Difficulty Equalizing

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markmantei

Contributor
Messages
455
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Location
Calgary, Alberta, Canada
# of dives
200 - 499
Maybe my hypochondriac side is getting the better of me. To be clear, I have had my ears to a point of light discomfort, but nothing I would describe as pain of any sort. I have had, relatively recently (last 12-18 months), a recurring issue with what I would call questionable blocks, though I have only needed to call one dive due to this issue. I can sink like a rock, equalizing regularly and have no issues (with the one exception noted above). Then if there is any reason to ascend and re-descend during the dive (i.e. bottom profile rises then falls), I will occasionally have difficult with re-descending, which will often take a significant amount of time, even if the starting depth is quite deep and the depth change is quite small. On a recent trip I had several issues. First full day of diving, we were doing surveying a wreck. During the dive we ascended from the side of the wreck to the top (~110' to ~85', I don't have my computer profile handy so I'm ballparking). The descent to the other side of the wreck was difficult, but after taking several minutes I was able to manage (on this dive I also experienced a reverse block starting at about 50', although that did clear by making an exceptionally slow ascent, this was the only time I have experienced a reverse block). On the next day, I had a dive to ~110 feet where we performed a wreck penetration. Following the penetration, we descended to ~140' to the bottom of the wreck. Equalization issues began at ~120' and it took probably another 5 minutes to descend the remaining 20'. The final day I also experienced issues, although this time near the beginning of the dive. We planned on descending to ~130'. Descent to ~110' was uneventful, however at that point I experienced issues and had to ascend, equalize and continue constantly equalizing until 126' which was the deepest I could obtain given that this dive was not a planned deco dive and I was with a recreational diver and I was concerned with his nodeco time. I chose to continue that portion of the dive ~10' above as I didn't want to waste additional time with the descent. If this was the only trip I experienced issues I would probably chalk it up to some amount of congestion, though I had no noticeable congestion during the trip. I have had intermittent issues similar to this both diving locally (in cold water) and on vacation (in warm water). I also feel that the issue is more likely to occur after repetitive diving (later in a multi-day trip). I figured I would try and get a referral from my GP to a local ENT. That said, the recent thread here: http://www.scubaboard.com/forums/di...ube-function-docvs-fri-am-medical-minute.html makes me question whether the use of the valsalva (generally the only method I use) is potentially also a cause, and maybe I should be practicing alternative maneuvers in the pool as well. I am wondering if the repeated use of valsalva (though like I said, I don't feel it is done with too much force, and never causes pain or discomfort) may be contributing to or aggravating an underlying issue or causing a flare up in some other condition. Thanks for any opinions or advice.
 
That said, the recent thread here: http://www.scubaboard.com/forums/di...ube-function-docvs-fri-am-medical-minute.html makes me question whether the use of the valsalva (generally the only method I use) is potentially also a cause, and maybe I should be practicing alternative maneuvers in the pool as well. I am wondering if the repeated use of valsalva (though like I said, I don't feel it is done with too much force, and never causes pain or discomfort) may be contributing to or aggravating an underlying issue or causing a flare up in some other condition. Thanks for any opinions or advice.


As I mentioned in the thread, valsalva is safe in general, as long as you don't "push through the pain". However, every diver should know several ear-clearing maneuvers, since they may be necessary in various situation. Specifically, the negative pressure techniques like the Toynbee maneuver (pinch nose and swallow) may be helpful, especially in a reverse block situation where the middle ear pressure is higher than the ambient pressure.
 
As I mentioned in the thread, valsalva is safe in general, as long as you don't "push through the pain". However, every diver should know several ear-clearing maneuvers, since they may be necessary in various situation. Specifically, the negative pressure techniques like the Toynbee maneuver (pinch nose and swallow) may be helpful, especially in a reverse block situation where the middle ear pressure is higher than the ambient pressure.
Thanks for the advice Mike! While I do occasionally practice some alternative equalization procedures (jaw wiggle, swallowing, yawning... sorry I don't know all of the proper terminology), I can honestly say that I don't use them unless the valsalva is not effective. I, through my own ignorance, did not know about the pinch and swallow, but can definitely feel the pressure differential caused just by performing it in front of my computer. I will definitely try it out next time I find myself wet. Is that useful for descending as well (given that it is creating a negative pressure) in addition to your suggestion regarding reverse blocks?
 
Thanks for the advice Mike! While I do occasionally practice some alternative equalization procedures (jaw wiggle, swallowing, yawning... sorry I don't know all of the proper terminology), I can honestly say that I don't use them unless the valsalva is not effective. I, through my own ignorance, did not know about the pinch and swallow, but can definitely feel the pressure differential caused just by performing it in front of my computer. I will definitely try it out next time I find myself wet. Is that useful for descending as well (given that it is creating a negative pressure) in addition to your suggestion regarding reverse blocks?

Sure! Theoretically, you want to push air into your ears when you descend (valsalva), and get air out of your ears when you ascend. From a practical point of view, the air tends to come out of the ears pretty easily along the pressure gradient during ascent, which is why reverse blocks are less common than regular blocks. But when the ET is congested or functioning poorly for whatever reason, sometimes you need to just break that seal. This is why alternating positive and negative pressure can be helpful (that is, Valsalva and Toynbee maneuvers).

Safe diving!

Mike
 

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