Preventing Ear Barotrauma

On my last dive trip, I was diagnosed with ear barotrauma. The symptoms were that several hours after the dive, both ears started to hurt and I developed a head ache. The doctor who diagnosed me put me on antibiotics, advil and Sudafed. I experience the same problem on a trip the year before and think I was misdiagnosed by the nurse on the small island we were diving on.

Now, on reflection, I think I missed a condition I had that contributed to this. Over the last last several years, I've developed a perpetual post nasal drip down the back on my mouth and throat. I chose not to treat this with medication. In hind sight, this condition likely contributed to my barotrauma. Unfortunately, neither myself nor my doctor caught the association with potential ear problems.

I have an appointment with an ENT coming up but here in Toronto Canada. DAN has not been able to provide me a reference to any specialist with dive medicine qualifications in my area.

I thought I'd ask here if anyone else has experienced this and have found a good prevention regiment. I understand from the doctor who diagnosed me there are steps that can be taken such as taking Sudafed starting the week before diving. The first is I've got myself on the medication for post nasal drip.

Thanks in advance for any insights. Hoping this does not mean the end of my diving days.

What are you taking for the post nasal drip? The plague of my life!

TimG, my doctor prescribed Avamys fluticasone fuorate nasal spray from GSK. I've only been on it for about a week and it seems to help but I still have the condition.

However, unless I'm wrong, it seems you are able to dive with post nasal drip without any problems. I was hoping it was the root of my problem.

Thanks for that, Paul. Yeah, happily it doesn't stop me diving and no problems with ear equalisation etc. But, mercy, I do seem to have it all the time. Yuk!

Best prevention for baurotrama is to pay attention to equalization when descending, especially near the surface. Focus on that when you initially start the dive rather than fiddling with a camera. Descend slowly, equalize often.

Some thing during the dive when you're taking photos.. pay more attention to any changes in depth you might be making while absorbed in the camera.

I can't count the number of times I've followed a subject to get the shot (especially on video!) and ended up making large depth changes without equalizing. It wrecks havoc on your ears

Thanks DREIFISH. Yes, that is part of my plan. To equalize often starting on the boat. I also plan to do it while ascending.

 

I can't count the number of times I've followed a subject to get the shot (especially on video!) and ended up making large depth changes without equalizing. It wrecks havoc on your ears

This is a biggie. I end up with a sawtooth profile and my ears are killing me after a week of diving!

Thanks all. As I suspected most of the problem is self inflicted.

Since this a relatively new problem for me in the last couple of years, I'm wondering if anyone has had an ENT eliminate any other possibilities? I've heard of people being diagnosed with conditions requiring surgery to correct.

I have found that keeping sinuses clear by flushing with saline prior to diving is a big help for equalization issues.

A visit to an ENT will help.

What I tell our new divers (and try to do myself) is to equalize every time I take a breath while descending and again while ascending. I have always had some trouble equalizing, and this has helped me a lot, along with descending very slowly and deliberately.

If I am going to be making many repetitive dives in a row, I may also take Sudafed (the real stuff that you have sign for at the pharmacy, not the "over the counter" stuff), and/or may spray a little Afrin decongestant in my ears (not the nose as you would normally). The Afrin in the ears trick helps very quickly, and was something that a Harbor Patrol diver told me about quite a few years ago. Of course, those are not approved uses for either medication, use at your own risk, I am not medically certified to give you advice, etc. etc.

Ear issues after a week of diving are extremely common for many people. There are a few things that you can do. I have the post nasal drip thing also...

1) Take a decongestant of some sort. I use Zyrtec (Cetirizine) a non-prescription 24 release pill. It's mostly for allergies (I don't have any) but it does a good job of drying things up. I take it every night before bed for best results in the morning. It is safe to use 365 days a year for most people.

2) Use drops to clean ears and remove water after each day of diving or after every dive if your problems are severe. Many people use a home made mix of alcohol / vinegar in a 50/50 mix.

3) Some people I know (dive pros) swear by mineral oil drops in the ear before every dive. This likely prevent water from being trapped in the ears and cleans out bacteria.

4) Be diligent about slow descents and gentle ear clearing as you drop. No violent pressure should be needed. If you feel the urge to push harder then descend even slower.

5) New divers are often over-weighted and drop like cannon balls. See number 4, you should descend slowly and under total control of your decent rate.

For ear hygiene using something to dry out your ears is very worthwhile - basically trying to prevent ear infections coming on - I use Aqua-ear available over the counter in Australia it's a blend of isopropyl alchohol and and glacial acetic acid (no water) in a little squeeze bottle. It's disinfectant and also absorbs water helping dry out the ears. Saline nasal sprays can also help. I found getting advice on diving rather difficult from medical practitioners that don't have any dive experience. Luckily I can most clear my ears extremely easily just by swallowing as I descend so can't help much with advice on how to do so.

Thought I would add my two cents since I just came back from a two-week dive trip and had ear problems, again.

In the past my problems were definitely related to not equalizing often enough while doing a lot of 'contour diving'.  (Following the terrain at close range and going up and down a lot.)   And after a week of diving my ears would start getting sore.  If I then did a second week of diving I would always end up sitting out a dive or more (this trip one dive plus an entire day) to recover a bit.

This last trip I was very careful indeed to clear my ears early and often.  I think that eliminated pressure-change-induced issue for me.   One day when my right ear was sore I was extremely aware of pressure changes, and I determined that pressure changing was not an issue for me.

Which led me to the simple, yet profound epiphany - I was getting swimmer's ear after about a week of diving, and this had been going on for years, perhaps a decade!

The solution was swimmer's ear drops.   Once I started using it, my ears improved quickly and I was back in the water after one day of rest. (Skipped four dives).   Then the ear drops ran out, but by that time I was almost completely recovered, or so I thought.   The problem came back the day after I was done diving while flying home.   And once again, after I got home and started using drops (CVS generic brand), the problem has been going away again.

So now I'm going to do everything - equalize a lot and be aware, treat my ears with drops after each dive, and take nasal spray and/or decongestants as well when needed.  I favor a nasal spray called 4-Way, and for decongestant, Mucinex DM tablets work great.

Phoenix Arizona Craig

I have battled this for as long as I have been diving.

I use Flonase (OTC now) and it has helped a lot. My ears still get a little sore but nothing like they used to.

I have gone to alcohol and vinegar after the dive instead of the drops with glycerin.  (After a very unpleasant incident in Crete with the bomb detector machine thinking my glycerin was some sort of explosive.)

It takes about a week for the Flonase to take effect. I hope this helps. Best of luck, ear problems suck.

Regards,

K

Not sure if anyone else has an external ear problem. If so, I used to have it around once a year,  and now I use Doc's Pro Plugs. No problems since we started using them about 5 years ago. I have no interest in their company - just a customer who thinks they work for me.

Tom

Regarding swimmer's ear vs sore from too much equalising, I have always used a gentle pull on the ear lobe as a test. If that causes pain, it's more likely to be a swimmer's ear infection on the outside. If no increased pain from pulling your ear, something is wrong inside.

I'd also caution against "too regular" use of alcohol drops. I had one dive trip where they aggravated my ears when used multiple times a day. Maybe I needed to work up to it and toughen up my ear drums!

I only ever use the alcohol drops once I've done diving for the day, too often and your ears will get irritated.

When I started diving, I have some pressurization problems and a couple of barotraumas. To prevent this, I also “train” my ear when grounded. The balloon treatment for the glue ear disease has been very helpful. In Amazon, you can find some balloon and the nose gear to inflate them. So far, so good. No more ear problems!