Eustachian tube dysfunction

[Buadhai]

I've been diving since the early 1970s. For most of that time I had no trouble equalizing; simply swallowing or jiggling my jaw would to the trick.

When I reached my mid 50s I started having major problems. None of the non-pressure equalizing methods would work (I've watched the video and tried them all) and I'd have to resort to the Valsalva Maneuver. Of course, this ends up forcing fluid into the eustachian tube resulting in even more problems.

I've tried so many things: "practice" equalizing for days before a dive trip; oral antihistamines; oral decongestants; nasal spray decongestants and steroids.

Nothing seems to work. I can equalize using the Valsalva Maneuver, but this is a slow and sometimes painful process. And, it's not much good if conditions require a quick descent.

I've never had any long term pain or any nasal discharge. I have and have always had only mild allergies.

I went to an ENT specialist who looked at my ears with a microscope and did a hearing test and pronounced everything well and fit.

I just got back from a four day liveaboard. After the first day I thought I'd have to abandon diving for the rest of the cruise. I did manage to do all the dives, but it was touch and go in the equalization department.

Is this an expected consequence of old age (I'm 63 now) or is there something else I should try?

 

[DandyDon]

I'm sure you will get some good replies here soon enough. Tell me, which oral decongestants have you tried? I don't know if pseudoephedrine is allowed in your country? It's the only one that works really, but has been controlled so much because it is also used to produce dangerous drugs.

Ok, I looked, and it seems that you can't get it there? Sale of pseudoephedrine pills banned - The Nation

 

[Buadhai]

I actually used pseudoephedrine this last trip. I had a few tablets left over from before the ban.

I didn't take it the first day, which was an awful day, ear-wise. Subsequent days, on which I used pseudoephedrine, were better, but still not much fun.

(I figure I can always get more from my Meth dealer. )

 

[TSandM]

I'm not aware of any recognized change in Eustachian tube function with age. Has your weight changed significantly?

If the ENT doc didn't see any problem with your Eustachian tube function, it's hard to know what your issue actually is. Valsalva is a very inefficient method of equalizing, though, and there are a number of others. Some are explained HERE. You might also benefit from watching Dr. Kay's video on the diver's ear, which is found HERE.

 

[Buadhai]

Thank you very much for that first reference. (I'd seen Dr Kay's video.)

I have the rare talent of being able to wiggle my ears quite a bit. I think I will be able to manage the BTV (VTO) Maneuver. If I do a partial swallow and wiggle my ears I can feel the eustachian tube open with a pleasant pop and none of the snap, crackle and pop I hear with Valsalva. I'll give it a shot.

Edit: My weight hasn't changed much; has hovered around 80 kilos for the past decade or so. A far cry from my marathon running weight of 65 kilos, but that was a long time ago....

 

[gert7to3]

I've gone over to Neil Med (or similar) sinus rinse on dive trips. It seems to both soothe and clear my sinus passages.

NeilMed Pharmaceuticals - Sinus Rinse Isotonic

I make sure that I have pseudoephedrine with me. Should I feel congested I would use it, but it can have side effects.

 

[Buadhai]

How frequently do you do the sinus rinse?

 

[DandyDon]

How frequently do you do the sinus rinse?

An ear doctor who posts here frequently really likes the approach. He suggests the Neti Pot. Neti pot: Can it clear your nose? - MayoClinic.com

It is a very old practice that originated in India: Nasal irrigation - Wikipedia, the free encyclopedia

The NeilMed article link includes some cautions, specifically to wash you hands well, wash the equipment well, and use sterile water as some rare cases of lethal brain infections have been reported. I suspect they all happened with the use of untreated well or surface water as the Wikipedia article points out "Naegleria fowleri contamination of water supplies is rare, as even light chlorination will kill the parasite" but safety first, whatever. The NeilMed page does not say how often other than to use at least an hour before bedtime, and the Wikipedia page suggests once a day. It also warns against using homemade salt solutions, but many do mix their own salt & baking soda.

 

[Buadhai]

Thanks for the links. I now recall that I once had a liveaboard roommate who used a neti pot. I will look in to it.

Easy enough to get decent bottled water here in Thailand. I'll have to look around for the sinus rinse. NeilMed doesn't seem to distribute locally, but there must be equivalents.

Thanks to all. Some interesting ideas and great information. (I'm feeling relieved about my diving future!)

 

[DocVikingo]

NeilMed doesn't seem to distribute locally, but there must be equivalents.

Indeed there are, Buadhai.

Heres' my sidebar on nasal irrigation from the May, '08 issue of Undercurrent (Scuba Diving Magazine, Undercurrent Reviews Dive Resorts, Liveaboards, & Diving Gear):

“Shooting Saltwater Up Your Nose

Is your nose stuffed up enough that diving isn’t appealing, or even to the point where congestion may dangerously interfere with equalization of the ears?

It may sound a bit zany and gross, but the evidence, both published and anecdotal, largely supports the salubrious effects of saline irrigation on both nasal membrane drying and congestion (e.g., from long airplane flights, breathing hyper-dry scuba gasses and allergens). Such irrigation shrinks the mucus blanket and flushes out the excess, reducing nasal irritation and swelling.

There are scores of salt-based OTC nasal washes on the market such as Sinucleanse, BreathEase and an array of NeilMed products. Many come with a soft syringe. Or you can purchase special tips that attach to oral hygiene devices (e.g., the WaterPik NA-2 Gentle Sinus Rinse).

Many divers choose a simple home remedy that is cheaper and works just as well. Boil two cups of tap water for 10 minutes, stir in one teaspoon of salt (refined sea salt is recommended to avoid additives, but isn't necessary) and one-quarter teaspoon of baking soda (sodium bicarbonate). Adding more salt than recommended can do more harm than good, so don’t overdo it.

After the brew has cooled to lukewarm, draw it into a clean nasal or ear syringe until full, then lean over the sink, squeeze gently and allow the solution to run through the nasal passages. Sniff it in, spit it out, then gently blow your nose. Repeat with the second nostril. Again, don’t overdo it - - one or two treatments a day should be sufficient.

Now go make your next dive. - - Doc Vikingo"

BTW, I was Thailand in March of this year and noted Decolgen Plus & Tiffy Dey being sold OTC. The former contains pseudoephederine & the latter phenylephrine.

Regards,

DocVikingo