Different question on deviated septum

[kas]

Hello and thank you in advance for your help.

Here is the gist of my question: why does a deviated septum affect ability to equilize?

Second, does a deviated septum affect ability to equilize in both ears?

I am a shiny new diver who just completed his first open water dives.

I am extremely disappointed by my ability to equilize only very slowly, descending inch by inch and equilizing every inch or ascending to complete equilization. Ten minutes to get down to twenty feet deep!

Also, I had a small amount of blood in my mask (after all of that gentle pinching and gentle blowing, I'm not surprised) upon surfacing.

It's been three days and my ears still feel like they have been stuffed with cotton.

I have been told in the past that I have a somewhat deviated septum.

Going to doctor tomorrow to request referral to ENT specialist. I live in Chicago.

I have normal hearing, fly on commercial flights regularly with no problems, I had no cold, have never had alergies, but I do suffer from motion sickness when I am not driving, but riding in an automobile and severe, disabling motion sickness on the sea.

Thanks again!
Keith

 

[The Iceni]

Reference to the antomy of the nose and ear, and the mechanisms employed to clear the ears convinces me that it is not the deviated septum, itself, that is causing your problems.

I suspect Kas, if the origins of your deviated septum were traumatic, you may have damaged the bones surrounding the eustachian tube causing it to be narrowed on that side alone. If it is a feature of your "anatomy" you may have a naturally narrowed tube on that side.

There are, of course, more mundane causes such as allergic rhinitis, sinus disease, adnenoidal disease and posterior nasal polyps, all of which which could cause eustachian tube obstruction and/or the other features you describe.

You might wish to try a decongestant, or perhaps even a steroid nasal spray.

Don't give up! What you describe is VERY common in novice divers and often settles in time particularly with improved technique, and slow descent rate on leaving the surface, but it does indeed sound like it is a bit more than that in your case so you are wise to consult an ENT specialist.

I hope this helps.

 

[kas]

I appreciate the positive thinking. I badly want to be able to dive!

I saw my new primary care physican today and he advised me that my septum was not significantly deviated. I have had no nose trauma.

He also indicated that I had some blood both "in front of" and "behind" both ear drums. He suggested that I take Sudafed 12 hour for up to two weeks until my symptoms of "it sounds like I have a cotton ball in each ear" disappear. He gave me a referal to an ENT specialist and recommended that I see the ENT after a month or so, in order to enable the blood to clear up so that he can get a good look at my ear.

So, it sounds like my problem may be something other than the deviated septum.

After I see the ENT I would like to take his recommendations (meds?) and try another dive in a pool as a control compared to my last pool dives, where I did have to descend very slowly.

I am hoping that some obvious correction can be made so that I don't need meds, but even that would be preferable to never diving.

Any more thoughts for me? Possible causes? Related to my motion sickness? Strange that flying doesn't bother me?

Keith

 

[scubadoc]

Hello Kas:

As usual, Dr. Thomas' advice turned out to be quite sound! You obviously have had extreme difficulty clearing and most often the problem turns out to be one of 'poor technique' or no technique.

Dr. Allen Dekelboum has written a simple set of various techniques for equalizing the middle ear. These are attached.

Give your ear plenty of time to heal before you attempt descent again.

 

[The Iceni]

Hi scubadoc,

While Dr. Dekelboum gives some good advice I am not sure I agree with the following

b. Valsalva - increase nasopharynx pressure by holding nose and breathing against a closed glottis (throat).

If you perform this manoeuvre with a closed glottis the raised pressure within the chest will not be transmitted to the nasal cavity. The whole point of the Valsalva manoeuvre - as applied to ear clearing - is to attempt an exhalalation against closed oral (mouth) and nasal airways so that the raised pressure within the nasopharynx is transmiited to the middle air via the eustachian tubes.This makes the ears "pop" when the pressure within the middle ear is equalised.

My description of such a manoeuvre would be

Increase nasopharynx pressure by holding the nose and sniffing out into it.

It is a similar manoeuvre to when using a tissue to "blow ones nose" whereby the back of the tongue is used to seal off the mouth from the posterior oropharynx, with an open glottis.

Kas, it might help you to understand by loolking at the anatomy of nthe ear at; http://www.earaces.com/anatomy.htm

I am not really sure that what I describe is genuinely a "Valsava" manoeuvre but it is what is required.

(I know I'm being as pedantic as ever)

 

[kas]

I'd have a hard case arguing that my technique is correct, given that I am having such difficulty equilizing without other apparent causes, but I do think that I understand pinching my nose and blowing against the pinch. Is it not like blowing one's nose, but pinched? I also thrust my jaw and moved it side to side, yawned, swallowed, etc., but to no avail.

Guess that I'll need to see what my ENT has to say upon inspection.

If the cause is neither technique, nor deviated septum, nor allegy/congestion, I'll ask him about the other sources that Dr. Thomas cites below:

• allergic rhinitis
• sinus disease
• adnenoidal disease
• posterior nasal polyps

Thanks for all of your attention. I'm nearly resigned to ask no further questions until the ENT takes a look, but thought that I'd sneak in a couple more.


It is possible that I have an anatomic limitation of some sort (perhaps the polyps is such), that can tolerate flying, but not a decent of five feet without pain?

Should I wait for some healing prior to going to the ENT or get in to see one ASAP? I've no pain, but definitely can feel that there is a problem.

KAS

 

[John Reinertson]

Don't panic. This problem is so common that it ranks as by far the number one scuba injury.

Informal survey of a group of diving docs after a week of studying and diving showed around half had some degree of visible pressure injury to their eardrums. most were minor, but almost all of these were experienced divers and physicians.

Decongestants, steroid (cortisone) nose sprays, and experience solves most of these difficulties for most divers, with experience probably counting the most.

Practice equalizing gently on dry land, do a lot of pool work on your own (when you won't feel embarrassed to quit when you feel discomfort), and you will probably be equalizing comfortably in no time.

Always remember in the future to stop and equalize before it hurts, and if you have persistent discomfort, call the dive and go up.

Dive safe.. this is supposed to be a wonderful and painless sport.

John

 

[The Iceni]

kas once bubbled...
It is possible that I have an anatomic limitation of some sort (perhaps the polyps is such), that can tolerate flying, but not a decent of five feet without pain?

Should I wait for some healing prior to going to the ENT or get in ASAP? I've no pain, but definitely can feel that is a problem.

KAS

The pressure changes experienced when flying, particularly in civilian passenger aircraft are much, much less than that seen in diving, or even snorkelling. The greatest change being a reduction to about 0.7 bar at altitude when the aircraft cabin is pressurised. Even on descent the increase in pressure is only by a factor of about 1.5 (1/0.7) and this is undertaken quite slowly, over a period of twenty minutes or so.

Compare this with a diver descending to 5 metres (16 feet) and 1.5 bar. How long would you normally take to make such a descent? :blue:

Should I wait for some healing prior to going to the ENT or get in ASAP? I've no pain, but definitely can feel that is a problem.

My advice is do not risk further damage until you are given the all-clear and can at least make your ears "pop" easily on the surface.

 

[kas]

My poor composition above was misleading. It's fixed now. I'm wondering if there is any merit in seeing the ENT now, just a few days after the injury, or if seeing him after some healing has taken place.

It's probably irrelevant, as I've scheduled the first available appointment for two weeks from now, which will be three weeks after the incident.

I'll repost on the findings, but thanks for the advice.

KAS

 

[kas]

Today I saw an ENT at Chicago's Northwestern University Hospital. It's now been three weeks since the dive in which I had such difficulty equalizing.

My hearing and slight vertigo have disappeared, but lasted for over ten days following my qualification dives.

Hearing test showed that my hearing "is not normal--it's perfect." So no damage done.

Physical examination of the ear canal: doctor placed me in a seat that leaned back, then leaned back the head rest even further, so that my head was in the same position as if I were trying to look straight back over my own head, nearly as far back as my neck could stretch. Doc had me attempt a valsalva (sp?) and indicated that he saw no movement of the ear drum. Neither did I feel any equilizing when I attempted this. However, as I was walking out of his office, I tried a gentle valsalva from a normal standing position and found it to "work." BTW, when I do this while on the surface, I experience some discomfort for a few minutes afterward. Is this normal?

Examination of the septum: doctor described it as moderately deviated and while he did not believe that this deviation could be part of the solution, he suggested that if I wanted this elective surgery to reduce nasal breathing effort when ill, I might try diving once more to determine if this helped anything. He said that chances were very remote that the correction of the slightly deviated septum would have a significant influence on the ability to equilize, but, in sympathy for my apparent loss of a new favorite hobby, added "but I'd love to have you prove me wrong." He gave me the name of a coworker who performs this type of work (rhinoplasty, etc.).

He indicated that neither meds or surgery are available to "open" a narrow eustatian tube

The good news: the doctor could see no remaining blood around the ear drum (my primary care/general practicioner made this observation four days after the dives), no structural defects when examining ear canal, no obstruction, no unusual buildup, etc.

The bad news: based on both the empirical evidence as I reported the first dive and on his examination of an apparently ineffective valsalva (the eardrum did not move at all), the ENT indicated that I should take up skiing as a hobby.

I normally find doctors to poo-poo any intense use of the body, including serious weight training, dieting beyond the US RDA suggestions, etc., but this doc seemed quite reasonable and sympathetic.
Can anyone help me or am I really done so soon, with just six dives under my (weight) belt? Do the four potential causes listed in previous posts still remain potential causes?