Yet another ear thread.

[MaxE]

Just returned from a visit with an ENT Dr. looked for one familiar diving but could not get a solid referral. Seems I had a mild middle ear barotrauma. Likely caused while equalizing. Pushed too hard and fluid from eustacian tube into middle ear. I surfer seasonal allergies during 4 of the seasons so not diving with mild congestion is impossible for me. While the last episode seems to be worse than before, looking back it’s likely been a problem the last year or so. I will try to slow down descending and equalize more frequently (I never feel
like I’m having trouble) and make sure to do so with less force. The Dr also suggested I use Affrin spray in the nose before each dive and Sudafed. Is this sound advice? I’m not searching for a way to dive with a head cold or serious congestion, I fully realize that a medical cocktail may enable me to descend, but stop working before I surface and lead to reverse blockage and far more serious ear injury. I have used Sudafed for years and am comfortable with that but it’s not been enough and the affrin is an unknown to me

 

[fmerkel]

If you suffer continual seasonal allergies you should have been put on a regime of non-sedating antihistamines and nasal steroids a long time ago.
Has no one suggest this? If not, you need new doctors.
If tried did you have trouble with it? If so, what exactly?

Afrin and Sudafed are like putting air in a leaking tire. They CAN be useful, and the advice is sound. Both are mostly immediate and are temporary.
Better to fix the leak as well as possible FIRST.

 

[MaxE]

If you suffer continual seasonal allergies you should have been put on a regime of non-sedating antihistamines and nasal steroids a long time ago.
Has no one suggest this? If not, you need new doctors.
If tried did you have trouble with it? If so, what exactly?

Afrin and Sudafed are like putting air in a leaking tire. They CAN be useful, and the advice is sound. Both are mostly immediate and are temporary.
Better to fix the leak as well as possible FIRST.

I did years of allergy shots and during that antihistamines were out. After getting stuck 8 times a week for years I am significantly better than I was as a child. It’s alway somthing I have just lived with.

 

[BRT]

I seldom use Afrin to dive but seldom dive without pseudoephidrine.

 

[fmerkel]

So, you have NOT tried over the counter Claritin-type antihistamines? Not as good as Benadryl, but not sedating for most people. (Useless for me, tried them all).
You can also now get nasal steroids OTC, which would be more useful IMO.
Frankly I could not dive without them. Been using them for over 20 years.

Afrin and Sudafed are backups when the congestion is more pronounced than usual. I don't dive with a cold. That trashes me too badly to even consider it.

 

[MaxE]

So, you have NOT tried over the counter Claritin-type antihistamines?


You can also now get nasal steroids OTC, which would be more useful IMO.


Frankly I could not dive without them. Been using them for over 20 years

I have not tried OTC antihistamine, but will.

What OTC nasal steroids specifically? Flonase ?

 

[fmerkel]

There are 3 OTC antihistamines, last I counted. You may find one works better or has less/no side effects.
They may take awhile to work since they are a competitor at the cellular level with histamine. A single pill is not likely to do much. I'd give it a week unless you have issues.

I use Flonase. If you are near a Costo their Kirkland brand is way cheaper, works as well, and their spray bottle is better.For an expensive product brand Flonase has a pretty lame spray bottle.
Rhinocort is also available. Either should work.
Again, not like Afrin. Takes a few days to a week + to work well. Most common side effect is nose bleeds. Just back off and that should go away. Start with the directions and then figure out what works for you. I use more than recommended. My wife uses them as needed, sometimes going for days without, then using for a couple days if she gets stuffy.

You might consider saline nasal rinses. Most people get the heebie jeebies thinking about it but rinsing out the crap that gets stuck in your nose makes a huge difference. Think of all the stuff in the air, including the things you are allergic to. Then think of the volume of air that goes through your nose every day. It's a big volume and all that brings potential allergens. I'd be a miserable SOB without nasal rinses. I use the NeilMed squeeze bottle. Some people like the Netipot. All this stuff is in the same area in the drugstore.

 

[kmarks]

I use Flonase. If you are near a Costo their Kirkland brand is way cheaper, works as well, and their spray bottle is better.For an expensive product brand Flonase has a pretty lame spray bottle.
Rhinocort is also available. Either should work.
Again, not like Afrin. Takes a few days to a week + to work well. Most common side effect is nose bleeds. Just back off and that should go away. Start with the directions and then figure out what works for you. I use more than recommended. My wife uses them as needed, sometimes going for days without, then using for a couple days if she gets stuffy.

I use the Kirkland Signature version of flonase in the spring and winter because I have a severe grass allergy (spring) and the cold dry midwest air causes me a lot of problems over night in January. It works great and costs less than half what real flonase does. I never had a problem with the flonase sprayer, though. Another common side effect of nasal corticosteroids is headache. Rarely, you can end up with a fungal infection (rarely, as in, it's almost certainly not going to happen to you, but you should know), which can be life threatening. Don't share it with anybody and keep the sprayer clean.

Nasacort gives me nosebleeds almost immediately.

Afrin works great and takes effect within minutes, but you don't want to use it for more than a couple of days. It causes dependency very quickly and can lead to severe necrosis of your nasal passages and sinuses if you really get hooked.

You might consider saline nasal rinses. Most people get the heebie jeebies thinking about it but rinsing out the crap that gets stuck in your nose makes a huge difference. Think of all the stuff in the air, including the things you are allergic to. Then think of the volume of air that goes through your nose every day. It's a big volume and all that brings potential allergens. I'd be a miserable SOB without nasal rinses. I use the NeilMed squeeze bottle. Some people like the Netipot. All this stuff is in the same area in the drugstore.

Make sure you boil the water you put into your bottle/netipot, even if you think it is clean. Anything that is in that water is going to pass right by your brain and that's not somewhere you want bacteria and amoebas to end up. And your tap water certainly has bacteria in it. Also, don't use them within an hour of lying down. Some of the solution won't fully rinse out the other side and you don't want to go to sleep with water in your sinuses. It's great for washing out all the overnight gunk buildup first thing in the morning, especially after a hot shower opens everything up a little bit.

I know from experience that a reverse sinus squeeze is extremely uncomfortable. If your medicine manages to wear off at depth and you can't get the air out of your sinuses, you won't be happy on ascent.

 

[gert7to3]

I use saline nasal irrigation every morning starting a few days before leaving on a dive trip and through the dive trip. I learned another technique from a dive master in Cozumel. He would snort a handful of sea water once we were at the dive site. As to having to boil the water to sterilize it, IMO that is overkill. When you swim, snorkel or dive you get water into your sinuses. One of the advantages of using nasal irrigation is that you hydrate your sinuses. Tank air is quite drying. It gets me used to getting water in my sinuses as well. I will even take a toot of nasal saline solution just before hitting the water.

So far as other meds are concerned, I take Sudafed with me, but rarely use it. I also have Afrin (oxymetazoline HCl ) with me when I dive. If I feel congestion I will use the Afrin. However, if you use it (abuse it?) regularly you can get a rebound effect. Be careful, Sudafed can aggravate hypertension. I also have Benedryl on hand. It can help if you suffer an acute allergic reaction to an insect sting.

I do take Claritin (loratadine) or flonase regularly as I travel to a dive destination. Seems to keep unpleasant allergic reactions at bay.



I am not a doctor. This is what I do for me.

 

[doctormike]

Just to clarify, most of the things that work well for nasal congestion have little if any effect on the function of the Eustachian tube (which ventilates the ear). Systemic decongestants like sudafed can help, as can systemic steroids (rarely used regularly for equalization problems, but often used to treat barotrauma). Oral allergy drugs (antihistamines, Singulair, etc..) work well to optimize nasal sinus ventilation, but there isn't a lot of evidence that they are helpful for ear ventilation.

Topical nasal medications like Afrin (a decongestant), nasal steroids (Flonase, Nasonex), nasal antihistamines (Astelin), and nasal irrigation don't have much effect on the ET because most of the ET is deep in the skull base, and anything topical for the nose really only touches the end of it that extends into the back of the nose.

People often get barotrauma when diving with a cold, since an upper respiratory tract infection causes swelling of all mucosal membranes, including that which lines the full length of the ET. So if you have marginal ET function or poor equalization technique, you may have more problems equalizing than usual. Most people who use aggressive medical therapy to avoid ear barotrauma can learn to ventilate their ears - true anatomic ET dysfunction is rare in adults who have not had radiation therapy. However, it probably does exist to some degree. There is early evidence that ET dilation with balloon instruments may help a select subset of patients. I'm watching this closely, and may be doing it in the future.

Max, you are correct. Equalize early and often, and try different techniques if you are having trouble. Don't push through a problem equalizing, the greater the pressure gradient, the harder to equalize. Slow down your descent, stop, or possible ascend a bit if you are having trouble. If you can't equalize, thumb the dive, since a reverse block (on ascent) is much more serious.

Here is my page on ENT problems in diving, which helps explain the relevant anatomy, etc... While Afrin doesn't work that well for ear ventilation, it is a great drug for nasal congestion (three days ONLY!). However, it does wear off, and if you try to avoid sinus barotrauma with it to dive with a cold, you may end up with a reverse sinus block (which I have had!). For nasal congestion, irrigation with the Neti-Pot is terrific, but as Kmarks said, it is VERY important to use sterile water for this. It mechanically cleans the nose, and the salt solution acts as an osmotic decongestant, pulling water out of the nasal tissue...

Good luck, Max, hopefully you will be back to diving soon! If you want a local referral for a second opinion, feel free to PM me, I might know someone in your area...