I get dizzy coming up. Why?

[Bubbles-old]

Not sure if this is the correct section, feel free to move it.

I have no serious problems diving, I love it and go several times a week. I do have one tiny issue though and I wonder if there's help.

Say I'm kicking around at 30-35 feet and come to a drop and go down below 60' for a while. I can spend all the time I want between 60-130 feet with no problem, I enjoy it a great deal. The problem is when I come back up, once I hit 35-45' I get this overwhelming disorientation that completely takes away my ability to concentrate or do anything productive. I just hover there with my brain spinning. I sit or move slowly for a while and the problem will slowly remedy itself and everything will be fine. It happens on every single dive no matter the water conditions, no matter my condition. It is a standard aspect of every dive deeper than 50-60 feet for me. I've learned to deal with it and just hang tight for a minute or two when it happens.

My question is what causes this, too much pressure behind the ears not releasing rapidly enough? Is there anything I can do to stop it from happening? I've tried all kinds of ear cleaning devices from the squeeze bulb to those BS ear candles and nothing has helped so far. I can live it with, I would just like to make sure it isn't doing me any harm. Thanks.

 

[Rick Murchison]

You are describing vertigo - an often extreme disorientation, characterized by severe leaning or even tumbling feelings. It is almost certainly caused by unequal pressure in your inner ears - that is, one of your ears is equalizing more easily than the other.
Solutions vary from descending a bit until the sensation goes away and trying to come up more slowly, working your jaw back and forth, to just ignoring it and continuing the ascent until the "sticky" ear catches up with the other one. Option one is best if you have the gas to do it.
Rick

 

[BillP]

Hi Bubbles:

Rick typed up and posted his short-and-to-the-point version while I was busy on this novel. He's already answered, but I'll post this anyway.

Your instinct for the source of the problem was probably close, but you were working on the wrong side of the eardrum. Dizziness during ascent is most often due to a problem called alternobaric vertigo. It is caused by a pressure differential between your two middle ears (the part behind the eardrum). When divers descend, the increasing pressure of the water is transmitted to the eardrums through the outer ear canal. The pressure could be enough to injure the eardrums after just a few feet of descent if the diver didn't "equalize" their ears by allowing air from the throat (at the same pressure as the surrounding water) enter the middle ear through the eustachian tubes.

Some divers equalize their ears more easily than others, either because of anatomy or technique. Ineffective, forceful, or infrequent clearing on descent, diving when congested, or just unlucky anatomy can make it difficult for air to pass through the eustachian tubes to the ear. There are times when a diver can clear their ears adequately on descent, but the air in the middle ear has a difficult time escaping back into the throat through the swollen or blocked eustachian tube as the air expands on ascent. If one ear clears better than the other, the relative increased pressure in one ear puts pressure on the ear's delicate vestibular balance mechanism. This unequal pressure causes the vertigo or "dizziness" that divers sometimes experience on ascent.

Alternobaric vertigo is usually associated with difficulty clearing the ears- often with one ear particularly more difficult than the other. It most often occurs on ascent, but can occur during clearing on descent or even with a valsalva on the surface. Vertigo that occurs on ascent that disappears immediately if the diver descends again is diagnostic of alternobaric vertigo. The dizziness usually lasts a few seconds, but can last 10 minutes at times, and has been known to last as long as 10 hours. Sometimes the diver will get the dizziness when ascending and notice a "hissing", "squeaking", or "popping" sound in one ear as the dizziness improves. It isn't at all uncommon for alternobaric vertigo to be worse at shallower depths where the pressure changes are often relatively more rapid than at deeper depths.

Vertigo underwater with its associated disorientation and even nausea/ vomiting can be extremely hazardous. As with most conditions, the best treatment is prevention. Some dive experts say that divers with a history of alternobaric vertigo should not dive. Ever. Others say that divers who've had alternobaric vertigo shouldn't dive if they can trigger an episode on the surface with a valsalva or if they have congestion or difficulty clearing. Divers who have had alternobaric vertigo in the past (and all divers, really) should take particular care to clear their ears before descent and frequently (every two feet or so) and gently on descent. Ascents should be slow, and if vertigo develops the diver should descend until it clears (if possible) and then try an even slower ascent- preferably on a line or other fixed reference. The diver's buddy should be close at hand and be familiar with the diver's history of vertigo on ascent.

Flushing the nose with a saline nasal spray (eg Ocean) before a dive might help with clearing. Oral decongestants like long acting pseudoephedrine (eg 12-Hour Sudafed) or long lasting decongestant nasal sprays like oxymetazoline (eg Afrin) can help with equalization, but introduce potential problems of their own. (See other threads on this board.) Some people think that the expectorant guaifenesin (eg plain old Robitussin with no other letters like "DM" or "CF") thins mucus and should help with equalization. There's a product called Clear-Ease ( http://www.sinus-relief.com/clearease.html ) that is a lozenge you suck that has enzymes that supposedly break down the proteins in mucus to help clear congestion. It makes sense that it might work, but I don't have any experience with it and it sure seems darned expensive for meat tenderizer in a lozenge.

There are other possible causes of dizziness on ascent. Diving in strong surge, ascending rapidly in a cloud of disorienting bubbles, "blue water" or "black water" ascents without visual reference can all lead to disorientation and dizziness. My list of causes or suggestions for cures is by no means exhaustive or complete. I'd be happy to see other divers give their input.

HTH, and be careful down there,

Bill

 

[Bubbles-old]

Wow, thanks guys!! That was incredible. I really learned a lot. The diving around here is typically very slow on ascent, you swim out getting slowly deeper as you go, level off about 90' and work your way back in/up when 40% of your air is gone. The nature of this diving gives incredibly slow ascent times and a naturally occuring safety stop since the last 100 yards is right about 17' deep depending on tide.

I do hear whistling in my right ear once in a while while coming up so I do think that I have uneven pressures. This makes a lot of sense to me.

I dove today and it happened again as expected, just above 40' and I do what I always do, just flutter along, stare at my computer or compass, etc. Basically take my mind off it until it passes. It's only a minor inconvenience, I consider getting my right fin on and off much more of pain to be honest.

Going to try a couple of the things Bill suggested, they do sound helpful. If this is as bad as my diving gets then I'm doing pretty good. My dive partner is in a wet suit and he freezes his cockles when we get down to 75' or so. I'd rather have a bout of dizziness. Thanks again.

 

[Dr Deco]

Hello Bubbles:

The comments by BillP and Rick are very complete.

You can be sure that this is not a problem with decompression and gas phase formation. Such vestibular problems do occur, but only when individuals have been deeper than 400 fsw.

Dr. Deco

 

[John Reinertson]

The above comments are excellent. I have only one option to add, partly because I've had good luck getting divers and pilots with difficult clearing to do so easily-- That is to consider the use of Cortisone based nose sprays. Common brands are Nasonex, Nasacort AQ, Flonase, Vancenase, Rhinocort, and Beconase. They have no tachycardia effects, they are slow in onset (you should start two to three days ahead of vacation),and they wear off slowly (occasionally a problem with sudafed or decongestant sprays.)
You can use decongestant sprays with them, and the combination is more effective than either one alone.
The only real downside is they are RX only (you'll have to check with your doc) and rarely, they dry the nose enough to cause minor nosebleeds. People prone to nasal congestion or difficult equalizing have more satisfying dives with a little preparation. Pain sucks, and dizziness is unpleasant and potentially dangerous.

Dive safe and comfortable,
John Reinertson