Difficulties Equalizing

[danvolker]

On my most recent dive trip I had more difficulty equalizing than I'd had on the previous 2 (I've only gone on 3 dive trips so far). After my second trip I figured I was over this huge difficulty equalizing, but this time it was even worse.

It took me between 5 and 10 minutes to get down to 20 feet.

In fact, I don't think I was completely equalized even then, in my left ear.

Then I had decreased hearing in my left ear, so skipped my last day's diving.

On return home, I saw an ENT. My hearing in the left hear was slightly less than it had been. The question is, is it permanent or temporary? So we're going to retest my hearing in a few months to find out.

She found no problem in the ear on physical examination. She said that if I'd sustained inner ear trauma I'd have dizziness, but I never had any dizziness. But the exam ruled out middle and external ear problems.

However, I suspect inner ear damage is exactly what occurred.

Anyway, as a result, I've decided to descend even slower next time. The thing is, I felt rushed to descend, because my buddy or buddies were waiting for me at the bottom of the line.

The weird thing is I have no difficulty at all equalizing my ears on the surface.

So I'm thinking that my problem is not pre-equalizing as I'm descending. That is, I need to equalizing before the ears hurt. Once the outside pressure is greater than the inside pressure, equalizing becomes difficult or impossible.

And I need to dive with someone who doesn't care if I take all day descending. In other words, a paid dive buddy (DM). It'll make my dive trips more expensive, but I think it's necessary.

The thing is, I'm going on these dive trips solo, so I can't expect a pick-up buddy no matter how nice and friendly to wait 10 or 15 minutes for me to get to 20 feet. That's a bit much to expect from anybody but family.

Another thing is I'll probably enjoy shore diving better, since you get to see stuff right from the shallows. For example, at Sunset House there are plenty of fish right there near the shore, in 10 feet of water.

Recently a new ENT set up practice in my area. I told him that I'm a scuba diver with ear issues, and he said he used to be a dive doctor for the Navy. So I'm going to go see him, see if he has any insights.

The Sudafed suggestion is a good one for young people, but I don't think it's a good idea for people my age (59). I don't have high blood pressure, but I see lots of patients who are middle-aged whose blood pressure goes high every time they take decongestants. Anyway, it's probably okay, but I'd prefer to find a non-medicinal solution to my problem.

The Frenzel technique would probably work, if I could just figure out how to do it. I read all the explanations and instructions, but I just can't do it.

The combination of valsalva and swallowing works perfectly well for me every time--on the surface.

Matt,
My wife SANDRA has had sinusitis for decades, and used sudafed up till recently to allow her to dive.....the far healthier solution we found ( really suggested by her allergy DR) was nasal irrigation....The NeilMed bottles, with a solution using 2 of the packets per bottle ( hypertonic) one bottle in each side.....it acts to clear out pollen and other causes of inflamation, and the hypertonic solution acts as a decongestant.....good for 3 to 4 hours at minimum for Sandra.

I doubt you have a sinus much worse than she does, but if so, you could irrigate on the boat again right after the first dive....

This also seems to prevent sea sickness--potentially due to dropping inflamation in the middle ear ????

 

[HowardE]

Well, I'm a doctor, and I don't dislike Afrin.

Afrin and similar decongestant nasal sprays are addictive, in the sense that, if you use them frequently, your nasal passages develop a tolerance to them, so that you need to keep using them in order to not be stuffy. The chronic nasal congestion caused by nasal decongestants is called rhinitis medicamentosa.

But if you don't use it for longer than 3 days at a time, this addiction is not likely to occur.

Me personally... I accept the risk of "addiction" to the afrin, and know the rebound effect if/when it does happen.

Regarding the ProPlugs, the website says that they prevent water from entering down to 20 feet, then allow water to enter. Hm. How does that help? Wouldn't you just be delaying the equalization issue until 20 feet? And then wouldn't it hit you rather suddenly...? There must be something I'm not getting here...

Maybe a little water gets in, but whatever it does... they work for me. I've dived to over 200 feet using proplugs, and don't get that "soggy ear" feeling when not using them. I also have much less of a problem equalizing when using them. I have dived over 200 times a year for the last 3 years because of work, and swear by these.

 

[FPDocMatt]

I'm 57, and did'nt start diving until 2 years ago(at the age of 15, my local doc advised me not to dive because of ear problems). Today I have more than 100 dives, and have never experienced problems, as long as I'm equalising enough.

That's encouraging, thanks.

My wife punctured her ear on dive number 6 because the DM did'nt give her enough weights....she went right up from 10-12 meters, and POP... Learned a lot since then

That's interesting. I didn't know that a rapid ascent was a risk of barotrauma to the ears. Let's see. The pressure inside is higher than outside, so that's a reverse block? Yes, that makes sense.

During the CESA part of the open water course I had ear pain. I mean, what are you going to do, stop ascending? In a real CESA you're kind of committed.

The same thing happened during the rescue diver course while bringing the unconscious diver to the surface. You don't really have an extra hand to grab your nose.

My understanding is that the reverse equalization process on ascending doesn't really require an equalizing maneuver, since the eustachian tubes work better when the pressure inside the middle ear is higher than the ambien (wait a minute, that's ambient--hey, I don't suffer from insomnia!) pressure. You just have to ascend sufficiently slowly to allow the ears to equalize on their own.

But I didn't realize that ignoring that particular pain could have the consequence of a ruptured ear drum. Thanks for sharing that, now I know.

 

[lv2dive]

When I first started diving I was always the slowest to ascend - by a LOT. I always made sure I spoke to the dive leader, so I could be first off the boat, and I was still the last down. When I first got certified, my typical vacations were week-long trips with two morning dives, two or three times a year. The first few trips, I was always very slow the first few days but my ears had "normalized" to everyone elses by the end of the week. After the first few trips, it usually only took a day or so for me to be more in the norm. After a few years, my ears acclimated to the pressure changes and hot drops (negative entries) were not even a passing concern. Point being: I would not be surprised if this becomes less of an issue for you, the more you dive. Good luck.

 

[FPDocMatt]

As a result, we often go into the water first to spend more time descending.

Yeah, I did that on my last trip. Still took me much longer than anybody else, and they were waiting for me. But that's a good idea. I remember thinking that they should take me out by myself in the boat a half hour before, drop me in the water, then go back to the dock and get everybody else.

If it's a drift, we end up zipping along shallower keeping the rest in sight.

Yeah, this is what I was thinking I'd do in Cozumel.

Otherwise, it is too bad for the rest of the folks. We will not speed up the descent because folks are "waiting". If they are guided dives - well they will just have to wait for us to catch up.

Yes, I need to adopt this viewpoint. Permanent hearing loss is just not worth it.

On the other hand, in my case, I may never make it down to the depth where everybody's waiting. I'd rather not have them all waiting on me. I think having a DM as a buddy will solve that problem (when I'm on a solo trip).

 

[Hawkwood]

Matt,

For your first trip to Coz, I'd recommend hiring a DM with you for the first day. That is what we did many years ago. Got us understanding currents and he also worked with my wife on strategies as to drifting with the group, keeping them in sight, while slowly descending. Also kept any "pressure" off to keep up with the group. After the first day we'd were comfortable enough not to need him any more.

 

[vladimir]

Regarding the ProPlugs, the website says that they prevent water from entering down to 20 feet, then allow water to enter. Hm. How does that help? Wouldn't you just be delaying the equalization issue until 20 feet? And then wouldn't it hit you rather suddenly...? There must be something I'm not getting here...

You're not getting it because it's not there. There is no plausible mechanism whereby ProPlugs could facilitate equalization. But, as I understand it, they will transmit the pressure change while excluding water for the first 20 feet via compression of the air pocket. So you don't delay equalization.

Anecdotally, I have found fluticasone propionate spray to be helpful, though the mechanism for that is a little murky as well.

Edit: fluticasone fuorate

 

[Hatul]

I'll add my advice. The old adage an once of prevention... applies here. Once you get pain in the ear if you keep descending things only get worse. I think a vacuum effect forms in the middle ear which tends to close up the Eustachian tube. So if you do feel discomfort ascend, equalize and try the descent again.

A low dose Sudafed 15-30 mg (oral) taken at least an hour before diving may help. I doubt the 15 mg dose (half the tablet) will have much effect on your blood pressure.

 

[DivemasterDennis]

I am blest with giant sinuses and easy equalization, but I have dive friends who are not. They swear by taking a single little red sudafed one hour before diving. I also suggest some alternative clearing methods to them that work in some cases. Exhaling through you nose can have a good effect, as can swallowing, jaw wiggling, and a "yawning" type maneuver (hold on to your reg!) Rolling you head from side to side is another clearing action. I see some people overly concerned with clearing and they aren't very productive in trying to clear because they are so constant in their actions. A slow descent is no crime- if I was diving with you I'd tolerate it, paid or not. One of the reasons I rarely have clearing problems is a slow descent. Position may also have an impact. While many teach that a feet first descent makes for the easiest clearing, I don't think that is invariable so. I like a descent in a position kind of like freefalling sky diver best. The best technique, or combination of techniques, is the one that works for you. Practice, experiment, and I am sure all will be well.
Divemaster Dennis

 

[dumpsterDiver]

Matt,

For your first trip to Coz, I'd recommend hiring a DM with you for the first day. That is what we did many years ago. Got us understanding currents and he also worked with my wife on strategies as to drifting with the group, keeping them in sight, while slowly descending. Also kept any "pressure" off to keep up with the group. After the first day we'd were comfortable enough not to need him any more.

How does someone dive in Cozumel if they can not equalize relatively quickly? How does the DM's presence help?

Won't the surface currents be faster than the bottom current where the remainder of the group is located and result in major separation problems unless the diver who descends slower kicks a bunch to try to follow the remainder of the group?

Wouldn't that make the descent even more stressful.. having to kick horizontally and try to precisely control depth and facilitate a very gradual descent?