Difficulties Equalizing

[vladimir]

Okay, that makes sense. But if they transmit the pressure change, how do they help?

They don't.

Oh, I should have said, my ENT recommended I start using fluticasone, which I have done. The mechanism is that it decreases inflammation. If your mucous membranes are swollen due to inflammation, this will help to shrink them. It's better for you than Afrin, because it gets more to the cause of the swelling. But Afrin works immediately, and you have to use the fluticasone twice daily every day. Fluticasone doesn't have a rebound nasal congestion effect, either.

Thanks, that's pretty much what I had assumed. Doctormike, ScubaBoard's resident ENT, also takes it, if I'm not mistaken.

 

[Ayisha]

When you use it with the 2 packet strength, it opens your sinus up within 20 minutes or so........

But does the residual liquid drip out your nose when you're trying to equalize?

With the Nasonex the morning of diving, it interferes with my equalizing by being blown out while equalizing and blocking my nose when it wasn't before. I always pre-equalize on the boat and at the surface and there is no indication that I am congested, and then it hits while descending - only with Nasonex. The Neil Med is a lot more liquid and could stay in there for a while.

Maybe Dr Beckwith should try without the sinus rinse prior and see if there is any difference?

 

[FPDocMatt]

You've brought up an interesting point. I am supposed to take Nasonex every day and everytime I took it before the morning dives, I would end up having a hard time equalizing, a lot of "sea pearls" and some blood in my mask - and I didn't feel congested before the dive. If I take Nasonex the night before instead and not the morning of, no issues. So eventually I stopped taking it the morning of a dive.

In addition to suppressing the immune system, steroids can weaken connective tissue. Basically, they suppress the body's defenses in general. This is because they're a stress hormone. When you're in a fight-or-flight situation, your body needs all its energy for the immediate danger. Everything else is suppressed. Anyway, nose bleeds are a common side effect of nasal steroids.

I use Neil Med Sinus Rinse only when I'm sick, so I've never used it before diving. I'm wondering if it would have the same effect as the Nasonex of dripping down after the fact? The Neil Med states to use it at least an hour before bedtime due to post-nasal drip down the throat. Do you think it could be causing excessive mucus if it's too close to your diving time?

Sinus rinse definitely can result in needing to blow your nose after the fact. For me, it doesn't cause post-nasal drip. in fact, I used to have bad post-nasal drip, but don't any more since using sinus rinse. But I suppose it could result in post-nasal drip depending on the person's internal anatomy. But the post-nasal drip wouldn't be excessive mucus, just left-over salt water from the rinse itself. Sinus rinse gets rid of excess mucus, that's its purpose.

---------- Post added April 22nd, 2012 at 04:07 AM ----------

Maybe Dr Beckwith should try without the sinus rinse prior and see if there is any difference?

Hey there's an idea. I'll give it a try.

 

[Quero]

Matt I think you're on the right track with your idea to pre-pressurize your middle ear before you begin to descend. This is what I teach all my students to do, and I also tell them to equalize on every breath as they descend rather than waiting for pressure to build up. This way you are pretty much staying ahead of the pressure gradient rather than correcting it.

NetDoc mentions extending your neck to stretch the tubes, and along those lines I generally find that one ear clears more easily than the other so that if you stretch your neck and turn the blocked ear towards the surface, the micro-stretching and tension on the "bad" tube is often enough to let the bubble of air pass through it to the middle ear.

The first 20 feet are typically the hardest for equalizing because the pressure change is felt with a relatively small change in depth. I tell my divers who are having serious trouble with equalization to look at their computers when they ascend due to clearing problems, and to ascend just 20 cm (.2 m), try again, and then go up another .2 m if that doesn't work. I guess on a dive computer measuring depth in feet, .5 ft would be a good amount. The reason I advise pretty small steps is because the pressure change is marked at shallow depths, but also if you go all the way to the surface, you have to redo all the equalization over again that you might have already achieved successfully. That is, if you've made it down 10 feet and your ears are okay, but at 11 feet you are unable to clear, try going up to 10.5, making an attempt to clear and then re-descending slowly once you're successful. If you go up to 9 feet or 8 or 7, you just have to cover all that difficult distance again.

Finally, I'm also 59, and I take Claritin D (12-hour variety) the morning of every dive day. I don't have a BP issue (my BP is always in the range of 100-120 over 60/70), but I don't notice it raising my BP at all in a general way, and I only take it when I'm going to dive.

 

[Dan G]

This is a problem that many people encounter. If you are waiting for pressure to build up before you try to equalize you are asking for problems. Here are a few tips I regularly teach my students...

• Start on the surface before you start to descend. Blow, then go!
• Time your equalizing intervals to preempt the feeling of pressure buildup.
• Be sure to "look up" and stretch the front of your neck while equalizing. This will help to open up the Eustachian tubes.
• Never attempt to force the process! If a gentle attempt is not enough, ascend a few feet and try again. Keep ascending until you can equalize or hit the surface.
• Once at depth, STOP trying to equalize. You can traumatize your ears by overdoing a good thing and make subsequent descents even harder.
  

Just in case you don't realize this: I am not a medical doctor. I used to fix sick networks but my advice comes from me being a Scuba Instructor.

Pete, can you please elaborate on this point? Will the pressure I feel at depth eventually subside if I do not equalize there? What should my approach be as I feel the need to equalize when at say 80' for example? Is it just a perceived need?

 

[The Chairman]

Dan... once you get to your target depth, equalize once more and then STOP!!! I see a few peeps who keep trying to pressurize throughout the dive. The constant over pressurization will traumatize any ear and make the next descent even more problematic. If you are still feeling discomfort or pain, you need to make a decision about whether to ascend a bit to where the discomfort stops and try to equalize again, or to abort the dive. If you still feel discomfort as you ascend, you have probably traumatized your ears and the discomfort you were feeling had nothing to do with equalizing further.

 

[scuba_steph]

What's the best way to decongest before a dive? I always have problems equalizing and it's usually from mucous.

 

[tamas970]

I had that issue on my very first fun dive, after OW training. I got cold and fortunately I hadn't book a dive for the morning. I drank a lot of hot tea and inhaled the hot steam heating up my sinuses. 4-5 cups (and their steam) were enough to clear my nose until noon and Ihad no problems on the afternoon dive.On that very dive I learnt that I can continuously equalize if i don't stop pinching my nose and keep blowing into. This way I couldeasily descend 4-5m without pain (before I had issues in 2m). This might be a take home message for the slow equalizers: don'tstop, just keep equalizing continuously. It's less hassle than restarting the procedure anyway.