ear squeeze - advice from board

[Spec]

Hi Folks,

I did a search on the board on this topic - but have a few specific questions for those who may have experience in this.

Just got back from Caribbean and for the second time in a row - experienced ear squeeze. I dove in the early summer - ocean diving - and had problems with clearing my right ear. As those who have experienced this know - it is very painful.

It is only happening on the right side and it seemed fairly serious this time - ended up at the resort Doctor and he indicated there was bleeding behind the ear drum.

I took some pseudofed (sp?) recommended by one of the people on the dive boat several hours before the dive.

Here are my questions......

1. What is the best medication to take to help with this problem and how far in advance should it be taken - before the dive?

2. Should I consult a ear, nose and throat Doctor and have it looked at??

Thanks very much for your advice and attention!

Ended

 

[Bob3]

Here's a couple of quick comments, I'm sure our board MDs will have more to say.

Yes, absolutely see your ENT. Having a belfry in your head can be very distracting at times

I take sudafed the day before I FLY, as well as the day before I dive, and then before diving. Use the 12 hr stuff.

Start clearing your ears about an hour before your dive, and at the surface before you go down, clear often & early, before you feel the need for it.
If your ears don't clear, go back up.

 

[blodal]

I have trouble with my left ear. I found that by tilting my head to the right, with left ear pointing up, equalizing was very easy. It's like clearing one ear at a time, but it works for me.

Ditto on the Scubafed, I also use some nasal spray (Afrin generic)2 hours before the dive. This helps to open everything up. Don't use too often or the effect can be negative.

Good luck!

Bill

 

[Sensei]

Hello.

I have had problems with equalizing in the past as well. I have read posts on this forum as well as some other sites. I also read FAQ at DAN's web site.

I would definitely see an ENT if the pain does not go away or if there is blood after a couple of days.

I saw an ENT when I had the problems. He gave me a something (prescription) I cannot remember the name off the top of my head. What I do is I start using it once a day starting one week before my dives especially if they are going to be intense (deep and multiple dives a day). I also take Sudafed 12 hr starting 1 day before my dive and make sure the effect of the drug does not go away (gotta do the math) while I am underwater.

I was also told to start clearing while I am putting my dry suit on, while I am getting ready to jump, while I am on the surface and as soon as start my dive. Clear often before you feel any pain. If there is pain, ascent, clear again, if you cannot clear, dive is over. One of the divers I have a lot of respect for once told me that it is not worth having hearing problems in the future but you can always dive in the future once your ear heals.

There is also possibility of external ear infections. If you look at some of the posts, there are some home made special solutions (white vinegar, rubbing alcohol, etc.) that you can apply to kill any bacteria that may sit in there. Soemthing like that can make clearing difficult as well.

I am not a doctor but I hope this information helps a little bit. You can also always call DAN ( I do not work for DAN either)

Dive Safe,

Gokhan

 

[MechDiver]

I will add to the rest, see an ENT.

What helps me, and I don't take sudafed or other stuff, is to decend while blowing constantly against my nose. If I can do that for 10 to 12 feet I have a much easier time from then on. Go figure.

Phil

 

[Spec]

thanks everyone for these replies - I will take your advice and see an ENS and begin the Sudafed before the dives - and time it well.

cheers.

 

[danw2002]

Just went though a muli dive and ended up forceing liquid up into the middle ear. before this had never really had problems clearing(age sucks sometimes..) the ol ears. here is what i learned after not diveing for a month(had plenty of time to do research).
1. even when you are not diving, get into the habbit of just clearing your ears thoughout the day, this helps work the 'e-tubes' and helps keep things working better.
2. If you tend to stuff up a bit during a dive, take some scubafed(sudafed) before a dive and time its use for effect.
3. i now start working the ears right when i am setting up and suiting up, so they get looser for the dive itself.
4. start clearing right away as you get ready to decend and keep doing so, stay ahead of the curve, do it well before you feel any pressure, once you feel presure, you are at that point having to overcome the e-tubes getting restricked and that can lead to squeeze....so if it takes almost keeping your fingers on the nose(or however you do it, although if you are reading this, you cant do it the easy way anymore and have to use your fingers to close the nose) and almost doing it constatanly for the first 20ft, then do it.
hope this helps....dive safe.

 

[John Reinertson]

Treatment for stuffy nose/ poor clearing
What follows is what I frequently recommend to divers, pilots, etc.
This may or may not be applicable to your situation/condition.

This is similar to currently recommended approaches to control of asthma, another chronic respiratory inflammation condition.

1. First line therapy for frequent nasal congestion (and frequent difficulty clearing) Is Nasal cortisone sprays. There are several brands available, such as Flonase, Nasonex, Nasacort-AQ, and others.
Almost all of them use the same steroid molecules used in asthma control, and just like in asthma, they are first-line therapy.

2. Second line therapy for chronic congestion is a toss-up between the newer non-sedating antihistamines (specifically Allegra or Claritin) or the mast cell desensitizers/ leukotriene inhibitors ( nasalcrom spray is a mast cell desensitizer and Singulair tablets are a leukotriene inhibitor). Older antihistamines may also work well but have more risk of sedation. (see warning regarding testing new meds before the trip, below.)

All chronic therapies take days to get working full power, but generally offer the most powerful relief with the least risk.

3. For the acute congested nose, (as in I'm diving in a couple hours, what do I do?) we move on to Sudafed (pseudoephedrine) tablets and/or Oxymetazoline nose sprays, which work by acting like adrenaline in the nasal mucous membranes and elsewhere. This reduces swelling by constricting the blood vessels in the swollen tissues (and may have some other effects.)

With Sudafed, adrenaline-like effects on the whole body include increasing alertness, but may possibly raise blood pressure and may lower the threshold for anxiety or panic. There are some theoretical concerns for a modest effect on Oxygen toxicity and or seizure threshold, but there is no real data, and the physiologic rationale is weak. I would personally sweat the anxiety effects more than OXTOX effects, but this is just educated speculation, and many many divers take Sudafed with good benefit.

The most common nose spray adrenaline-analogue is oxymetazoline, marketed in the US as Afrin nasal spray and many others. In US markets, any "12-hour" nasal spray is based on oxymetazoline. These sprays are analogous to albuterol for asthma (salbutamol to the Brits in the audience) and other adrenaline-like asthma inhalers.
One specific caution with adrenaline-like nasal sprays.. when they wear off, the sinuses may become tightly blocked, and you end up with a reverse squeeze on the way up. Use only the twelve hour ones, and use them only for a couple days before graduating to a chronic suppressive treatment.
Using Afrin for a week-long dive trip can lead to rebound and early wearing off by the last part of the trip.

In asthma, these adrenaline-like medicines are referred to as "rescue" medicines, to be used when the chronic suppressive therapy fails. I feel we should look at nasal congestion the same way we look at asthma.

Similar "wearing-off" effects are seen with chronic sudafed. Day 5 of a seven day trip is the wrong time to start feeling worse and having more pain or risk a squeeze.

ANY MEDICATION that is new to you
should be tested well prior to a dive trip. Any one person can develop unusual side effects or a medication allergy, and
130 feet is not the place to find out that your new medicine makes you drowsy or hyper. It would also not be the greatest choice of times to find out your doc's advice didn't work and your ears still won't clear.

Note to the other docs.. the mention of Singulair for nasal congestion is outside current labeling, but has worked in a couple patients, and has a reasonable rationale.

Note to the non-docs.. This is my opinion as to a reasonable approach to treatment of a complex problem. It cannot be taken as a statement that this is the best treatment for you, or that it's the only thing that will work for you. Only you and your physician can determine that. Some patients with anatomic abnormalities of the Eustachian tube witll not respond at all to this.

All I wish is for happy and painless diving for you..
I hope this works for you... if not, I hope you find something else that does and share it with us.
Just back from 8 days Bonaire and worked well for me ( as usual)
John

 

[Sensei]

John, I really liked your post. You covered it very well. Thanks for the info.

Dive Safe,

Gokhan