Ear pain when going upwards?

[TheRealScubaSteve]

But it's very hard for me to gather spit and, as I said, I cannot swallow dry. When I start getting uptight because I cannot gather spit, that's when I do the Valsava manoeuvre.

Every now and then I have such a sensation, though it's never happened while diving. You might try tilting your chin up slightly, so your neck is fully "exposed." If I do this and touch with light pressure on either side of the cervical lymph nodes or near my adam's apple, I can immediately swallow whether dry or not.

No idea why it works, but it does.

 

[Compressor]

@ElizaDoolittle Please call Divers Alert Network using the non-emergency # and ask for advice. Hope you are a member of DAN.

+1 (919) 684-2948

Monday–Friday, 8:30 a.m.–5 p.m. ET

General Inquiries
Phone: Option 1

 

[Marie13]

@ElizaDoolittle Please call Divers Alert Network using the non-emergency # and ask for advice. Hope you are a member of DAN.

+1 (919) 684-2948

Monday–Friday, 8:30 a.m.–5 p.m. ET

General Inquiries
Phone: Option 1

She’s in Spain so it would be DAN Europe.

 

[Andrewey]

I usually carry on going upwards slowly. I haven't dived many times since I was certified, and it's always with my instructor (who organises short dive trips). Since he claims it's impossible that I may have equalising problems while going upwards, and I think he may feel impatient waiting for me while I struggle with it, I don't insist on going even more slowly than he has told us to go. When I hear my ears start popping wildly, I suppose that's what makes the pain not too strong, as I assume it means my ears are compensating in some way, though not well enough, or it wouldn't hurt at all. But I can't deny I feel very worried while all of this is going on. In fact, I was on the verge of not getting certified, because my instructor said I sort of kicked in a weird and anxious way when going to the surface. My last OWD dive was a bit of a disaster, as I was worried about my ears from the very beginning, but, apparently well enough to be certified.

When I travel by car in the mountains and I swallow, my ears pop without problem, no matter whether I'm ascending or descending, so does this mean that if manage to swallow while going to the surface I would equalise well? The problem is my anxiety makes my mouth even drier.

Should I go downwards a bit, equalise as usual when descending (swallowing, if I can, or doing the Valsava manoeuvre if I can't), and start going upwards again as soon as I do it? As I said, I think I shouldn't do Valsava while going to the surface, should I?

Number 1: Personally, I would absolutely find a different instructor. That individual clearly doesn't know about a reverse block, but that's beside the point... No matter what, you should feel comfortable with whoever you are diving with and never feel like you are inconveniencing someone with your own well being. Whether or not that instructor is being inpatient or you attribute impatience doesn't really matter- if you are worrying about inconveniencing others, you're more likely to cut corners or make mistakes. Ultimately, I think finding an instructor that you find compassionate and is willing to go at the speed you need is important for your safety and piece of mind.

Number 2: I would echo the idea of calling DAN Europe. If that is not possible, there are some great forum posts on scubaboard that explain reverse blocks. That doesn't mean that's exactly what's happening, but I've had a few dives with a similar situation (later realizing I had eustachian tube issues secondary to an occult URI that self resolved) and I had to change my plan of ascent. Ultimately, the quick and dirty version is that going down or up should not cause pain- if so you need to back to the level where the pain was not present, try and re equalize, and slowly proceed. Do not try and "push past it" or you risk either a bad time at best or possible serious injury.

 

[Jim Lapenta]

The instructor is dead wrong and you need to get away from them. Ascending too fast or just too fast for you can indeed cause equalization issues on the ascent. A very slight problem with the ears, eustachian tubes, or sinuses can be a source of pain or irritation on ascent. I have experienced this from time to time myself after diving with students who for whatever reason want to ascend quickly.
Even after being told time and time again that for recreational diving there is no such thing as too slow of an ascent when you have the gas and no deco time.
The slowest person sets the rate of descent, swims, and ascents. Anyone who objects to that is someone who I will not allow to dive with me.

 

[tursiops]

Valsalva is only one of several ways to equalize. Check the DAN resources for ear. You may find another technique that works better for you.

Middle-Ear Equalization

Middle-ear equalization is a basic and necessary diving skill. Learn about why it's so important, how to do it and some helpful tips to make it effective.

dan.org

The popping sounds you hear may be from your sinuses, not your ears. Go as slowly as you need to on both descent and tell your instructor he is wrong.

 

[VikingDives]

I usually carry on going upwards slowly. I haven't dived many times since I was certified, and it's always with my instructor (who organises short dive trips). Since he claims it's impossible that I may have equalising problems while going upwards, and I think he may feel impatient waiting for me while I struggle with it, I don't insist on going even more slowly than he has told us to go. When I hear my ears start popping wildly, I suppose that's what makes the pain not too strong, as I assume it means my ears are compensating in some way, though not well enough, or it wouldn't hurt at all. But I can't deny I feel very worried while all of this is going on. In fact, I was on the verge of not getting certified, because my instructor said I sort of kicked in a weird and anxious way when going to the surface. My last OWD dive was a bit of a disaster, as I was worried about my ears from the very beginning, but, apparently well enough to be certified.

When I travel by car in the mountains and I swallow, my ears pop without problem, no matter whether I'm ascending or descending, so does this mean that if manage to swallow while going to the surface I would equalise well? The problem is my anxiety makes my mouth even drier.

Should I go downwards a bit, equalise as usual when descending (swallowing, if I can, or doing the Valsava manoeuvre if I can't), and start going upwards again as soon as I do it? As I said, I think I shouldn't do Valsava while going to the surface, should I?

It took me 20 years to suffer a reverse squeeze, and I will admit being scared when it happened. I was relatively deep (20 -15 meters) when it began and I didn't have a lot of air. I had to descend about 3 meters to make the pain go away and the whole time I was worried that I wasn't going to make the safety stop or the surface without running out of air. It's a pretty bad feeling when you think you might have to accept a = painful injury and an emergency ascent (I'd been left behind at depth).

Find a new instructor. Any instructor that doesn't know that this is a real issue, is incompetent at best. Tell your new instructor that this is an issue for you, and start your ascents early. Some people think that being deeper is better, but put that out of your mind. A dive that ends well, even if it is a short dive, is far better than a stressful dive.

When I've experienced squeezes like this, I've had to do ascents that were something like up 60 cm, and down 30 cm to let the squeeze pass. If you have plenty of air, that's not a problem. I'd recommend that you tell your new instructor that you want to control the speed of the ascent, and that you are going to take it really slowly. As you get less anxious about equalizing problems, the problems will likely go away.

As for the dry mouth problem, I've found that removing the regulator for a few seconds and rubbing your tongue over the palate (top of your mouth) can help. Just make sure you are stable in the water (not ascending or decending) when you do this.

Lastly, know that stressed divers have more ear problems. If you are feeling stressed, take the time to relax and breathe. A good buddy (or instructor) wants you to be relaxed in the water, and you should take the time to help yourself before a problem surfaces.

 

[Bob DBF]

It took me 20 years to suffer a reverse squeeze, and I will admit being scared when it happened.

My first reverse squeeze took me over twice as long and it was in an airplane and it hurt like hell. It took enough decongestants to make me loopy and over an hour before I equalized. I do not recommend it. At least diving you can decend and try again more slowly, which brings up yet another reason to reserve air for emergencies.

 

[ElizaDoolittle]

Thanks everyone! I've taken good note of all your advice. Unfortunately, I'm not a member of DAN, because as so far I've only dived in organised trips with my instructor, which don't happen often during the winter, and which not always suit my availability at the weeked (I live very far from the coast), what I usually do is take a daily or weekend insurance.

As you say, maybe it's time to move on and forget about this instructor. Having an OWD certification, I know I can dive alone (by this I mean going by myself to any dive centre and doing a dive with them, not diving without a buddy), but I thought that the instructor would know my shortcomings better (moreover, most of the people going in his organised trips are also beginners like me).

Would going to an ENT doctor help in some way? As I said, mine tested my ability to compensate, but I suppose she only tried it worked when increasing pressure outside. I wonder whether she'd be abe to find the reason why this happens to me and recommend something. Or will all she'll be able to tell me be the same you've alredy said, that I must go a bit downwards every time I feel some pain and compensate there?

Funny you've mentioned planes. The first time I was in one I was ten years old, and although I don't remember whether I felt pain or not, I know I started crying when we took off because of something happening to my ears. As I say, I don't remember whether it was pain or discomfort, or noises, or what, but it didn't stop until someone gave me a bag of candy to lick. Maybe there's been some issue with my ears from the very beginning. But the next time I boarded a plane I was 26, and it didn't happen again, so I never gave it any importance.

 

[Duke Dive Medicine]

Thanks everybody for your answers!



How should I do it? I remember hearing that doing the Valsava manoeuvre while ascending is not right. If I'm not wrong, it increases the pressure in your throat so as to open the Eustachian tubes, which are kept closed because of the increase in the pressure caused by the water. If I do it during the ascent, wouldn't I be contributing even more to "bending" my eardrums outwards?




As I said, I'm not sure I'm equalising well on descent. If I manage to swallow (which is not often), I hear the pop and I feel reassured I've just compensated well. If I can swallow, I equalise very easily. But it's very hard for me to gather spit and, as I said, I cannot swallow dry. When I start getting uptight because I cannot gather spit, that's when I do the Valsava manoeuvre. But doing it, I've never heard any pop, so I don't know whether I've equalised or not. The lack of pain seems to indicate I have, but I don't know.

I have no condition of the type you mention, as far as I know (at least, no allergy, I know that for sure). But what I have is a tendency to have a very slightly blocked nose when I wake up in the morning. Is that an irritation of the mucous membranes?

Definitely do NOT perform the Valsalva maneuver on the way up, this will add air to an already overpressurized middle ear and put you at high risk for barotrauma. The pinch-and-swallow (Toynbee) maneuver is more gentle than the Valsalva maneuver but can still add air to the middle ear. I'd recommend seeing a good ENT physician who can check your Eustachian tube function and provide further advice on interventions. You may hear advice about systemic decongestants and nasal sprays; with your particular situation, if you choose to do that, you'll need to exercise caution because they can wear off while you're at depth and potentially put you at higher risk for reverse barotrauma and alternobaric vertigo.

Best regards,
DDM