Meds for clearing

[diveguy600]

About 25% of the time I go diving I encounter a situation where I am just not able to equalize at all and my ears are in terrible pain when I descend no matter what I do. This happens when there are absolutely no outward symptoms - i.e. my breathing is fine and clear, no evidence of a cold and I do not feel unwell at all. I haven't been able to figure out what the root cause is. As you know diving can be expensive and signing up for dives and then not be able to complete the dive due to ear trouble could may as well be like gambling in Vegas.

I know this is controversial and some divers advocate against it...but, what are the most effective medications that assist with ear clearing? Which of you use these meds and how has it changed your ability to equalize? I have heard about Sudafed and Claritin. A lot of these doses I see are for a few hours of effectiveness which should cover the duration of the dives.

 

[vladimir]

Watch the video entitled The Diver's Ear—Under Pressure to see if there might be alternative clearing techniques you can employ.

Familiarize yourself with reverse block, if you're not already, so you know what the risks are of taking decongestants while diving.

In addition to the usual decongestants and antihistamines, consider a nasal steroidal inhaler, like Avamys (fluticasone furoate).

Search the posts of doctormike, DocVikingo, TSandM, and DukeDiveMedicine for more authoritative information.

 

[ColoDale]

I use sudafed. I don't use antihistamines just because they put me in a fog. I also sometimes will irrigate with saline spray. If I have to go to the point of neti pot then I shouldn't be diving.
I have also found that if I clench my jaw in a certain way I can't equalize as well so I move my jaw around sometimes during the descent and keep the mouthpiece a bit loose. I also don't tilt my head to one side when equalizing - this may be just so I feel the equalization in both ears the same.

I guess I have been fairly lucky that I have not had to abort dives due to my ears.

You might have an ENT look at your ears for a root cause. If it were temporary congestion then usually one of my ears is affected unless I am totally plugged up i.e. a head cold, then I wouldn't be diving anyway.

 

[Lizard Leg]

Just trying to get to 30' would take me 10 minutes before - bouncing up and down trying to get ears to clear. I did a shot of this in each nostril about 30-60 minutes before splashing the first dive yesterday. Went to 48' and never even slowed down until I was at the bottom with no issues whatsover. Best advice my ENT ever gave me!

 

[Cixelsyd]

I suffer from bad allergies, so my usual cocktail of dive medicines consists of Zyrtec-D and two shots of Flonase in each nostril. I usually start them a few days before diving to make sure everything is open and clear on the day of diving. I like both of these drugs because they are long acting (12 hour) so they won't wear off halfway through the dive and they are non-drowsy, so I don't get any fog.

 

[Jim Lapenta]

I would not recommend any of the meds to any new diver. Without an ENT's advice who actually understands diving and dive medicine following the home remedies above could easily result in serious injury. The 12 hour meds are perhaps the most dangerous and most likely to cause problems. Regular use can result in a rebound effect that makes the congestion worse. I used to use sudfed on a regular basis for diving. Until a 12 hour brand wore off in less than 6 since I had a fast metabolism and built up a tolerance for it. The paralysis on the right side of my face went away after about 4 days and the numbness and tingling took 3 weeks after the reverse block I suffered due to the meds wearing off sooner than expected happened. The longer you take a drug like these the more likely you will build up a tolerance for them and not be able to accurately predict their duration.

The best thing to do is to start equalizing early. Like the day before the dive. Gently. I will often do a valsalva a few times a day before diving and start GENTLY equalizing on the way to the dive site. This helps to stretch the eustachian tubes and keep them flexible. It will also likely alert you to any congestion you were not aware of and allow you to take proper action. Ie see a doctor or don't dive. Nothing down there is worth a blown ear drum.

 

[Lizard Leg]

Agreed with above post. I went to my wife's ENT after I had trouble clearing. Did the test, no blockages, etc. Everything was fine. She recommended the nasal spray I posted, but with the advice of ONLY once a day, and only when diving. She said it would have a rebound effect, and that the evening after the dive I would probably be pretty stuffy, and to only use it when diving - not every day.

For me - Ive used it on two dives and it was a huge difference. I did try it on dry land hanging around the hosue to make sure there were no drowsy/loopy side effects, but I guess the point I need to clarify in my original post is - this was on the advice of an ENT who has experience with divers and worked for *MY* situation. ymmv

 

[Colliam7]

I know this is controversial and some divers advocate against it...but, what are the most effective medications that assist with ear clearing? Which of you use these meds and how has it changed your ability to equalize? I have heard about Sudafed and Claritin.

To anser your specific question, I use (and recommend) Sudafed - the original pseudoephedrine, NOT the rather innocuous Sudafed PE (phenylephrine). However, . . .

About 25% of the time I go diving I encounter a situation where I am just not able to equalize at all and my ears are in terrible pain when I descend no matter what I do. This happens when there are absolutely no outward symptoms - i.e. my breathing is fine and clear, no evidence of a cold and I do not feel unwell at all.

To echo several comments, see an ENT physician with an understanding of dive physiology before attempting to self-medicate. (You can contact DAN and they may be able to assist in identifying one in your area.) What you describe does NOT sound like a situation easily remedied by decongestants (or antihistamines) alone. Notwithstanding the absence of symptoms, you could quite possibly have an ENT problem that should be addressed before continuing to dive.

 

[TSandM]

It is impossible to tell you what medication will be most effective, without knowing what the problem actually IS. If you have allergies, an antihistamine or steroid may be most effective. If you have vasoactive rhinitis, a steroid or a topical vasoconstrictor like Afrin may be most effective. If your problem is technique, no medication will solve it, and if your problem is anatomy, the same may be true.

I would highly recommend a thorough evaluation by a diving-savvy ENT doc before you consider using medication to solve your problem. Although not being able to clear is a nuisance and disappointment, a reverse block could destroy your hearing or worse, leave you with life-long vertigo. It's nothing to regard lightly.

 

[al248005]

I agree with Jim on the medicine stance. I have seasonal allergies and in late May early June they are usually at their peak. I have found with the medicines such as the Zyrtec and Claritan D's that by taking it, it won't clear up my congestion fully. This may sound weird but it usually only works for one side; either the left or right. It will clear one side completely but it seems like it pushes everything to the other side and congests it even more. Last year I came across a product in which there actually was a lengthy post on it in here that worked miracles for me: NeilMed Sinus Rinse. Since using it I have not had to use over the counter meds again to deal with my congestion. Another thing that I find that works well like others have said is equalizing every so often on the way to a dive site. This should give you a good indication of whether or not you'll be able to dive. In my experiences if I haven't been able to equalize on land I won't be able to underwater.