Reverse Squeeze Help!!

[junior2725]

i recently returned from a trip to Cozumel. I have always had problems with reverse squeeze (at least this is what I think it is). I have no problems equalizing on the way down. Every once in awhile I might feel slight pressure on the way down but no problems equalizing it. It is very rare that I feel pressure and need to go up a few feet to equalize. The problem occurs on my ascent. This occurs even on shallow dives of twenty feet max. On ascending I feel pressure building in my ears then it starts to hurt some and eventually I hear the ears clearing. After about four days of diving in Cozumel I started having more pain upon ascent and trouble. I remember one particular time that we went through a swim through and depth changed by about fifteen feet. I was in excruciating pain. I really wanted to call the dive, but I knew that ascending more would just make things worse. After a few minutes my ears cleared some and the pain stopped. I still felt pressure but the pain was gone. I have no idea what to do to help this. From everything I have been taught, you ascend and then try to equalize again, but ascending causes the problem. I just watched the video by Dr. Edmond Kay but the only thing he really mentions is don't try to pressurize while ascending. In the past I have tried to pressurize to no avail and also tried to just move my jaw around. Now I know I shouldn't try pressurizing, something about is messing up breathing while ascending. Does anyone have any ideas as to what I can do to fix this problem? It doesn't seem to be a huge problem when diving one day every once in awhile, but when I go on a dive vacation it becomes more of a problem. I almost skipped out on the last couple of dives in Cozumel, and I don't want to feel this way in the future. Thanks for anybodies recommendations.

 

[Doc Harry]

You've got quite a problem there.

I'm not sure that there are any earth-shaking solutions for you. Your sinus anatomy may be problem. If your problem cannot be corrected by other means and you're serious about diving, then a CT scan of your sinuses and a consultation with an ENT surgeon may be worthwhile. Maybe you have sinus polyps.

Do you smoke? Smoking will irritate the sinues and stimulate mucous production that may block your sinuses.

Are you well hydrated? Water is the best expectorant there is. Good hydration will keep your mucous thin so it drains easily. Thick mucous can plug up your sinuses and cause problems.

Of course, a slow ascent and equalizing frequently is always important. Pick up a free diving text, free diviers have a million different techniques for equalizing:

Manual of Freediving: Underwater on a Single Breath

You may need to take a break from diving every few days during long dive vacations to give your sinuses a break.

Some may recommend saline nasal washes but I have no experience with such treatments and so cannot comment.

Good luck.

 

[Zippsy]

mmmmmm..... that is a problem. I may be telling you something you already know but I just want to make sure you understand the basics. I deal with many new divers who have trouble equalizing upon descent so they learn lots of ways how to put more air INTO their middle ear, ie., equalize. Since not many people have trouble equalizing upon ascent, if they have problems later, they still think equalizing on ascent means putting more air INTO the middle ear - but it doesn't mean that at all. Upon ascent, you need to let the expanding air out. Some ways to do this include pinching your nose and sucking in. Wiggling your jaw, looking up, stretching your neck side to side, etc all may help too. NEVER blow against a pinched nose when ascending though - that will have the opposite effect and cause more pain and damage. Ascending VERY slowly should help too for both your ears and helping to avoid DCS.

 

[TSandM]

I suspect what is happening is cumulative barotrauma over multiple days of diving. If you are just even the slightest bit late equalizing, it causes swelling and fluid transudation into the middle ear. Over a period of days, you get increasing edema (swelling) of the structures, narrowing the Eustachian tube and making it harder to get air in and out of the ear. That same thing can occur with the sinuses.

Paying diligent attention to equalizing early and often can help. It might also be reasonable to do a trial of decongestants, although they are not without their issues. Timed-release preparations are less likely to wear off during a dive, but that still can be a concern. In addition, if you dive Nitrox, there is some anecdotal evidence that pseudoephedrine can augment central nervous system oxygen toxicity. Those things said, a lot of divers do use decongestants with some success.

 

[junior2725]

Thanks for the advice. Next time I dive, I will try moving my jaw, stretching, etc as I ascend. Hopefully if I remember to start doing that before it starts hurting that will help. I've never smoked in my life. I do have problems every once in awhile with sinus infections. I didn't feel any congestion while in Mexico, but should I maybe always take some kind of decongestant to help out before diving even if I don't feel congested. Even if I don't feel any congestion before the dive, at the end of the dive I always have plenty of stuff that I need to blow out of my nose. I do realize that it is a problem with the air coming out of my middle ear, just wasn't sure what I could do to help it along. It seems weird to me that I have no problem with air going into my middle ear on the way down, but have such a problem on the way up. I am definitely serious about diving. I am getting my rescue and dry suit certification in the next few weeks. I have a trip planned in august to do a wreck diving specialty class in Canada. I will need to dive at least 3 days in a row and they will be deep dives. I think if this doesn't help, then I will look into seeing an ENT before my trip. Thanks for all your advice.

 

[junior2725]

I suspect what is happening is cumulative barotrauma over multiple days of diving. If you are just even the slightest bit late equalizing, it causes swelling and fluid transudation into the middle ear. Over a period of days, you get increasing edema (swelling) of the structures, narrowing the Eustachian tube and making it harder to get air in and out of the ear. That same thing can occur with the sinuses.

Paying diligent attention to equalizing early and often can help. It might also be reasonable to do a trial of decongestants, although they are not without their issues. Timed-release preparations are less likely to wear off during a dive, but that still can be a concern. In addition, if you dive Nitrox, there is some anecdotal evidence that pseudoephedrine can augment central nervous system oxygen toxicity. Those things said, a lot of divers do use decongestants with some success.

TSandM
I think that may be what caused more pain over multiple days of diving, but I sill have this problem if I haven't dove for weeks and am on a shore dive of 20ft max. It just doesn't hurt as much when I haven't been diving over multiple days. I will be more diligent about equalizing on the way down also. Usually I equalize about every five to ten feet and have no problems.

 

[kbuschmann]

TSandM
I think that may be what caused more pain over multiple days of diving, but I sill have this problem if I haven't dove for weeks and am on a shore dive of 20ft max. It just doesn't hurt as much when I haven't been diving over multiple days. I will be more diligent about equalizing on the way down also. Usually I equalize about every five to ten feet and have no problems.

I think you have just come up with the answer to your own question. It is unusual, though not impossible, for a eustachian to dysfunction on the way up that has just functioned well on the way down. It is far more probable that the eustachian was perturbed on descent. Equalizing every "five to ten feet" is likely not adequate. Better every three to five feet. Also, the method of equalization may be problematic. The venerable Valsalva is traumatic to the soft tissues of the eustachian and sinus ostia, and if you are combining this with a somewhat overpressurized tube from tardy equalization, then trouble is likely to visit. A better technique is the Frenzel. Give these things a try.

Kim B
Diving Medical Officer, Flight Surgeon

 

[Doc]

Thanks for the advice. Next time I dive, I will try moving my jaw, stretching, etc as I ascend. Hopefully if I remember to start doing that before it starts hurting that will help.

No, "Junior", you missed entirely the most important part of what Zippsy posted in his response.

Pinch and Suck It is the obvious reverse of ValSalva.

Do this upon ascent. Do it often. If you're ears hurt, descend two or three feet and try again. Learn where the sinus passages are so that you may massage them with your fingers as you ascend. Above your eyes under the brow of your skull is the easy one to describe.

Of course, it does work best if your sinus ducts are clear and unrestricted by swelling or goo. (Please excuse that fancy medical nomenclature)

 

[junior2725]

Thanks. From now on I will equalize much more often on descent even if it is not bothering me. RoatanMan, thanks for pointing out the most important one of pinching and sucking on ascent. I will do both things on my next dive. Hopefully this will help solve my problem. Thanks for everyones responses. This has given me a lot of things to remember about equalizing better for my next dives. It might be a few weeks before I get anything but some pool dives in, but I am looking forward to trying these things.

 

[stefo2]

From everything I have been taught, you ascend and then try to equalize again, but ascending causes the problem.

Am I am misunderstanding something here? If I felt pressure / pain in my ears during ascend, I would not ascend further until it clears (well, if it doesn't, at some stage I guess I will simply have to ascend in spite of the pain).