Nasal septum deviation - difficulty equalizing left ear

[Mike126]

LVFT - I'm not a Dr and have never played one on TV so take what I say as only my experience... (Legal disclaimer is now out of the way )

I too have had a history of issues equalizing. Although mostly as I got older. When I was in my 20's equalizing was not an issue. Now that I'm in my mid 50's it has become more of an issue. My ENT has prescribed for me the following regime:

- Sinus irrigation a few weeks prior to diving. I stop about 3 days before. I also try to do this once or twice a week regardless of diving.
- Sudafed a day or two before diving (I also take Mucinex to thin things out so it will drain)
- Afrin the day of diving: 3 sprays each side 20 mins before the dive and 2 more 5 mins before
- Equalize before you go in to pressurize your E-tubes
- VERY VERY VERY slow descent. I prefer using a down line and literally descending about a foot at a time until I get to about 20' then take it a little faster but slow until at 30 - 40'

I don't worry too much about Afrin wearing off since it is 12 hour strength. I generally only do 2 dives or less a day. I practice equalizing almost everyday. I do find that I tense up when I wear a mask and have a regulator in so I need to work on the mind over matter thing....

Good luck. Doctormike gives good advice.

 

[doctormike]

I asked about Balloon Dilation and he mentioned Dr. Poe up in Boston. He said he had a conference with Dr. Poe in September and I should check back with him in early October to see if Dr. Poe had any information. Really? It's June and I'm supposed to wait until October?

Leaving aside the bedside manner issues, perhaps what he meant is that balloon tuboplasty for ET dysfunction is still in the very early stages, not standard therapy, and that the pros, cons, indications and contraindications are still being worked out? That's how I see it, but then again, I only do pediatric ENT. So it's not like you are waiting for a package or something that is generally available and just needs to be scheduled - I really don't think that this is done widely, and certainly not in a large population of scuba divers. Something to think about, maybe when Dr. Poe presents his data in October things will be more clear, maybe not.

 

[LVFT]

- Sinus irrigation a few weeks prior to diving. I stop about 3 days before. I also try to do this once or twice a week regardless of diving.
- Sudafed a day or two before diving (I also take Mucinex to thin things out so it will drain)
- Afrin the day of diving: 3 sprays each side 20 mins before the dive and 2 more 5 mins before
- Equalize before you go in to pressurize your E-tubes
- VERY VERY VERY slow descent. I prefer using a down line and literally descending about a foot at a time until I get to about 20' then take it a little faster but slow until at 30 - 40'

Appreciate the response, sir! I do the sinus irrigation daily (regardless if I'm diving or not). I have taken Sudafed the morning of my dives, but have never tried taking it a couple days prior. I think I'm going to give that a shot before my next set of dives. I think I will try this same approach with the Mucinex as well. Like I mentioned above, I have had success this Afrin which often leads me to believe that there is nothing wrong with me from a physiological standpoint. I also try to equalize with every breath on descent in a head up position, but unfortunately most of my diving consists of drift dives so I don't have the luxury of a line. Perhaps, I'll schedule a dive in the Gulf because I know they use a decent line down their reefs. The diving isn't great, but hey, it will be a good test! You also mentioned being more relaxed and I think this is a big one that is often overlooked. I was able to do a shore dive prior to my boat dives the last time out. This mixed with Afrin was one of the few times I descended faster than my dive buddy. Granted it's not a race, but the point being that I had no issues. I heard *puffs* in my ears as I descended and it was such a great feeling.

Leaving aside the bedside manner issues, perhaps what he meant is that balloon tuboplasty for ET dysfunction is still in the very early stages, not standard therapy, and that the pros, cons, indications and contraindications are still being worked out? That's how I see it, but then again, I only do pediatric ENT. So it's not like you are waiting for a package or something that is generally available and just needs to be scheduled - I really don't think that this is done widely, and certainly not in a large population of scuba divers. Something to think about, maybe when Dr. Poe presents his data in October things will be more clear, maybe not.

Fair enough with regards to the bedside manners I apologize for the rant, but was a little heated. Perhaps you are correct regarding the balloon tuboplasty. He did mention that it is a fairly new procedure and the benefits from the procedure are still being measured. Based on what a few others who have had the procedure said, it seems to be beneficial. However, I think I'm going to shelf this idea for the time being and try some other routes. I'm going to stick with limiting dairy and utilizing the Mucinex a few days prior to my next set of dives. If that fails, I think I'm going to sign up for a Skype equalization session and try to master the Frenzel maneuver. If neither of these bring success, I think I'll look into the balloon tuboplasty procedure a little more seriously.

What are your thoughts on using Afrin longer than 3 consecutive days? As hypothetical example:

Person A: uses 10 squirts a day for 3 days = 30 squirts
Person B: uses 5 squirts a day for 6 days = 30 squirts

Is person B less susceptible to rebound congestion after day 3 or does the frequency and dosage not really matter? Perhaps a person could use 1 squirt a day or 10 squirts a day and they'll both see the onset of rebound congestion within the same time frame. Hopefully that made sense

 

[doctormike]

Fair enough with regards to the bedside manners I apologize for the rant, but was a little heated. Perhaps you are correct regarding the balloon tuboplasty. He did mention that it is a fairly new procedure and the benefits from the procedure are still being measured. Based on what a few others who have had the procedure said, it seems to be beneficial.

This is an important point, and it applies to ballon tuboplasty as well as herbal supplements that are claimed to "fight inflammation". The ONLY way we know that ANYTHING in medicine works is through a blinded, randomized trial. Especially when you are dealing with a condition that has an extremely high rate of spontaneous improvement (like ET dysfunction), you can't rely on anecdotal evidence.

For example, I treat ET dysfunction (ETD) in children, which is a bit different than in adults. But kids tend to collect middle ear fluid. If you have 1000 kids with ME fluid, and then check them all three months later, 800 of them will have clear ears. If you give all of those kids garlic oil drops, or special shampoo, or magic beans, you will then have 800 parents writing glowing online reviews about how the drops or the shampoo or the beans cured their kids ear problems. If you try something else that fails 90% of the time, something that is even worse than just waiting, you will STILL have 100 parents swearing that it works.

Sure, there are some things that we don't test with randomized clinical trials because of the nature of the condition. Emergency tracheotomy is effective for acute upper airway obstruction, and I wouldn't want to be randomized into the control group for that study! But I personally wouldn't have any elective procedure done just because someone said it helped. I would only do it if it had been actually SHOWN to help. And that means a randomized trial, with appropriate controls.

However, I think I'm going to shelf this idea for the time being and try some other routes. I'm going to stick with limiting dairy and utilizing the Mucinex a few days prior to my next set of dives. If that fails, I think I'm going to sign up for a Skype equalization session and try to master the Frenzel maneuver.

Sounds wise. Remember, the internal carotid artery (the big pipe that brings blood to your brain) is right next to the ET. Maybe tuboplasty is safe. But I would like some more data before trying it myself.

What are your thoughts on using Afrin longer than 3 consecutive days? As hypothetical example:

Person A: uses 10 squirts a day for 3 days = 30 squirts
Person B: uses 5 squirts a day for 6 days = 30 squirts

Is person B less susceptible to rebound congestion after day 3 or does the frequency and dosage not really matter? Perhaps a person could use 1 squirt a day or 10 squirts a day and they'll both see the onset of rebound congestion within the same time frame. Hopefully that made sense

I don't know if anyone has such precise data. There is a bell curve for everything, and some people are just more prone to rhinitis medicamentos (Afrin addiction) than others. Maybe he is right that five days is OK, but unless you are having a problem clearing your sinuses, Afrin doesn't always do much for ETD.

 

[LVFT]

I hope you did not just ruin my Afrin placebo effect!

However, in all seriousness, great information as usual. Perhaps, I'm a little nervous/anxious when going so long in between my dive trips that it's causing me to tense up during descent. I'm always worried about my ears the entire boat ride to the dive site and perhaps it just manifests into a self-fulling prophecy. I will try out my next course of action and report back. Thanks again, Dr. Mike!

 

[Mike126]

LVFT - One other suggestion. Over the winter I try to pool dive to practice my equalizing techniques. The nice thing about that is you are in a very controlled environment and can take as much time as you need to descend / ascend. I generally find that I don't have the post dive ear discomfort that I have in the OW dives. Mostly due to the fact that I am taking my descents very slowly.

As for Afrin over a multi-day trip, please talk to your Dr about using any meds. As Doctormike has stated each person is different with regards to addiction issues etc. I generally don't dive consecutive days as I don't want to stress out my eardrums and only use it for diving.

I feel your pain! Hopefully the next major evolutionary change to the human body will be better E-tubes and eardrums for diving! Release 1,534,031,034,872,983.001!

 

[LVFT]

Good info, plus it never hurts to work on buoyancy in the pool as well.

On an unrelated note, just noticed you were from Herndon. Actually lived in Arlington for about 5 years. You ever dive the Millbrook Quarry out in Haymarket? Actually got certified in that quarry in the middle of October or November (can't recall). Really makes me realize how spoiled I am to dive in WPB/Jupiter without a full 7mil, hood, and gloves

 

[Mike126]

Oh yes Millbrook![emoji45]. I try not to go there since it has 0 vis and pretty cold. But it is hard to drive 3+ hours each way to go to other quarries. Millbrook had zebra mussels a few years back and they really kept the water fairly clear. The state made the eradicate them due to the potential downstream impacts.

I do have a trip to Turks & Caicos coming up so that will get me into nicer diving.


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[TSandM]

I would highly advise that, if you are going to use Afrin on consecutive days, you keep the dose low. I advise my patients to use ONE squirt, not two, in each nostril, and to do this no more than once a day. Rebound IS real, and the nasty cycle of rhinitis medicamentosa is real, too.

 

[newsted]

Hi.
I have a similar problem so I am gonna use this thread.
I have hard time equalizing my right ear. The doctor told me I have a nasal septum deviation and that could be the reason. I have read on this forum and in this thread that a surgery can help to deal with this problem. Is there anyone else who can positively say that the surgery helped with equalizing?
The other problem I have is that around 30% of my dives end up with a bloody nose/mucus. Not too much blood just little bit in the mask. Every time I am ascending slow and actually can hear a hissing when the air is escaping. Before every dive I use Otrivin sinusitis spray. Is there anything else I could do to solve this? Neti-pot? Meds? Surgery?
BTW milk does NOT cause mucus production. I have read in several threads that divers are cutting on diary especialy milk. It is a myth.
Relationship between milk intake and mucus production in adult volunteers challenged with rhinovirus-2. - PubMed - NCBI
Milk consumption does not lead to mucus production or occurrence of asthma. - PubMed - NCBI
Fact or Myth: Does Milk Cause Mucus? : Underground Health Reporter