What can I do about my ears?

[diveguy600]

I need some help and advice here. I got my OW cert in April 2009. When I first attempted it due to equalization problems on my open water dives I perforated my left eardrum. After it healed I was able to successfully do the rest of the course and earn my OW. Since then I have completed my Advanced OW and have also done almost 100 dives all over the world through a mix of perseverance and luck. Diving is something I truly love and I relish at every chance I have to dive whenever I am at any destination. However, I have had persistent trouble with equalization and my ears. Sometimes I am able to equalize beautifully, this is especially true in warm water of 80+ F. However at other times my ears absolutely refuse to equalize no matter what technique I use - valsalva, chewing etc. I have tried everything, this is despite having no apparent symptoms of any cold or congestion. One time in Thailand on a Similans liveaboard I was able to equalize just fine one day and the next it was impossible. I also have problems taking off and landing on airplanes so I know something is wrong - perhaps my tubes are way too narrow.

The question here is what are my options? I know I can go to a doctor and get it diagnosed but if it is anatomical then is that the end of it? I am scared to dive anymore since it's just an uncomfortable exprience for me. Last time I went diving in Catalina the water was cold and I just could not equalize at all! I don't want to perform any kind of surgery since I am scared it will be a risk to my hearing if something goes wrong!!

I would like to continue this sport if I can actually reliably know I can complete the dives I sign up for.

 

[Quero]

You need to go see an ENT specialist. It's hard telling what it might be. One of my divers (a fun diver) had nasal polyps. Sometimes they obstructed the passages so that she couldn't equalize and at other times she did just fine. She had them removed, and since that time she's fine. A different diver, a student, just couldn't get down without a struggle. I took him to the doc and it turns out he's got a deviated septum. He never finished the course, but he does plan to have surgery to correct it since it's not just a problem for diving--as you say, it's hard on landings when traveling by air as well, and there are other breathing issues too. Some people have eustachian tube narrowing, so any little bit of mucus plugs them up, and what you could do about that sort of anatomical issue, I don't know. The point is that without having a specialist take a look, you just can't be sure what to do about your ears!

 

[doctormike]

It's actually rare for nasal obstruction to be the primary problem causing difficulties with ear equalization (as opposed to sinus equalization). This is a common assumption, since people who have marginal Eustachian tube dysfunction (ETD) who then get an upper respiratory tract infection will have a worsening of their abilities to equalize their ears, along with nasal symptoms. This is because the ET is lined with the same stuff (respiratory mucosa) as the nose, so when it all gets swollen, both the ears and the nose can suffer, especially during diving.

I totally agree with Quero that a good examination by an ENT doctor is the first step (feel free to PM me with your location, I may be able to give you a local referral).

In the meantime, here is my article on ear disease and diving: Ear Injuires

And here is Dr. Kay's excellent summary of the various equalization techniques (you may have missed one): Prevention of Middle Ear Barotrauma

Dive safe!

Best,

Mike

 

[deborahdelamar]

If possible, see an ENT who either is in a dive-medicine group or who treats divers. DAN, in the USA at least, may be of assistance in locating a physician in your area. And when you call to make your appointment, confirm that the clinicians are familiar with diving-related issues since that is why you plan to visit in the first place!

 

[doctormike]

If possible, see an ENT who either is in a dive-medicine group or who treats divers. DAN, in the USA at least, may be of assistance in locating a physician in your area. And when you call to make your appointment, confirm that the clinicians are familiar with diving-related issues since that is why you plan to visit in the first place!

Yes, good point... unfortunately, that's a big "if possible"! DAN is terrific, but their referral network is only as good as there are doc willing and able to fill those spots. While there are a number of hyperbaric medicine specialists around the country, they tend to be pulmonologists or critical care physicians by primary training who then go on to sit for the HBM boards. For ear stuff, it's probably better to go to an otologist - that is, an ENT doc specializing in ears. I'm not an otologist, I'm a pediatric ENT doc, but I will see adults with dive issues for basic problems. Anything that requires specialty care (like a perilymph fistula), I refer to an otologist.

OP, you mentioned Catalina. If you are in the LA area, one of the oldest and best respected otology groups is there:House Research Institute

 

[diveguy600]

thanks to all the informative responses!! Yes, I am indeed in the LA area, Orange County to be more precise
Another aspect is costs... I have full coverage health insurance through work, I have to find out if procedures like correction of a deviated septum etc. are covered through insurance and if not how much such a procedure would cost (from a google search it looks like around $10,000)

I should mention that when I sleep I can breathe better if I sleep on my right side than I can if I sleep on my left side (I feel more breathing restriction on my left) so I am guessing this could be a sign of a deviated septum!