diver and board-certified diving physician. Dr. Dekelboum had never heard of such a thing either, and says he equalizes better at 80 than he did when he was young.
For Hank: let's dig a little deeper into your individual issue. You said that you try to limit your fluid intake on days when you free dive. Dehydration could certainly play a part, as you observed, since your mucus would be thicker and more likely to cause obstruction of the Eustachian tube. You can strike a happy balance between dehydration and gulping so much water that you can't get a full breath. Maybe if you purchased a CamelBak or similar product, you could hang the drinking tube over the edge of the boat and take sips of water between dives while you're still in the water.
Have you changed your free diving habits lately (e.g. increased the number of your dives, changed equipment, changed equalization techniques, or changed the location of your dives)? Have you moved to an area that might have a higher pollen content?

 

[dumpsterDiver]

If my ears are not working well, I sometimes fill the mask with seawater and snort the sea water through my sinuses. This has helped me and other people as well.

I also am sometimes bothered by reverse block, but for some reeaso almost exclusively when scuba, not freediving. One thing that may help with little downside (other than choocking) is the use of a sugar free nebthol cough drops before diving and while in the boat. the menthol seems to help a lot. I used to scuba dive with a lozenge when i was a commercial scuba diver and dove 5 hrs per day. It helps with dry mouth from compressed air as well.

I would be afraid to be using a lozenge when actively freediving because of the aspiration issue.

 

[Duke Dive Medicine]

If my ears are not working well, I sometimes fill the mask with seawater and snort the sea water through my sinuses. This has helped me and other people as well.

It might help temporarily but since salt water is hypertonic, it could pull fluid into your sinuses and aggravate the problem later on. Do you notice the reverse blocks on dives where you've snorted the sea water?