Middle ear barotrauma

[boulderjohn]

About vertigo....

I was once doing an instructional technical dive with 3 students. One of them was assigned the task of leading the descent. At about 120 feet he started to slow and appeared cautious. He shook his hand in the "having some trouble" sign, and I got close to him. At 150 feet he had a look of panic and thumbed the dive. We all ascended together while he clung to the line with his right hand, which is something we do not normally ever do. I held on to him, but he was not in full blown panic--he vented his wing and his drysuit on his own as we ascended. His eyes were very wide, though, and he clung to the line, including on the surface.

It was vertigo. Everything started spinning for him on the dive. Now that he was on the surface, he felt fine, but he knew he was done diving for the weekend. His theory was that on a dive the week before, he had had trouble equalizing, and he had made the mistake of forcing it. He was afraid he might have perforated his eardrum. He went to a ENT and, sure enough, there was a tiny pinprick of a break in his eardrum. Once that healed over, he was fine, but he certainly had to wait for it to heal over.

 

[Millemar]

Is the affected ear the same one that gave you problems on Palau? Your description of your current injury sounds like another reverse middle ear squeeze.

The fact that you had pain on ascent is significant. The anatomy of the Eustachian tube is such that air exits the middle ear much more easily than it enters. Equalization on ascent is a passive event generally and doesn't require any effort on the diver's part. If you were feeling pain on ascent, that indicates that the Eustachian tube is significantly obstructed. You could do a lot of damage if you try to dive again right now with that level of swelling. I would wait at least a couple of weeks before even trying to equalize the ear on dry land.

Whatever you do, do NOT try to force the ear to clear. Doing so can result in further, possibly permanent injury. After a couple of weeks you might consider trying to gently Valsalva on the surface and seeing if you can get the ear to clear. Don't even consider diving if you can't get it to equalize easily on the surface. What follows is not a recommendation one way or the other, but if it clears easily for you, it may be reasonable to attempt another dive, following @boulderjohn 's excellent advice. Pre-load your ears before descending, stay ahead of the descent (i.e. equalize even though it doesn't feel like you have to), and stop immediately and ascend if you can't equalize. If you continue to descend without being able to equalize, you'll only close the Eustachian tube off more tightly. You should never get to the point of feeling pain on descent. If it hurts, you've already gone too far.

Some people find OTC decongestants, NSAIDs, and nasal sprays like oxymetazoline beneficial in cases like this. Of course that decision is up to you, as is ensuring that you use them safely. Be careful if you use any of these while actively diving; if they wear off on the bottom you could risk another reverse barotrauma.

Best regards,
DDM

 

[Millemar]

Thank you for your response. The ear I had trouble with on this trip was not the same ear that gave me some trouble in Palau. I’ve never had any trouble with this ear before. The good news is that after taking about 10 days off diving and practicing the various equalization techniques above the water, I was able to do a successful beach dive with no issues. Since then, I’ve done about a dozen boat dives ranging from 25-75 ft over a period of a couple of weeks. No problems at all.

I think the equalization techniques definitely helped, but even though I haven’t had any additional problems, I’m now a little concerned about future diving in terms of my ability to handle deeper dives and/or multiple repetitive dives such as on a liveaboard. I don’t want to be overly conservative since many of the world’s best dive sites are accessible only by liveaboard, but I also don’t want to be foolish and have long-term problems.

What is your advice as to the best way to assess my ability to do liveaboards and deeper dives in the future?

 

[tursiops]

After a couple of weeks you might consider trying to gently Valsalva on the surface

...or, some other equalization technique. Valsalva is notably the cause of a lot of problems.

 

[Millemar]

...or, some other equalization technique. Valsalva is notably the cause of a lot of problems.

Yes, I wasn’t previously aware of the range of other techniques. Once I tried them, they helped a lot.

 

[tursiops]

Yes, I wasn’t previously aware of the range of other techniques. Once I tried them, they helped a lot.

Sounds like we have the same ears....
Don't hurry to get down, especially if you've not been diving for a while.
I always try and equalize like I was voting in Chicago...early and often. (Bad joke.)

 

[Millemar]

Sounds like we have the same ears....
Don't hurry to get down, especially if you've not been diving for a while.
I always try and equalize like I was voting in Chicago...early and often. (Bad joke.)

Ha ha. We were thinking of going to Galapagos for our next trip but apparently negative entry is an absolute requirement for many of the dives. Sounds like a bad idea for someone with ear problems. One thing that has helped me resolve the problem I started with on this trip is not descending head first.

 

[Duke Dive Medicine]

Thank you for your response. The ear I had trouble with on this trip was not the same ear that gave me some trouble in Palau. I’ve never had any trouble with this ear before. The good news is that after taking about 10 days off diving and practicing the various equalization techniques above the water, I was able to do a successful beach dive with no issues. Since then, I’ve done about a dozen boat dives ranging from 25-75 ft over a period of a couple of weeks. No problems at all.

I think the equalization techniques definitely helped, but even though I haven’t had any additional problems, I’m now a little concerned about future diving in terms of my ability to handle deeper dives and/or multiple repetitive dives such as on a liveaboard. I don’t want to be overly conservative since many of the world’s best dive sites are accessible only by liveaboard, but I also don’t want to be foolish and have long-term problems.

What is your advice as to the best way to assess my ability to do liveaboards and deeper dives in the future?

The largest relative pressure change happens in the first 33 feet, so typically the deeper you go the easier it becomes to equalize. If you pay close attention to equalization techniques like you seem to have been, depth should not be an issue.

Re repetitive dives, salt water can have a tendency to irritate the mucous membranes so you'll have to be mindful of that. I'd just re-iterate the recommendations from above, especially the one not to continue your descent if you can't equalize. It's better to thumb one dive than to get a squeeze and have to sit out a bunch of them.

Best regards,
DDM