Question Vertigo on Ascent - Stumped

[TMurrr]

Dive buddy:

Upon further analysis, my right sinus has a much harder time equalizing than the left. I always manage to get it equalized eventually but when the worst incident occurred, I may not have had enough time to fully equalize my right sinus due to other factors and stresses.

 

[paddydiver]

Another idea to help might be to practice using a reel and SMB and ascend with it every dive. I've found this to be a help with divers I was teaching/guiding in the past. Your buddy is not that experienced so it's easy to go up a little fast, then drop down again while trying to equlise and so on. Using a line can really help control a slow ascent and it also gives you something fixed to focus on if you re feeling a bit dizzy.

 

[lowwall]

Dive buddy:

Upon further analysis, my right sinus has a much harder time equalizing than the left. I always manage to get it equalized eventually but when the worst incident occurred, I may not have had enough time to fully equalize my right sinus due to other factors and stresses.

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[JoeTPhilly]

Dive buddy:

Upon further analysis, my right sinus has a much harder time equalizing than the left. I always manage to get it equalized eventually but when the worst incident occurred, I may not have had enough time to fully equalize my right sinus due to other factors and stresses.

I had trouble equalizing my right side too. My ENT performed a Eustachian tube ballon dilation and it helped. I also descend slowly and equalize often and tilt so my right side is higher.

 

[Duke Dive Medicine]

Finally got a response:


"Between 3s-60s, its gotten longer and more aggressive as I've gotten older"


"I stare at the ground, I find a piece of coral and stare at it as well as monitor my depth because sometimes I start to breathe faster"



Bear in mind I did not share the description of alternobaric vertigo with my buddy before asking her your questions.


All of our diving is here in sunny South Florida, or closer to the equator. But noted on gentle ascending and rinsing and blowing the nose! I'm sensing a theme that my buddy needs to pay more attention to equalizing and slow ascents.

The transient nature and occurrence on ascent are both characteristic of alternobaric vertigo. It's unexpected because the ears normally don't require active equalization on ascent, so it can be disorienting and frightening. Thankfully it usually goes away on its own once the ear clears.

Dive buddy:

Upon further analysis, my right sinus has a much harder time equalizing than the left. I always manage to get it equalized eventually but when the worst incident occurred, I may not have had enough time to fully equalize my right sinus due to other factors and stresses.

The sinuses don't have much to do with the Eustachian tubes anatomically, though the mucous membrane is continuous with the nasopharynx where the opening of the Eustachian tube is so if your buddy has some sort of chronic inflammation (allergies maybe?) coupled with some anatomic differences on the right side, that could present as both sinus issues and ear clearing issues.

Clearing on descent is one thing, and there's been some solid advice here as far as going slowly and staying ahead of the descent with equalization. On ascent, I recommend that your buddy NOT use the Valsalva maneuver because that could make the vertigo worse and even cause harm. Instead, use a passive equalization method like the Toynbee maneuver (pinch the nose and swallow) or VTO (voluntary tube opening) if your buddy can do that. It's really helpful to have a descent line to reorient if the vertigo happens; absent that, you as the dive buddy can provide a solid reference point. If it happens again, pause the ascent and take a moment to clear the ear.

Alternobaric vertigo can occur outside diving so any otologist should know the mechanism as @jmark18 said and be able to test for Eustachian tube patency. That would be a good next step, especially if this is getting worse as your buddy gets older.

Best regards,
DDM