Question Issue with ascend and descend

[Diversanon]

Hi all, having some medical issues and appreciate any support/response here.

Currently doing my divemaster in Raja Ampat and facing some pretty rough sinus squeeze or reverse block. First dive yesterday, I submerged as normal horizontally slowly making my way down to depth. At around 5m, pain was pretty high equalizing so stopped and went back up a few meters to allow slower equalization. Went through multiple cycles of this but equalization never reached well and ultimately called the dive about 10 minutes in.
Past experience - never really had trouble equalizing and did not feel congested/sick. Around 130 dives in various conditions

After canceling the other dives yesterday, I doce today and took it really slow on the descend. I had issues with descend again (once again multiple repeat intervals to adjust) but at around 25m, it all of a sudden cleared and was fine. Took a shorter dive sub 30m and ascended fine. Second dive, descend was be dry smooth. However, on the ascend to the safety stop, my head felt like exploding. Don’t think I’ve felt pain to that level prior.

Talked to DAN hotline, and the nurse said it could be middle ear barotrauma (given the sudden relief of the first dive). also eluded to my 28 hour flight time a couple days before also impacts ear pressure.
Grabbed a physical opinion from the ER in Raja Ampat and she saw redness but no infection or perforation, and she diagnosed an infection potentially in the ear.

I know it’s hard to diagnose online and everyone’s case is different, but I wanted to gather more data from other divers to see if this has happened to them before or what they think it is.

Really appreciate the help in advance

 

[Duke Dive Medicine]

Hi all, having some medical issues and appreciate any support/response here.

Currently doing my divemaster in Raja Ampat and facing some pretty rough sinus squeeze or reverse block. First dive yesterday, I submerged as normal horizontally slowly making my way down to depth. At around 5m, pain was pretty high equalizing so stopped and went back up a few meters to allow slower equalization. Went through multiple cycles of this but equalization never reached well and ultimately called the dive about 10 minutes in.
Past experience - never really had trouble equalizing and did not feel congested/sick. Around 130 dives in various conditions

After canceling the other dives yesterday, I doce today and took it really slow on the descend. I had issues with descend again (once again multiple repeat intervals to adjust) but at around 25m, it all of a sudden cleared and was fine. Took a shorter dive sub 30m and ascended fine. Second dive, descend was be dry smooth. However, on the ascend to the safety stop, my head felt like exploding. Don’t think I’ve felt pain to that level prior.

Talked to DAN hotline, and the nurse said it could be middle ear barotrauma (given the sudden relief of the first dive). also eluded to my 28 hour flight time a couple days before also impacts ear pressure.
Grabbed a physical opinion from the ER in Raja Ampat and she saw redness but no infection or perforation, and she diagnosed an infection potentially in the ear.

I know it’s hard to diagnose online and everyone’s case is different, but I wanted to gather more data from other divers to see if this has happened to them before or what they think it is.

Really appreciate the help in advance

From your description it sounds like you're having difficulty with both your ears and your sinuses. If so, this could indicate either some sort of infectious process like a cold or mild COVID, or environmental allergies. It's probably not going to resolve quickly, and if you continue to dive in that condition you could be risking further injury.

Best regards,
DDM

 

[DiveProKoko]

Take a course of antibiotics and stay out of the water completely until course of medication is complete. Could be 5 to 10 days. Give it a try after that. I suspect you'll be good? Not a doctor, but the only time I've ever seen a person who can usually clear easily suddenly have an issue, it was an infection.

 

[Duke Dive Medicine]

Take a course of antibiotics and stay out of the water completely until course of medication is complete. Could be 5 to 10 days. Give it a try after that. I suspect you'll be good? Not a doctor, but the only time I've ever seen a person who can usually clear easily suddenly have an issue, it was an infection.

If this was a bacterial infection then an antibiotic prescribed by a physician to treat the most likely bug would be a solution. I don't think that is known in this case.

Best regards,
DDM

 

[Diversanon]

From your description it sounds like you're having difficulty with both your ears and your sinuses. If so, this could indicate either some sort of infectious process like a cold or mild COVID, or environmental allergies. It's probably not going to resolve quickly, and if you continue to dive in that condition you could be risking further injury.

Best regards,
DDM

That's helpful to read here. Based on what you're saying, these infections may increase inflammation and make it harder to equalize since areas are blocked.

I was planning for resting 5-7 days before trying another dive. If the problem persisted, I would probably abort the divemaster until when I have time in a couple years

 

[Diversanon]

Take a course of antibiotics and stay out of the water completely until course of medication is complete. Could be 5 to 10 days. Give it a try after that. I suspect you'll be good? Not a doctor, but the only time I've ever seen a person who can usually clear easily suddenly have an issue, it was an infection.

Outer ear infection isn't really occurring, though it definitely could be middle ear infection. Trying a regimen of antibiotics for a few days and seeing what happens off that before diving again

 

[kinoons]

If this was a bacterial infection then an antibiotic prescribed by a physician to treat the most likely bug would be a solution. I don't think that is known in this case.

Best regards,
DDM

I agree - the overwhelming majority of acute sinus and ear issues are not related to a bacterial infection. Most are viral infections and subsequent/concurrent inflammation. Sometimes allergic rhinitis is the cause. Time alone usually resolves the problem. I’m not your provider, so this isn’t specific advice for you, but in general an antihistamine and nasal steroid can be used for sinus and ear issues. A systemic steroid burst, like prednisone 40-60mg for 5 days could also be tried.

I usually do not prescribe an antibiotic until two weeks have passed and steroids haven’t helped.

 

[AnnoyedSpelunker]

It's an inner ear infection most possibly Labyrinthitis. Avoid diving or plugging in headphones/earphones for a week.

 

[Duke Dive Medicine]

That's helpful to read here. Based on what you're saying, these infections may increase inflammation and make it harder to equalize since areas are blocked.

I was planning for resting 5-7 days before trying another dive. If the problem persisted, I would probably abort the divemaster until when I have time in a couple years

Probably not a bad idea. @kinoons mentioned some meds that some people find helpful so those may be worth a try, though I would advise caution if you do given your description of reverse block. If you take medication at the wrong time it can wear off while you're on the bottom and lead to another reverse block.

FWIW I didn't see anything in your description that would suggest inner ear involvement as mentioned above.

Best regards,
DDM

 

[Kendall Raine]

I submerged as normal horizontally slowly making my way down to depth. At around 5m, pain was pretty high equalizing so stopped and went back up a few meters to allow slower equalization. Went through multiple cycles of this but equalization never reached well and ultimately called the dive about 10 minutes in.
Past experience - never really had trouble equalizing and did not feel congested/sick. Around 130 dives in various conditions

I'm not qualified to offer medical advice but I've had symptoms similar to yours-both pain on descent as well as reverse squeeze.

I suspect sinus inflammation is at the root of the trouble. Whether caused by a cold, sinus infection or other problem I can't say.

That said, I almost always begin my descent by equalizing first (performing valsalva manuever) at the surface, and then every 3-5 feet, descending feet first, for the first 30 or so feet. If I descend horizontally, or worse, head down, I sometimes get a sinus squeeze on the descent which can cause pain in various sinus cavities (frontal, maxillary). If I cause problems on the descent, that can precipitate a reverse squeeze, as well. Once that process has started, equalizing becomes increasingly difficult and the only solution is time off.

Afrin, in combination with Flonase or, better, Budesinide, can help, but the key is to prevent problems early by going slow and feet first during the initial large pressure changes.

Good luck.