Ear Barotrauma, on the way up or down?

[fisherdvm]

Reverse squeeze (the inability to equalize while ascending) is a big problem, but less likely than the inability to equalize while descending. I would say that reverse squeeze is caused (more often than not) by individuals taking decongestants prior to a dive, and having those meds wear off prior to accent. Not a good situation to be in, as you must choose between severe ear trauma / pain, and running out of air. Not a hard choice, but still very unpleasant.

Jay

I believe what you are saying is wrong. Close to 1/2 of divers will get barotrauma to the ear. My barotrauma occurred because I did not use any medications. Now I routinely use claritin and afrin before each dive. As my dive trip usually do not exceed 5 or 6 days, the rebound effect of afrin does not occur.

Most decongestants I use are long acting. Afrin spray last at least 6 hours, and I use it immediately before diving. Claritin is suppose to last 24 hours, and I use it within 4 hours of diving. Sudafed last about 4 hours, and most divers use it immediately before a dive.

My gut feeling is, we can decrease the incidence of ear barotrauma by admitting that it is a frequent and preventable diving injury, and not taking the machismo standpoint that "you will just need to learn how to equalize", or "it is caused by your decongestants".

My gut feeling is - the longer you dive, and the less attention you pay to your ear - you will have permanent damage to your ears.

Eventually one will catch a cold, and will want to save a dive... Not worth the hearing loss, in my opinion.

 

[Scuba-Jay]

My gut feeling is, we can decrease the incidence of ear barotrauma by admitting that it is a frequent and preventable diving injury, and not taking the machismo standpoint that "you will just need to learn how to equalize", or "it is caused by your decongestants".

My gut feeling is - the longer you dive, and the less attention you pay to your ear - you will have permanent damage to your ears.

Eventually one will catch a cold, and will want to save a dive... Not worth the hearing loss, in my opinion.

No no I think we are on the same page, albeit maybe a different book. It's my contention also that most reverse squeeze is caused by a divers refusal to call a dive when sick. Instead, they rely on various medications to relieve the symptoms which often times are short lived in their effects.

 

[String]

Although few in number ALL the reverse blocks ive heard about personally were in divers that were using decongestants (of any type) prior to a dive.

Also with pseudo-ephedrine containing drugs, be aware of the possibility of it reducing the O2 tox threshold if diving deep and/or on EANx.

 

[Scuba-Jay]

Although few in number ALL the reverse blocks ive heard about personally were in divers that were using decongestants (of any type) prior to a dive.

.

Amen...

 

[Thalassamania]

Now you have.... But I never claim to know all the answer. It just puzzled me when I was a kid ... Now with 2 doctorate under my belt and 2 residencies later, I realize I know alot less about medicine than ever.

Yes, now I have ... and I find it interesting since I have been operating, for years, under the clearly incorrect view that reverse block were basically "dry" clogs usually resulting from a drug rebound since the increased air pressure is usually though to be sufficient to dissect it's way out twixt wet, and even swollen mucosa. Anything that you can add concerning the etiology would be greatly appreciated.

 

[Scuba-Jay]

you want some pics? Here but stay away from my front door....

http://myspace-094.vo.llnwd.net/01209/49/08/1209418094_l.jpg

 

[Rick Inman]

Yes, now I have ... and I find it interesting since I have been operating, for years, under the clearly incorrect view that reverse block were basically "dry" clogs usually resulting from a drug rebound since the increased air pressure is usually though to be sufficient to dissect it's way out twixt wet, and even swollen mucosa. Anything that you can add concerning the etiology would be greatly appreciated.

I get some reverse blockage when the local water temps get below 40 degrees, and I never take any meds. I'll be clear when I enter and have no problem descending, but after 30 or more mins in the cold water, my sinuses seem to block up and I get some pain on ascent, even some blood now and then (but not enough to not dive ) . In fact, some sudifed would probable solve the issue, but I don't like to med and dive.

I've only experienced this in fresh water.

I will say that I think the poster is misusing the word, hypothermia. I doubt he's actually hypothermic, just cold.

 

[Thalassamania]

I've only experienced this in fresh water.

Is that truly wierd or might it be that the fresh water is colder than any salt water you dive?

 

[knewthomas]

Although few in number ALL the reverse blocks ive heard about personally were in divers that were using decongestants (of any type) prior to a dive.

Now you've heard your first case of a reverse block w/o drugs...
Nine years ago I spent a summer diving 2x a day 6 days a week. I never used meds while diving and had no noticable congestion prior to diving. On my last day I was ascending and had a sudden and sharp pain in my upper jaw just above my front teeth. It passed after a moment and I continued to the deco stop. Upon surfacing I had a mask full of blood. The afternoon dive was my last on site and I still didn't have any congestion. I did my last dive and twice on asecnt had to pause due to pain in my sinus. Although it was sore, it did pass. But I did have a little blood in my mask. Lastly, I had no discomfort when I got on an airplane 3 days later.
I've never had this happen while diving since then, but now when I get congested the pain and pressure start in my upper jaw and it never used to.

 

[fisherdvm]

Although few in number ALL the reverse blocks ive heard about personally were in divers that were using decongestants (of any type) prior to a dive.

Also with pseudo-ephedrine containing drugs, be aware of the possibility of it reducing the O2 tox threshold if diving deep and/or on EANx.

String, you missed my post that I was diving without using any decongestants. Since then, I've started using decongestants to protect my ears from damage.

Here is one study which support the use of decongestants among divers:


1: Ann Emerg Med. 1992 Jul;21(7):849-52. Links
Pseudoephedrine for the prevention of barotitis media: a controlled clinical trial in underwater divers.Brown M, Jones J, Krohmer J.
Emergency Medicine Residency Program, Butterworth Hospital, Grand Rapids.

STUDY OBJECTIVE: To determine the efficacy and safety of decongestant prophylaxis among first-time underwater divers in the prevention of barotitis media (middle ear squeeze). DESIGN: Randomized, double-blind, prospective clinical trial. SETTING: Recreational diving schools in Panama City, Florida. TYPE OF PARTICIPANTS: One hundred twenty volunteer scuba divers under the supervision of certified instructors. INTERVENTIONS: After randomization, each subject received a 60-mg tablet of pseudoephedrine or placebo 30 minutes before diving. Prospective data were collected, including subject demographics, signs and symptoms of middle ear squeeze during the dive, and possible drug side effects. The otoscopic appearance of the tympanic membrane was graded according to the amount of hemorrhage in the eardrum, with Teed scores ranging from 0 (normal) to 5 (gross hemorrhage and rupture). chi 2 and t-tests were applied with significance set at P less than .05). The Mantel-Haenszel test was used to test the null hypothesis that the mean Teed scores of the two treatment groups were equal. RESULTS: A total of 116 subjects met the inclusion criteria and completed the study; 60 received 60 mg pseudoephedrine, and 56 received placebo. The treatment groups were similar with regard to age, sex, medical history, and depth of the first dive (P greater than .5). Ear discomfort and blockage during the dive were present in 8% (five of 60) of those receiving pseudoephedrine versus 32% (18 of 56) of the control group (P = .001). Similarly, the pseudoephedrine group had smaller Teed scores after diving than did the control subjects (P = .003). Adverse effects were minimal; two patients experienced dizziness and nausea. CONCLUSION: These results suggest that the use of an oral decongestant before diving decreases the incidence and severity of middle ear squeeze in novice divers.

PMID: 1610044 [PubMed - indexed for MEDLINE]