Mild ear and sinus barotrauma and diving afterwards.

Questions relating to medical issues and treatment. Where possible and appropriate, we will request comment from qualified and reputable NZ-based diving doctors. If your query relates to a personal medical issue, we recommend you contact your GP or relevant medical specialist.

Mild ear and sinus barotrauma and diving afterwards.

Postby sfish » Mon Mar 23, 2009 11:55 pm

I was looking forward to post the great events of having the pleasure to share diving experience with people that had never done it before...and how much fun that can actually bring!
I will put a report on this for sure (and lots of pictures), but right now the post I need to concentrate on is about the follow on event of, what otherwise was a fantastic couple of days (but more on the positive soon :D ).

So to cut a long story short, one of my friends did his intro dive on Friday.
We could not have asked for a better day for it and we had the boat more or less to ourselves, just the 4 of us. So lot's of space and no stress.

What seems to have happened is that when he went down at the start of that trial dive he was so busy thinking about everything else he forgot to equalize.
He knew because he felt the pressure then.
The Instructor (this was the official PADI intro to scuba diving), quickly signal to him to go back up a bit and start equalizing, which he did straight away.
They went on with the dive, 11meters 36 minutes...big smiles as they came back onto the boat....The Instructor said straight away he thought he will shine through the Open water course 8) 8)
I stopped the camera though as I saw some blood in his mask as he was climbing back the ladder.
Instructor said must have been a blood vessel and not to worry, so we didn't. And the bleeding was not bad at all, it’s not like blood was pouring out or anything of that scale.
Everyone felt very happy and could not stop talking on how much fun that had been. :D

Afterwards new diver started to have troubles with his ears. Not so much pain put he felt like there was water in between them and he heard crackling noises every time he moved. He found that quite annoying.

I kept an eye on the situation over the week end, got him to read about equalizing so I could get some idea on whether to ask for help and what to communicate. I needed to have some idea of what might have gone wrong.
It's very hard with a new diver to find what they did and didn't do and also the last thing I want is stress him out or worry him, and it’s a lot to take on first time.

But as he was not getting better I got help from P. t. E. to see if there was anything we should do or if we should just ignore it, and also wanted to give the new diver some re assurance.
It kind of worked but the ears were not getting better, in fact by Sunday it was the other ear that was causing trouble.

This morning he went on to try decongestant as we had been advised. But instead of helping he could hear like drums banging in his head for at least one hour. Again not so much pain but the noise.

I knew then he had to go and see someone. I phoned DAN to go through the symptoms and see who they would advise in the diver home location. I only know a couple of brilliant ones in Auckland and abroad.

Until then we were thinking mild ear barautroma (I had fisrt been thinking reverse block).....DAN agreed and said to go and find a doctor, but that even a GP will do as we needed to have the ear looked at to see how it actually looked inside to make the next treatment decision. He said a dive doctor would be a bonus but a GP would do just fine.
When I talked about the nose bleed he also mention there is a potential that we had sinus barautrauma as well, so to get it checked too. :cry:

Diver has re-register with a GP who specialize in dive medicine, and we should know tomorrow the extent of the situation (well that’s assuming he still wants to talk to me after seeing the GP). I don't think it is anything too dramatic as he is not in any insane pain, and if anything was perforated I assume he would be. Nevertheless he does need to get a physical diagnostic and associated treatment.

DAN said he should not dive for next ten days to two weeks, well there is no risk of that :cry:
Although after the dive he did say he was really wanting to do some more and take his open water as soon as. And how wonderful experience it had been!
He also said that a bad day diving would always be better than a good day at work (and he did not think he had a bad expereinec either), that’s when I knew he was hooked on diving regardless :D

My main concern, other than the immediate want to get him seen so he gets a diagnostic and get this sorted.... is whether this is in anyway a sign that diving is simply not for him?
And that well I really don't know. Some people just do not have the ears for it. I know of at least 2 people (family members that can not physically dive at any depth)
I have asked P. the E. and I have asked DAN, and it's hard to say (plus I think they did not want me to feel too guilty, which I do anyway).

One school of thought says that once this is fixed and he is back in the water and has learnt to equalize, he could be a "happy diver".
Another one is that his ears are not very good with pressure and that it may not be his thing.
Patient is otherwise fit and participates in all sorts of team sports etc in his spare time out of the water; he is just over 40 and has no problem with pressure in planes. He had never tried scuba diving before.

I am interested in hearing if this may have happened to you, your students, your buddies, what the circumstances where and the consequences. I am not trying to draw any conclusion or speculate, as everyone is different of course, but would like to be equipped with real story so I can make him understand that these things do happen and hopefully can have a happy ending. But likewise if that is a sign that he can't dive and his new GP (and other specilaists) is/are about to tell him that, then I'd like to hear your stories as well so he'll know some people are just not made for it, and that’s ok. Where I stand I have very little data and would like to help him the best I can outside the medical aspect of this?

Any comment welcome,

Thanks ahead.
"Blogging: Never before have so many people with so little to say said so much to so few."
Image
sfish
Member
 
Posts: 46
Joined: Mon Dec 01, 2008 5:46 pm
Location: Auckland, New Zealand...

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby Andy » Tue Mar 24, 2009 8:54 am

I've had, or seen, students that have many of the individual symptoms - but normally not all at the same time!

Blood in the mask is fairly common, I think - tends to be equalising too hard (read, too late!). Different approaches to equalising may help, as well as thinking about doing the valsalva earlier and mroe often. I had a really troublesome student who couldn't even equalise in 1.5m of water.... ended up doing a lot of research on how the competitive freedivers equalise. There are exercises you can do that make equalising easier.

Crackling, painful ear is again common - we don't really use the Eustachian tubes much in normal life. Generally, the crackling sensation tends to go away over time as the diver does more and more dives. For some, though, it doesn't.... I know that some people have small tubes that easily get blocked with mucus and other cr@p. There is, I beleive, a procedure for "reaming out" the tubes - but I don't beleive it is recommended in many circumstances, particularly for what is a "lifestyle choice". Hopefull GregV will chime in and provide a more informed opinion on that one, as I'm a little outside of my field here - however, I would tend to think that exercises to strengthen the muscles that open up the Eustachian tubes would have some benefit here.

Note: This is an instructors perspective, and not an informed medical opinon at all!
Andy
Serial Poster
 
Posts: 4628
Joined: Thu Feb 01, 2007 1:29 pm
Location: Auckland

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby Xman » Tue Mar 24, 2009 4:15 pm

Andy wrote: There is, I beleive, a procedure for "reaming out" the tubes - but I don't beleive it is recommended in many circumstances, particularly for what is a "lifestyle choice". Hopefull GregV will chime in and provide a more informed opinion on that one, as I'm a little outside of my field here - however, I would tend to think that exercises to strengthen the muscles that open up the Eustachian tubes would have some benefit here.

Note: This is an instructors perspective, and not an informed medical opinon at all!


Not directly related to the original question, but just some relevant info. My wife Jo has extremely narrow eustachian tubes and has, earlier in her life, had the operation to widen them. She was cleared by an ENT specialist do go diving. She did the pool portions of her open water course no problem (shallow pool though). When on the first open water dive she got to about 6 or 7m and was unable to equalise. The instructor did the right thing and brought her up a few meters and tried again. Still no luck some up a few more meters and try again. It was clear that she was unable to equalise and the instructor brought her to the surface. Unfortunately she had partially equalised on the way down at some point and this pressure was now unable to be released. The reverse block blew out her eardrum (extremely painful) and the situation means that she was unable to dive again.

The main point I would make is that there ARE some people whose eustachian tubes are too narrow for them to safely dive. I hope that the person in question gets cleared and is able to continue on with diving.
ImageXman
Forum Moderator
User avatar
Xman
Member
 
Posts: 1007
Joined: Mon Jan 29, 2007 10:24 pm
Location: Laingholm, Waitakere

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby Peter the Eel » Tue Mar 24, 2009 6:28 pm

More info on Saturday's diagnostic + cause and effect:

Middle Ear barotrauma of descent (middle ear squeeze):

About one quarter of diving trainees experience this to a variable degree.
If equalisation does not occur, the middle ear space is partly filled with blood and swollen tissues. The depth at which this damage occurs depends on the size of the middle ear space. It is normally reached at 1-2 meters and if the diver does not equalise by the time he has reached this depth, barotrauma of the ear is likely.
With mild barotrauma pain or discomfort in the ear may be felt after the dive.
There is often a feeling of fullness or water in the ear. Crackling sound may also be noticed especially with every jaw movements. This is caused by bubbles of air in blood/body fluid mixture with the middle ear.
Blood from the middle ear can sometimes then be forced down the Eustachian tube when the middle ear gas expands on ascent. After surfacing the diver may then notice small amounts of blood coming from the nose or mouth.

Treatment:
Advised the patient to try nasal decongestant spray if symptoms were still present by Monday morning.

Decongestant in this occasion was ineffective and we are awaiting the diagnostic from the physical examination (if B still talks to S :evil: !).
Image
User avatar
Peter the Eel
Member
 
Posts: 16
Joined: Wed Feb 18, 2009 11:07 pm

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby Scuba Sam » Mon Mar 30, 2009 10:23 pm

Peter the Eel wrote: Crackling sound may also be noticed especially with every jaw movements. This is caused by bubbles of air in blood/body fluid mixture with the middle ear.


I've got "slow ears" - on my open water course my buddy had completed all her drills at the bottom of the diving pool before I made it down the ladder to the bottom. Various things help me to be better some days than others, and I avoid any diving where there is an increased likelihood for me to be swept up or down several metres at once (e.g. certain spots when we were at the Three Kings).

But I get the cracklng sound constantly with jaw movements, whether I have been diving recently or not - I thought that was from equalising!! I didn't realise it was abnormal - if anything it tends to happen more when my ears are better at equalising. I've only had blood in my mask once, years ago on a wreck dive, and only a trace. I await medical explanations with interest... I hope its good news for your buddy.
User avatar
Scuba Sam
Member
 
Posts: 109
Joined: Mon Sep 01, 2008 1:49 pm
Location: Whangarei, Northland

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby sfish » Tue Mar 31, 2009 12:13 am

Reply a little bit overdue....just getting there with catching up with all the posts. I did check up on him regularly though seeking for good news...whilst Nem and Pete did a great job with my guilty feelings (thanks guys).
So after medical inspection indeed it was Barotrauma.....and not mild Barotrauma :-((
He was advised to take it easy and that if noise and pain hadn't gone away three days later (i.e a week after the incident) to take/use some more nasal spray decongestant.
We had been advised this the day after the incident and on the Monday he had tried it however had used a child one (That's all he had at home), but then that did hurt him a lot when he did use it with no results.
The good news is that the adult spray did work (I think he used the Sudafed one, though any pharmacy brand will do), as a few hours later he was finally able to equalize....Can you imagine not being able to equalize for a week!
Well at least h could equalize with one ear then banging noise in the other.
Now 4 days on,after he started to spray he is better but the ears are still not totally right, one still can't equalize and the crackling noise is still there in the other.
He needs to try to use the spray twice a day and wait 10 minutes then start equalizing softly, to do so instead of using the nose to equalize he was advised to still pinch the nose but then instead of blowing, swallow, so no blowing to avoid further pain discomfort or damage....I guess that's why this is taking a lot of time (?!?!?).
Good news is that he is still keen as ever to dive when the time is right so we have not lost him as a fellow diver....

I will go ahead and post the trip/training report as this was such a great event. I was waiting to hear how he was getting on before rubbing it in on the forum, but he is cool about the whole thing so I'll get the write up done shortly.
"Blogging: Never before have so many people with so little to say said so much to so few."
Image
sfish
Member
 
Posts: 46
Joined: Mon Dec 01, 2008 5:46 pm
Location: Auckland, New Zealand...

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby justsimon » Tue Mar 31, 2009 9:00 am

Now 4 days on,after he started to spray he is better but the ears are still not totally right, one still can't equalize and the crackling noise is still there in the other.


As I understand it, using those nasal sprays for more than a couple of days can result in rebound congestion. I'm been advised in the past to stop using them after 3 days (I'm not a medico).
User avatar
justsimon
U/W Photographic genius
 
Posts: 1012
Joined: Tue Aug 14, 2007 9:19 pm

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby sfish » Tue Mar 31, 2009 12:15 pm

justsimon wrote:
Now 4 days on,after he started to spray he is better but the ears are still not totally right, one still can't equalize and the crackling noise is still there in the other.


As I understand it, using those nasal sprays for more than a couple of days can result in rebound congestion. I'm been advised in the past to stop using them after 3 days (I'm not a medico).


Holly C***....thanks for that I'll get the hold of the dive medics and check that one out now.....
"Blogging: Never before have so many people with so little to say said so much to so few."
Image
sfish
Member
 
Posts: 46
Joined: Mon Dec 01, 2008 5:46 pm
Location: Auckland, New Zealand...

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby guru » Tue Mar 31, 2009 12:18 pm

justsimon wrote:As I understand it, using those nasal sprays for more than a couple of days can result in rebound congestion. I'm been advised in the past to stop using them after 3 days (I'm not a medico).


I've had the same recommendation when using the nasal version of 'Otrivin'
Self confessed IT hack and genuine nutjob.
Wise words of Mr Miyagi: "Don't forget breathe..very important!"
User avatar
guru
Member
 
Posts: 403
Joined: Mon Mar 23, 2009 4:54 pm
Location: Newlands, Wellington

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby gingerninja » Sat Apr 04, 2009 7:27 am

sfish wrote:
justsimon wrote:
Now 4 days on,after he started to spray he is better but the ears are still not totally right, one still can't equalize and the crackling noise is still there in the other.


As I understand it, using those nasal sprays for more than a couple of days can result in rebound congestion. I'm been advised in the past to stop using them after 3 days (I'm not a medico).


Holly C***....thanks for that I'll get the hold of the dive medics and check that one out now.....


Don't freak out - decongestants do not cause rebound congestion. The problem is that if you are using a decongestant it could wear off while you are diving, and they congestion could cause a reverse block. Its not the medicine thats a problem, but the underlying reason for needing it.
Willie Apiata is the reason why Osama is hiding.
User avatar
gingerninja
Member
 
Posts: 207
Joined: Tue Jun 26, 2007 2:21 pm
Location: Hamiltron

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby justsimon » Sat Apr 04, 2009 8:19 am

sfish wrote:
justsimon wrote:
Now 4 days on,after he started to spray he is better but the ears are still not totally right, one still can't equalize and the crackling noise is still there in the other.


As I understand it, using those nasal sprays for more than a couple of days can result in rebound congestion. I'm been advised in the past to stop using them after 3 days (I'm not a medico).

Holly C***....thanks for that I'll get the hold of the dive medics and check that one out now.....

Don't freak out - decongestants do not cause rebound congestion. The problem is that if you are using a decongestant it could wear off while you are diving, and they congestion could cause a reverse block. Its not the medicine thats a problem, but the underlying reason for needing it.


Are you medically trained Ginjaninja? Could you say where you get this information from?
User avatar
justsimon
U/W Photographic genius
 
Posts: 1012
Joined: Tue Aug 14, 2007 9:19 pm

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby Andy » Sat Apr 04, 2009 11:58 am

I would hazard a guess that GN is talking about oral decongestants, e.g. sudafed?

Obviously you can question the credibility of Wikipedia, but:

http://en.wikipedia.org/wiki/Topical_decongestant and http://en.wikipedia.org/wiki/Rhinitis_medicamentosa


The key word here is "may" cause rebound congestion. It's not worth the risk in-my-completely-not-medical-opinion, I know someone who has become "addicted" (for want of a better word) to Otrivin as a result of over use.
Andy
Serial Poster
 
Posts: 4628
Joined: Thu Feb 01, 2007 1:29 pm
Location: Auckland

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby Gregv » Sat Apr 04, 2009 9:15 pm

gingerninja wrote:Don't freak out - decongestants do not cause rebound congestion.


Not sure whether the above was meant how I read it, but decongestant nasal sprays do cause rebound congestion if used for more than a short time. The time will vary between individuals, frequency of use, and the active component of the spray. Short acting decongestants all work using a vasoconstrictor. The exact drug used varies, but they all do the same thing for variable amounts of time - the blood vessels in the nasal mucosa clamp down easing swelling of the mucosal tissues. Less snot production, less swelling , less airway obstruction.

The rebound effect is not that well understood, but the blood vessels in the nose become tolerant to these vasocontrictors, so they stop working so well after a few days of use. If one continues to use them, some individuals can develop damage to the mucosal surfaces inside the nose that look like a burn. The extreme case is perforation of the nasal septum - I've never seen it, but its in the textbook.

Better off using nasal steroid like fluticasone et al for long term nasal congestion. Doesn't work as quickly, but much better long term.

gingerninja wrote: The problem is that if you are using a decongestant it could wear off while you are diving, and they congestion could cause a reverse block. Its not the medicine thats a problem, but the underlying reason for needing it.


Yes, a nasal decongestant can wear off while one is diving possibly leading to a reverse block, and that is probably reason enough to wait for your cold to settle before diving. But who hasn't done it?

Regards

Greg
User avatar
Gregv
Diving Doctor
 
Posts: 57
Joined: Sat Apr 07, 2007 7:42 pm
Location: Tutukaka, NZ

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby bertibull » Mon Apr 06, 2009 7:51 pm

i think i may have something similar, but would love to know what others think. For the last 6 months or so i have suffered from a painful nose and sore ears during and after my second dive. I am always absolutely fine on my first dive and don't have any problems equalising or getting down. On my second dive i can normally get down ok, but if i then try to go up and down a bit during the dive (as you normally would) i get a pain in my nose and my ears become sore. i thought that maybe my mask was a bit tight, so have loosened that, and my nose wasn't sore, but my ears were still sore. it is now 2 weeks since my last dive and i still have pain in 1 of my ears. i went to the gp on friday and they said that there looked like something was built up behind my ear, but that my good ear was the same. other than that they looked fine apparently. What do people think this is? why does it only happen during the 2nd dive? and is there anything i can do to stop it happening again. Any suggestions and advice would be greatly appreciated.
bertibull
Newbie
 
Posts: 1
Joined: Mon Apr 06, 2009 2:21 pm

Re: Mild ear and sinus barotrauma and diving afterwards.

Postby tara » Tue Apr 07, 2009 9:30 am

go back to the doctor. they are the experts.

they say there is something built up. what?
did they give you anything to clear it?
User avatar
tara
Dive Mistress
 
Posts: 848
Joined: Sat Sep 27, 2008 11:43 am
Location: Auckland

Next

Return to Diving Medicine

Who is online

Users browsing this forum: No registered users and 1 guest