Nasal septum deviation - difficulty equalizing left ear

[PACKRMAN]

Appreciate the response! Could you please elaborate when you say, "it helped." Did you always have issues equalizing and noticed a significant difference equalizing after the procedure? Did you have one ear that was more stubborn than the other and the procedure resolved it?

I spoke with an ENT a little while back and actually reached out to Dr. Mike here on the forums. I also scheduled a 2nd opinion consultation in the coming weeks.

It it was my right ear that I had difficulty clearing. As in even above water. After the surgery where he straightened a couple places and widened several more the ear is still slower than the left but will clear every time. I think several hundred dives practicing has helped too. I start clearing before my head goes under the water and at least once every breath to about 40 feet. Go slow, clear early and often. I find that after the salt water sinus purge of the first dive the second dive is easier. I do know a guy who uses a Netty Pot before diving. He swears by it, I hate the damn thing. I guess if it keeps you from having a surgery it is an option. My surgery was easy. Same day, orthoscopic, no packing up the nose. Tylenol was plenty for the pain. The worst thing was rubbing neosporin on the stitches inside my nose. Sorry about the lack of technical info, my medical expertise is limited to "I feel good, I don't feel good"

 

[doctormike]

my medical expertise is limited to "I feel good, I don't feel good"

That's basically the first three years of medical school...

The other important thing we learn is that you can't make an asymptomatic patient feel better!

 

[Redshift]

I couldn't equalize at all before having surgery.

 

[afdgf]

I have to chime in because of my experience. I also could not equalize my left ear and every scuba trip resulted in yet ANOTHER trip to the ENT. I finally went down to see Dr. Weeks in San Diego and told them I wanted the balloon dilation of the Eustachian Tube. They said "well lets check you out anyway." They said "No wonder you cannot clear your left ear, you cannot breathe through your left nostril either. You have a gigantic bone spur going all the way from front to back. I also had a smaller bone spur on the right also. I have been on allergy shots since 1966. They also said that I had a severely deviated septum. I was eagerly looking forward to having the surgery (which is a first for me, usually I dread it). They did the septoplasty, reduced the inferior turbinates, took out the bone spurs, removed some leftover andenoid tissue from when I was a kid, and did the balloon dilation of the Eustachian Tube bilateral. The result has been amazing. Nothing short of miraculous. I had no idea that normal people were like this. I now just lay in bed sometimes and breath through my nose. It is more entertaining than watching television. My allergies are now only 25% of what they used to be. I can go scuba diving and clear both ears without massive amounts of prednisone, pseudophed, and allegra, and afrin. Even with all of those drugs, I would usually have to skip the second dive of the day and take a day off from diving after a day of diving. NOW I can clear both ears, do the second dive of the day, am able to do consecutive days, and do not have any trouble with the airplane ride on the way back. I now realize how screwed up I have been most of my life and am somewhat angry that with all of the doctors I had seen, not one of them ever told me to get myself checked out. If I had not read about the balloon dilation of the ET thing, I would never have gone to Dr. Weeks in San Diego. This surgery has been a miracle and if anyone had told me that it was going to have this great of an effect I would never have believed them.
I do not know if I just wasted a lot of your time, or if this helps. Good luck.

 

[LVFT]

I have always had issues with my ears and sinuses from back when I was a kid. I began having trouble again last year during allergy season with my ears so I went to my local ENT doctor. I had a turbinate reduction and another procedure on my nose (under local in the office--I don't recommend local for most people and the nasal packing was pretty miserable). I also had a relatively new procedure done at another time called a balloon tuboplasty.

Both surgeries have helped tremendously. I still have a slightly deviated septum on the left (which is my problem side), but I am able to equalize very easily. I'm an RN in the operating room and don't want to have the septum fixed (it's a curse to know too much). The other two procedures helped me 85%. I still take nasal sprays and use the netibottle daily.

Appreciate the information! I will be sure to ask about the turbinate reduction procedure to see if that is something that will help me when I speak with my ENT. I've read some mixed reviews regarding the Septoplasty procedure and I think it's something I'm going to avoid unless it's necessary and/or would help. However, I don't think I've ever had issues equalizing my sinuses and based on what I've read and what Dr. Mike said, it probably wouldn't benefit me.

Sure... you have pretty well ventilated sinuses, with only a small retention cyst or polyp in the bottom of the left maxillary sinus (I usually ignore something like that, not really clinically relevant). Your tooth roots are going up into the sinus - any dental issues? Sometimes that can cause issues with diving, especially if there is a potential or partial fistula between the mouth and sinuses.

---------- Post added May 21st, 2015 at 10:52 PM ----------

No, never any major dental issues. Wisdom teeth were removed quite awhile ago and a root canal, but other than that, no issues. I have never had sinus or tooth pain while diving.

Quick question for you, based on the CT scan above, how would you classify my septum? From a medical perspective, is it viewed as deviated, slightly deviated, severely deviated....? I don't think I'm going to worry about correcting it since I don't believe that is the root of the problem, but would like to know your thoughts.

I have to chime in because of my experience. I also could not equalize my left ear and every scuba trip resulted in yet ANOTHER trip to the ENT. I finally went down to see Dr. Weeks in San Diego and told them I wanted the balloon dilation of the Eustachian Tube. They said "well lets check you out anyway." They said "No wonder you cannot clear your left ear, you cannot breathe through your left nostril either. You have a gigantic bone spur going all the way from front to back. I also had a smaller bone spur on the right also. I have been on allergy shots since 1966. They also said that I had a severely deviated septum. I was eagerly looking forward to having the surgery (which is a first for me, usually I dread it). They did the septoplasty, reduced the inferior turbinates, took out the bone spurs, removed some leftover andenoid tissue from when I was a kid, and did the balloon dilation of the Eustachian Tube bilateral. The result has been amazing. Nothing short of miraculous. I had no idea that normal people were like this. I now just lay in bed sometimes and breath through my nose. It is more entertaining than watching television. My allergies are now only 25% of what they used to be. I can go scuba diving and clear both ears without massive amounts of prednisone, pseudophed, and allegra, and afrin. Even with all of those drugs, I would usually have to skip the second dive of the day and take a day off from diving after a day of diving. NOW I can clear both ears, do the second dive of the day, am able to do consecutive days, and do not have any trouble with the airplane ride on the way back. I now realize how screwed up I have been most of my life and am somewhat angry that with all of the doctors I had seen, not one of them ever told me to get myself checked out. If I had not read about the balloon dilation of the ET thing, I would never have gone to Dr. Weeks in San Diego. This surgery has been a miracle and if anyone had told me that it was going to have this great of an effect I would never have believed them. I do not know if I just wasted a lot of your time, or if this helps. Good luck.

Awesome information! The recurring theme seems to be the success that people have had with the ET balloon dilation procedure. I actually just started reading into this the other day. To me, it seems like the risks are minimal in comparison to the benefits. If my ENT determines this to be in my best interest, I think this is a procedure I would be highly interested in.

I've read that it's a pretty quick procedure with minimal pain (if any). My only concern is that this seems like a rather new procedure that is not performed everywhere. I wonder if there is someone located on the East Coast that does it. Although I'm never opposed to visiting San Diego :cool2: I'd also guess that since this procedure is newer, it probably isn't covered by most insurances. Does anybody have any insight into this? Perhaps the procedure itself isn't covered, but insurance would cover other aspects? I know this something I should take up directly with my insurance provider, but was hoping someone might be able to shed some light on this.

THANKS TO EVERYONE HELPING OUT!!

 

[afdgf]

The guru on the east coast is Dennis Poe out of Harvard. This procedure is in clinical trials now for the US but has been accepted practice in Europe. When I had it it was part of everything else so I was under general anesthesia. There are other ENTs who are starting to do it, but Weeks and Poe are the originals in the US and have done more of them. It was still off label for the US so my insurance did not cover it by itself, but everything else was in plan, so the insurance paid for the rest of Weeks, anesthesiologist (but be careful to get on in plan), hospital etc. subject of course to deductible. The Balloon dilation procedure cost me an additional $3,000 out of my pocket, but that included both ETs. If you look at the internet reports on the septoplasty stuff in general you will find that about 2/3 of the people who had it love it. The other 1/3 had the surgeon screw it up. The moral of the story is that if you are going to have surgery, get it from a surgeon who does A LOT OF THEM, whatever procedure we are talking about. Good luck and let us know what happened.

 

[TSandM]

The moral of the story is that if you are going to have surgery, get it from a surgeon who does A LOT OF THEM, whatever procedure we are talking about

This is good advice for any surgical procedure of any kind!

 

[Bratface]

Doctormike--My ENT doc told me there are a few doctors who are doing the tuboplasty on children, under general anesthesia, of course. It is a controversial procedure and I knew that when I had it. I also read as much information about it that I could find. Another dive buddy had it done after mine and she also got good results. Definitely worth having it done.

 

[doctormike]

Doctormike--My ENT doc told me there are a few doctors who are doing the tuboplasty on children, under general anesthesia, of course. It is a controversial procedure and I knew that when I had it. I also read as much information about it that I could find. Another dive buddy had it done after mine and she also got good results. Definitely worth having it done.

I guess it depends on your definition of "children"..!

ET dysfunction in children is incredibly common, and usually goes away by itself. It's related to a number of things including the anatomy of the skull base, the consistency of the ET cartilage, and the function of the muscles that dilate it. But in almost every case, those things improve with growth.

The thing is that dilation does just what it says - dilates the ET. But the problem in the ET of early childhood isn't that it's stenotic (narrowed) and needs to be forced open, it's a functional problem of all of those mechanisms.

So if by children you mean a 2 year old with frequent ear infections or middle ear fluid, then that sounds pretty aggressive. If by children you mean a 12 year old who is having difficult in open water class, then that's a different story...!

---------- Post added May 25th, 2015 at 09:34 PM ----------

This is good advice for any surgical procedure of any kind!

Not always! There are some procedures with questionable indications but high reimbursement rates where being very busy might mean that your surgeon has other than your best interest in mind...

 

[LVFT]

First off, I wanted to thank everyone for helping out on this thread.

I was very disappointed with my 2nd opinion consultation this morning. I visited Dr. Jay Farrior here in Tampa and left without any new information. After waiting 1.5 hours in the exam room, the Doctor finally came in. Unacceptable. As such, we didn't start off on the right foot as I was very annoyed they were this far behind for an early morning appt. All he did was look in my ears and put decongestant cotton swabs up my nose. He then left again and returned to remove the swabs and have a look. This was the gist of my exam. I had to prod to get any information out of him.

I finally got him to review my CT scan and he basically said the deviated septum might be playing a role. Based on most of the information I've read, this is not the case. I asked about Balloon Dilation and he mentioned Dr. Poe up in Boston. He said he had a conference with Dr. Poe in September and I should check back with him in early October to see if Dr. Poe had any information. Really? It's June and I'm supposed to wait until October? Additionally, he said the Balloon Dilation would be performed in conjunction with sinus surgery. I'm not sure this is true and/or completely necessary. He also told me that I should try Afrin. I mentioned that I have used Afrin in the past with some success but did not want to overuse for fear of rebound. He told me that I shouldn't have any issues using Afrin for 5+ consecutive days of diving if I'm only using it prior diving. Is this true? I thought people were not supposed to use this drug for more than three consecutive days?

Well it looks like it's back to the drawing board. I have started experimenting with removing dairy from my diet to see if this has any impact. I'm hoping this will cut down on mucous production. I think I may try using Mucinex in the blue box a few days prior and during my next dives to see if that helps. Lastly, I was also researching the topic of inflammation. I was wondering if anyone had any experience using the following (the reviews seem positive): Amazon.com: New Chapter Zyflamend Whole Body, 180 Softgels: Health & Personal Care

Would this be of any help? My thoughts are that the ETs might be inflamed (perhaps from allergies, although I'm combating this with my allergy regiment), thus restricting the opening of the ETs. Any input would be greatly appreciated and thanks again for everyone helping out on this board!