Ear problem, Tinnitus & Buzzing - Never Diving Again

[lowwall]

@Duke Dive Medicine

 

[Angelo Farina]

are not the Frenzel and Marcante-Odaglia the same technique? Talk:Frenzel maneuver

Per Ear clearing - Wikipedia., I think I'm going to abandon the Vasalva manuever, learn these other ways, and teach them after reading your post and then finding the problems with Vasalva here: https://dan.org/wp-content/uploads/2020/06/smartguide_ears_2017_lores.pdf

Although many people confuse them, Frenzel and Marcante-Odaglia are not exactly the same.
The basic idea is the same: do not use lungs for creating pressure, and using instead the small volume of air trapped above the soft palate, compressing it acting on proper muscles which raise the soft palate.
The difference is that Frenzel is done with the mouth closed, making it more effective, but not practical for Scuba diving.
Marcante-Odaglia is with the mouth open (with the reg or the snorkel in your mouth).
The difference is subtle, but freedivers favour Frenzel because if provides faster equalizing. Deep free divers take also advantage of the closed mouth with the Frenzel-Fattah method, aka "mouthfill". Also this is hardly employed by Scuba divers, who instead usually use Marcante-Odaglia, albeit they call it Frenzel.
Please note that this is first hand information, as this was taught to me directly by Duilio Marcante in September 1978, during my first course for becoming instructor at Nervi Training Center (near Genoa).

 

[wetb4igetinthewater]

Although many people confuse them, Frenzel and Marcante-Odaglia are not exactly the same.
The basic idea is the same: do not use lungs for creating pressure, and using instead the small volume of air trapped above the soft palate, compressing it acting on proper muscles which raise the soft palate.
The difference is that Frenzel is done with the mouth closed, making it more effective, but not practical for Scuba diving.
Marcante-Odaglia is with the mouth open (with the reg or the snorkel in your mouth).
The difference is subtle, but freedivers favour Frenzel because if provides faster equalizing. Deep free divers take also advantage of the closed mouth with the Frenzel-Fattah method, aka "mouthfill". Also this is hardly employed by Scuba divers, who instead usually use Marcante-Odaglia, albeit they call it Frenzel.
Please note that this is first hand information, as this was taught to me directly by Duilio Marcante in September 1978, during my first course for becoming instructor at Nervi Training Center (near Genoa).

Thank you for the clarification. Wikipedia is not the final authority!

 

[Angelo Farina]

Thank you for the clarification. Wikipedia is not the final authority!

Very few people remain having been trained directly by the pioneers of scuba history, as Duilio Marcante.
A lot of information is lost, as the original diving manuals are now very difficult to find, and their modern substitutes were grossly simplified, removing the advanced knowledge, for making it possible to be certified in a few days.
So only places as SB remain as the only way of preserving experience and knowledge developed in those pioneeristic years to nowadays divers.
I try to bring here the small amount of such knowledge which I still remember.
Unfortunately, in various changes of home I have lost the original Marcante's diving manual that I did purchase in 1975, when I was 16.
It did contain a whole chapter reporting the story of Haggi Statti, a Greek sponge hunter who did free dive to more than 70 meters for savaging the anchor of an Italian military ship, at the beginning of 20th Century.
Marcante had access to the secreted Navy report on the case, and his book chapter was the most extensive and deep analysis of it.
I should really come back to my previous house and search for this book, it contains a lot of useful things which I should post here, before that information is definitely lost.
Dr. Odaglia was a friend of Marcante, and is considered the first modern (post WW2) MD specialised in diving medicine. He was often cited in Marcante's manual, as he was routinely consulted when writing the parts related to medical and physiological topics.
Of course the knowledge available in the seventies has been later much improved on several topics. But on other topics, instead, some information seems to having been lost. Particularly regarding equalization techniques, it is incredible that nowadays many instructors are teaching the obsolete and dangerous Valsalva method, ignoring entirely the existance of better techniques, as the original Frenzel method developed in 1943 and its modern variants developed just after WW2...

 

[wetb4igetinthewater]

it is incredible that nowadays many instructors are teaching the obsolete and dangerous Valsalva method, ignoring entirely the existance of better techniques, as the original Frenzel method developed in 1943 and its modern variants developed just after WW2...

But Angelo, that's what is taught as the primary equalizing technique in agency materials. That's what I taught. Now I'm always looking for better ways to teach, but I am also the president of the Dunning-Kruger club. So until information such as this gets my attention, I don't improve. So again, thank you for this information, and I will be on the lookout for Marcante's manual.

In Googling "Haggi Statti" I found this: The history of the Greek sponge divers – Freediving Courses Blog

For payment Haggi did not want money but asked the Italians to intercede with the local authorities to obtain for him permission to fish with dynamite for one year.

Ah, a true Greek! LOL!

 

[Duke Dive Medicine]

Hi guys, I'm new here and hope I post correctly and maybe find some help in my very sad situation.

I am not sure if im here in the correct address but I gonna try. I started to scuba dive November 2020 and I fell in love straight away. Since November I've been diving 22 times, did all courses until rescue diver and bought almost all my gear. I never loved anything like it. I am 30 years old in Australia. Now I even had to change my visa to a student visa and decided to study diving. In gold coast they offer a study for 1-2 years to become an instructor with many dives and detailed teaching. So I already paid visa and the school and quit my flat and job here in Sydney to go to Gold Coast. The course starts on the 15th march.

But now I'm very sad and scared because something happened to my ear. Around 2 weeks ago I was diving again. It was a 2 days dive holiday including 5 dives. The first day was good like always - 3 dives. The second day - 1st dive was the problem. I couldn't equalize and my left ear startet to pain. I might have waited too long (1 minute) before I ascended again a few meters until the equalizing worked which it did. We finished the dive (19 meters) after 55 minutes. The second Dive was OK and no problems. But then like 1 hour after the dive the pain came back, but on the surface. and my ear was buzzing a lot. I also had a pressure feeling in my ear. Those symptoms stayed for around 3 days. The pain and pressure feeling was gone. The buzzing too but a tinnitus (peeping this time) was left and I still have it 2 weeks later. A very little pressure feeling is left too.

I visited an ENT. She checked my ear very carefully, pumped air in my ear and also made a pressure test and hearing test. She said everything with my ear is alright. No rupture, no hole, inner ear looks OK and hearing too. I told her sometimes when I equalize I can hear a pfff tone in my ear like air coming out. But she said i def. Don't have a hole. She said after 2 weeks I can go diving again.

And I did. 15 days later (1 week ago from now) I went diving (2 times in a row) . This time I was very careful (descending slow and equalizing often and early). And everything went well. I had maybe 2 times in those 2 dives that I couldn't equalize but I acended 1 meter straight away and equalizing worked. The dive felt good. No pain no pressure feeling nothing. But again, even tho nothing happened and during diving I had no symptoms - 1 or 2 hours after the dive (when I was in my quite room) I could hear a buzzing in my left ear / head again. This time even Worse then 2 weeks ago. A very little pressure feeling came on the next day too. This was 2 days ago both. But I had no pain this time only the buzzing and pressure feeling. Both symptoms are gone again after around 40 hours after the dives. Now only the tinnitus (peeping) is left again. Maybe a little bit worse then 2 weeks ago not sure. Also when I swallow I can always hear a cracking in both ears.

I am depressed and scared I can never go diving again and don't start my diving study in gold coast. I love it too much but also this is now my study and life.

I went to the same ENT again. She said I can not dive again ever. I asked what's wrong with my ears and why I cannot dive again. She said my ear looks great. There is still no hole or rupture, or fluid or infection etc etc. So asked again what causes the problems then and why can I not go diving. But she doesn't answer it and says the tinnitus can get worse and I can lose my hearing.

Do you have any idea, advice or something for me? Maybe some hope? Does anyone have the same symptoms here like loud buzzing in the ear for 1-2 days after the dive? Or pressure feeling for 1-2 days? Does anyone dive with a tinnitus? I'm not sure if I should dive again as I love it so much I don't wanna stop it. And not sure what I will do with my studied now.

Sorry to write such a long text! But I hope to hear from you soon.

Many Grettings

Oezkan

Hi @Oezkan , I'm sorry that you're going through this. There could be a few things going on with you. You probably aggravated the Eustachian tube area during that dive on your dive holiday and caused some inflammation. It can take a LONG time for that inflammation to go away and for you to be able to equalize properly again - weeks to months. Diving while there's still inflammation there greatly increases the risk for further injury.

It's also possible that you suffered from inner ear barotrauma as @Angelo Farina mentioned. If you keep diving, you can aggravate it, so I would definitely avoid diving for the time being. I would politely disagree with Angelo re: the CT scan. CT is not diagnostic for inner ear barotrauma and is probably not indicated for you.

Assuming you have suffered inner ear barotrauma: from your description, it doesn't sound like you actually ruptured anything (i.e. perilymph fistula, or PLF) - the symptoms of PLF are generally worse and take longer to resolve. But, only someone who has evaluated you in person can make that call, and perilymph fistula can only be definitively diagnosed by surgically exploring the ear. If the symptoms resolve quickly, and it seems like they are, then surgery is probably not indicated for you either.

Going only by your description, I wonder whether the advice to completely stop diving altogether may have been a little premature, but again, I would definitely avoid diving for the time being and try to find an ENT who is familiar with diving-related ear injuries as @Lostdiver71 recommended. Dr. Mike Bennett is a very well-known diving physician who's in Sydney, which is quite a ways from you, but he's at least in your time zone and might be able to recommend an ENT close to you. Here's his info from the SPUMS (South Pacific Undersea Medical Society) website:

Assoc Prof Mike | SPUMS

Best regards,
DDM

 

[kelemvor]

Thank you for the clarification. Wikipedia is not the final authority!

all it needs in this case is for you to go in and correct the entry...

 

[Angelo Farina]

But Angelo, that's what is taught as the primary equalizing technique in agency materials. That's what I taught.

This is what bothers me. The risks associated with the Valsalva equalizing technique were clearly explained in my diving manual, which was written around 1973.
It did contain clear explanation of several better equalizing techniques, including Toynbee, Frenzel, Marcante-Odaglia and another pair I do not remember.
The only one modern technique missing was my favourite one, BTV: Tarek Sarouni

Here a later version of Marcante's manual: Manuale federale d'immersione - La Cuba 1979 | eBay

It is really sad that most of the information contained in it has been progressively removed, to the point that currently agencies are teaching bad techniques such as Valsalva.
One could think that progress provides better training, but my experience is exactly the opposite. And not only in Scuba diving, also at school and university.
The teaching I received in the 5-years classical high school in years 1972-1977 was vastly superior to what my son has got at the very same high school in 2010-2015.
Same for my engineering MD, 5 years long, in 1978-1982.
My son has got a much shorter and lighter three years engineering degree, missing several foundamental courses such as General Chemics, Applied Chemics, Physics, Applied Physics, Geometry, Rational Mechanics, Materials Science, etc.
Ok, he got Robotics, Data Base and Networking, which of course were not taught at my time, but lacking the fundamentals does not make him a real engineer, in my opinion.

 

[tursiops]

PADI neither teaches nor promotes Valsalva for equalization. Instructors might, but it is not in the PADI training materials. The Guide to Teaching says in confined water to:

Explain various equalization techniques, and have student divers practice them while swimming slowly from shallow to deep water, and returning to shallow. Allow ample time for divers to practice equalization techniques.​

Notice that several techniques are to be taught, with time to practice them.
PADI tends to defer to DAN on this kind of thing, and DAN is very clear, and has been for a long time:
6 Methods to Equalize Your Ears - Divers Alert Network
DAN states methods other than Valsalva may be safer. Valsalva does not work for me; for me, I use Toynbee.
See also: Middle-Ear Equalization - Divers Alert Network

 

[Oezkan]

Hi to everyone who is writing in my post here. Thank you very very much! I didn't expect so many answers in such a short time. You're awesome guys.

First of all thanks for the discussion about the correct and healthy equalizing method. It sounds a bit complicated and much for me as a new diver but I read your advice and I'm trying. But for now I can only test on the surface. I think (as Dan says) the method to pinch the nose and just swallow is a very healthy and good way to do it isn't it?

I was thinking a lot the last days what to do and if I just stop diving even though I really love it and all my future plans are based on it. But before I do so I wanted (as everyone here recommends) to get a 2nd opinion. Unfortunately there is no ENT with diving medicine or who dives himself here in Australia that I can find.

So on the 24th I got a appoinment now with a very special Professor in ENT who offers diving ent on his website too. And his Career sounds great too. I think he really is a good Prof. Dr. His name is Dr Nicholas jufas from Sydney.

Anyway as this takes so long I went to a normal diving doctor (gp with diving medicine) yesterday. He is also the doctor for the navy here in this state. He checked my ear (just a short look into it) and listened my whole story. He said it doesn't make sense to say don't go diving ever again from the ent. He is pretty sure I got a middle ear barotrauma. And not even a very bad one. Because I have no hole or rupture. Also the hearing test was good so it's probably. Not the inner ear. He said I need to test 4-5 weeks and should be able to dive again. But to make sure we well do a tympanogram first to see if my middle ear is good. If yes I go diving. If not we will fix it and I can go diving later on.

Now I got 2 opinions completly different. But this doctor sounds way more professional. I called my school to study diving 1 month later.

What do you think about it? Can I trust just a GP who is a diving medicine trained one? Should I still go on the 24th to Dr jufas? (private doctor very expensive)

Thanks again guys for all the answers!