Developing reverse block

[Hank49]

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?

Well, I AM 55 now. I look in the mirror and see my Grandpa.
I hydrate in the morning before going out and do take water but only after being in the water for at least 2 hours. Usually more like 3-4 hours. But I've always done it this way...for the last 7 years anyway.
I think I will now make it a point to get out after every half hour and drink 8-12 ounces of h2o.
I haven't moved to a high pollen area. I've been here in Belize for 11 years now. I've never had allergy problems my whole life except penicillin.
But, I HAVE started wearing a hooded vest in the last 7 months. It seals pretty tightly.
I still use the same technique as always while equalizing. First one at 6-8 feet and every few feet all the way down. Occasionally I feel a little pain but only if I get focused and am chasing down a fish. Most dives are between 25 and 65 feet.
I have been making a more conscious effort to clear my sinus/ nose more frequently since it started happening. Normally I would just pull my mask up and gently blow out some mucous. Now I suck in as well and....hawk it up and spit.
Last Sunday I was coming up though and the last 10 feet, it just didn't want to clear. I was out of breath and had to surface. More pain than I feel comfortable with. The it popped on the surface. I did a few more dives but not so deep.

 

[Duke Dive Medicine]

But, I HAVE started wearing a hooded vest in the last 7 months. It seals pretty tightly.

I wonder if this may be the root of the problem. Didn't you say that your reverse blocks have been happening for the last seven months?

Last Sunday I was coming up though and the last 10 feet, it just didn't want to clear. I was out of breath and had to surface. More pain than I feel comfortable with. The it popped on the surface. I did a few more dives but not so deep.

Be very careful with this. We are working with another experienced diver right now who suffered inner ear barotrauma while free diving.

 

[Hank49]

Could be the hood but it only happens in my left ear....so far.
I'm going to cut ear holes in the hood. And I"m going to drink fluids every hour or so. If I can remember.....Thank you for your help Duke Dive.

 

[Duke Dive Medicine]

Could be the hood but it only happens in my left ear....so far.
I'm going to cut ear holes in the hood. And I"m going to drink fluids every hour or so. If I can remember.....Thank you for your help Duke Dive.

No problem, any time. I'd be interested to hear if the ventilation holes work for you.

 

[dumpsterDiver]

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?

Nope never noticed that. If you put hypertonic saltwater into your sinus, wouldn't that pull fluid from the sinus tissue into the sea water... causing the tissue to shrink?

 

[dumpsterDiver]

Well, I AM 55 now. I look in the mirror and see my Grandpa.
I hydrate in the morning before going out and do take water but only after being in the water for at least 2 hours. Usually more like 3-4 hours. But I've always done it this way...for the last 7 years anyway.
I think I will now make it a point to get out after every half hour and drink 8-12 ounces of h2o.
I haven't moved to a high pollen area. I've been here in Belize for 11 years now. I've never had allergy problems my whole life except penicillin.
But, I HAVE started wearing a hooded vest in the last 7 months. It seals pretty tightly.
I still use the same technique as always while equalizing. First one at 6-8 feet and every few feet all the way down. Occasionally I feel a little pain but only if I get focused and am chasing down a fish. Most dives are between 25 and 65 feet.
I have been making a more conscious effort to clear my sinus/ nose more frequently since it started happening. Normally I would just pull my mask up and gently blow out some mucous. Now I suck in as well and....hawk it up and spit.
Last Sunday I was coming up though and the last 10 feet, it just didn't want to clear. I was out of breath and had to surface. More pain than I feel comfortable with. The it popped on the surface. I did a few more dives but not so deep.

I think the feeling a little pain issue is most significant. If you are actually feeling pain then you have under equalized. THIS will definitely cause swelling of tissue.

I try to completely avoid ANY pain when equalizing. Most freedivesr that I dive with all seem to pre-equalize. Right before their last big inhalation, you can see them grab their nose and slightly over pressurize the ears and i think I blow a little extra air in the mask as well. If you are careful with your jaw, you can retain this over pressurization for a few seconds and this allows me to do a surface dive and also one arm sweep to accelerate the descent. This gets my head to maybe 12-15 feet deep and as my arm sweep is complete, the hand goes to the nose and i can begin to blow and equalize.

My hand stays on my nose pretty much contiually to 30 -40 feet and then equalizations can be done less continuously.

Over pressurizing on the surface, keeping the ears over pressurized very slightly on descent and avoiding all discomfort is what works for me.

BTW, you probably do not need to cut holes in the hood, I often have to let water in around the external ear area by pulling back the hood face seal when I first enter the water. Once that area is flooded, i don't have to mess with it unless i get on the boat and the water drains.

 

[Duke Dive Medicine]

Nope never noticed that. If you put hypertonic saltwater into your sinus, wouldn't that pull fluid from the sinus tissue into the sea water... causing the tissue to shrink?

Hi Dumpster,
This isn't based on any research that I know of and I never thought I'd be talking at length about sea water up the schnozz, but here goes!
First I guess we should differentiate between sea water actually in the sinuses (which probably isn't the case unless you really try hard) and sea water in the nares and around the turbinates and the openings of the sinuses. A transient rinse of hypertonic saline wouldn't likely cause a significant fluid shift, but the leftover salt water in contact with the mucous membranes will have enough osmotic pressure to pull a small amount of fluid out. Could this have the net effect off shrinking the tissues? Probably not, since the tiny fluid loss would be made up in short order by the natural capillary leakage in the area. It's most likely that all you're doing is rinsing down excess mucous. I would think that the net effect of the leftover salt on your mucous membranes would be to cause irritation and make things worse, but it seems to work for you. Just watch what's around you when you let sea water into your works. You wouldn't want a stray jellyfish tentacle banging around in there. Also, Devon Diver made a good point earlier in the thread about risk for infection, so consider that as well. Vibrio is an ugly thing.
Overall, I'd recommend an over-the-counter saline rinse over sea water. Maybe you could keep one in your bag and use it before diving and between dives. They are made to be isotonic and they don't have the above-mentioned risks.
Cheers and healthy sinuses,
DDM

 

[Hank49]

A little follow up:
I've been drinking a lot of fluids throughout the day. I gulp as much water or Gatorade as I can hold before the getting in the water and every 45 minutes or so. Seems to be working. I can feel a little congestion starting but it's much better now. I'm doing up to 25 free dives a day and no problem. Whew......
I also don't drink any coffee on dive days to avoid the diuretic property of it.
Now my problem is a slight rash in my crotch from peeing so much in my wetsuit from drinking fluids by the gallon.
But it is odd that it never bothered me before. ??

 

[Duke Dive Medicine]

A little follow up:
I've been drinking a lot of fluids throughout the day. I gulp as much water or Gatorade as I can hold before the getting in the water and every 45 minutes or so. Seems to be working. I can feel a little congestion starting but it's much better now. I'm doing up to 25 free dives a day and no problem. Whew......
I also don't drink any coffee on dive days to avoid the diuretic property of it.
Now my problem is a slight rash in my crotch from peeing so much in my wetsuit from drinking fluids by the gallon.
But it is odd that it never bothered me before. ??

Thanks for the followup, I'm glad your sinus issues cleared up for you. Re the rash: you might try a barrier cream or, if that doesn't work, a condom catheter with a tube that dumps the urine out the bottom of your farmer john.

 

[Ardy]

Hank I hate to pee on your party but I have been suffering reverse blocks for the last 10 years. They are pretty scary as you think you are going to blow an ear drum. I tried upside down ascents, taking anti histamines etc etc. Nothing worked.

I went through all the normal stuff and the end result was it is age related. Evidently your eustachian tube gets softer or sloppier cant remember what was said now. It can block on a reverse. I found taking it easy on ascent was the best result not something that you can do free diving.

The only light is that at 64 I have not had one in the last two years. Guess they have gone from sloppy to hard and grizzled.