Equalization problems on second dive only?

[Omni]

I never had any sinus problems until I started diving in 2000, since then every time the weather changes I have nasal drainage and hay fever problems. I took my advanced a month after my OW and noticed that I was having equalization problems with my left ear, but only on my second dive of the day. It has been eight years and I still haven't found a cure for this. I have tried to really blow hard when equalizing, in fact I have blown so hard I can get air to squeak out of my tear ducts. I dont think that it is "ear fear". I have never hurt anything that I know of, no dizzness, earaches or anything of that nature. If the water is dirty I do have to use some ear wash in the shower that night to keep them from feeling funny but I attribute that to the dirt.

When we freedive spearfishing we usually don't go below 30 feet and I have noticed that I can dive all day without any problems. I have only had one problem in six years of freediving with the ear and I was going to around 35 feet, the problem happened at the end of the day. This weekend I did a dive to 80 feet on SCUBA then about three hours later I did two free dives one to 17 and 22 feet. On the third try I could only get about 7 feet and I noticed that my left ear would not clear.

I have seen my doctor about the problem and he gave me a scrip for Allegra. It really dries out the sinus's but it didn't work for the problem. I am missing tons of diving opportunities since I am limited to one dive a day. Any suggestions?

Omni

 

[DandyDon]

Ear problems are all too common, but the causes and resolutions vary among divers - and I am certainly not qualified to comment. I might guess that you're overdoing it on the first dive, causing some residual swelling that limits you on the second, but we have medical professionals who post here and are very helpful - as well as generally correct. Keep checking back over the next few days for such posts, ok?

In the meantime, there is a 45 minutes video linked in my Sig that has been very helpful to many. 8 years and 24 dives? You do need to dive more often.

 

[fisherdvm]

I don't know squat about the ears, so hopefully the ENT doc will mosey in.

I often look at respiratory mucosa in the same way as the skin is, and how it respond similarly to environmental agents.

In the medicine of the skin, you get what we call "dermatographism", where mast cells releases histamines, in response to friction on the skin - so you can write words on someone's back by scratching them with a sharp object. If this happens in the ear, like from excessive pressure - the mucosa will congest, and plug up the eustachian tube.

We also have another category, "cold induced urticaria" where cold temperature can induce histamine release. I think an equivalent to this is myself, and many individuals I have encountered - will report that when their body gets chill, their nasal passage, sinus and eustachian tube will become congested. Other doctors have argued with me on this, but it is undeniable in myself, and many others who have reported it to me. Perhaps this is happening to you, where you get cold on the surface interval or second dive. Perhaps drying off, and putting on a jacket at the surface can help.

I would suggest your practicing the clearing process frequently, and see if you can condition your eustachian tube to respond better to the pressure process. And also not to over do it with excessive pressure, especially under water. As other have suggested before, when you dive, pause every 3 ft, and pressurize lightly. Rather than going down every 10 ft, feels pain, and pressurize strongly.

These phenomenons are often histamine mediated, so I do have to agree with your doctor about trying the Allegra. Beyond that, recommending more, I will get chewed up by some instructors here about how dare a medical professional advises ANY DIVERS to take ANY MEDICINES.

 

[fisherdvm]

Here is a wonderful article on the topic of cold air induced respiratory problems:

http://www.ijch.fi/issues/662/662_Koskela.pdf

If you read the treatment, it sounds like typical treatment for allergic rhinitis - decongestants, antihistamine, topical steroid spray, topical decongestant.

 

[Omni]

Yeah I do need to dive more hence the trying to fix the ear problem. I don't think that I am overdoing it on my first dive as far as going to deep before clearing. I have gotten into the habit of clearing my ears every few feet on descent so I usually don't get a large pressure increase.

The "cold induced urticaria" makes sense to me. Whenever it gets cold here in the winter it seems that I am always dealing with clogged sinuses. I have only dove in one local lake, a spring and a quarry. In all of these places the water is cold and I never use a hood. In the lake where we do the freediving the thermocline is at 30 feet, that is why we don't dive deeper. Below the thermocline and in the other water bodies the temp has been running around 57-58 degrees. I will try a hood and some of the techniques from the ear video and see of that helps.

Thanks
Omni

 

[doctormike]

I don't know squat about the ears, so hopefully the ENT doc will mosey in.

Hey there!

As we always say, there is a bell curve for everything. And while most people land on the bell curve for equalization ability symmetrically with both ears, this is not always the case. Sometimes, one Eustachian tube will be very marginal, OK at the surface, but the first one to go when stressed.

The problem is that Eustachian tube dysfunction is like a vicious cycle. A poorly ventilated middle ear will result in progressively diminished middle ear pressure at the surface (as the middle ear mucosa absorbs gas). This leads to collapse of the eardrum, and congestion of the mucosa - the low pressure causes enough of a pressure gradient to cause fluid to move from the blood to the space between the cells , causing tissue swelling. When this happens to the tissue in the Eustachian tube, the marginally ventilated middle ear becomes even more poorly ventilated, worsening the problem. This may be why the OP was OK on the first dive, but had progressively more difficulty as the day went on...

Bottom line is, you need to be able to ventilate that space. Medical therapy has a very minor effect on this problem - antihistamines and decongestants help with nasal congestion but less so with ET dysfunction. Steroids (by mouth, not by nasal spray) will help, but this is clearly not something that should be used on a regular basis - many side effects.

Hard to suggest anything over the Internet, but the usual advice still holds - go slow, don't push past any equalization walls, and try to avoid diving during any inflammatory states (such as a cold or flu). fisherdvm's advice is also great (as usual!) - staying warm is good advice for a variety of reasons on a dive, this one included...

Mike

 

[OceanObsessed]

Its quite common for freedivers to experience more equalization difficulties as the day progresses during a long day of freediving. I have heard that this is due to slowly becoming dehydrated. You sweat alot while diving/freediving but it is not easy to detect since you are in the water. Perhaps you are gradually becoming dehydrated and it is just affecting you by the second dive?

I'm not sure about the pysiological explanation for this but if there is one I'd like to hear it.

-Chris

 

[Omni]

Sorry about the long delay but I have not been able to make it diving until this weekend. I purchased a hood and was able to make two dives in 57deg water. The first dive was to 85 feet and I had no problems. We had a 2 hour SI and then made a second dive. The profile on the second dive was crap "sawtooth" so I do not know how conclusive this is. I did not have a problem until 13 minutes in, we went to 15 feet, then surfaced then went to 39 feet and ended up bouncing from 20-40 feet with no problems. At the end we ended up at 50 feet and this is when I started having problems equalizing. I thumbed the dive and had no problems on the way up.

This tells me that the hood is helping and that it may be the cold water in conjunction with my left ear having a smaller canal then my right.

Omni