Eustachian Tube Issues

[Pyde]

I just wanted to reach out to others that may have similar issues with their Eustachian tubes as me and see if anything fixed it.

I went to an ENT specialist about an ear hemorrhage after diving and descending in elevation by car shortly after the diving i did.

I dove at an elevation of 5584 and drove down to an elevation of 4226. The hill we drove down drops elevation fast and I ended up having the hemorrhage while driving down the hill with my wife. The pain was awful but at least it didn't rupture my Tympanic Membrane

Thats the basic back story. The reason for the hemorrhage was because my tiny Eustachian Tubes wont open on my right ear. For some reason it is sealed shut from mucus. The ENT was the one who told me about my tiny Eustachian tubes and that i should use Nasacort before my dives and use it daily to keep my tubes open. Well this hasn't worked at all. I have been at a dead stand still in my diving because of this issue. The Dr. said to wait 2 weeks. I waited almost 3 months.

I finally got tired of waiting around so i scheduled my Advanced Cert and got through all my dives with a closed Eustachian tube. It took my 12 minutes to get to 75 feet deep waiting for my Inner Ear to fill with fluid for the first dive so i could finish my deep dive. The Inner Ear filling with fluid is how my ear equalizes at this point. After that I was able to go up and down a little faster. The other problem I am facing is with ascending. If I go up to fast the pressure inside my ear pushes on the Tympanic Membrane and creates a vertigo effect. It sucks feeling so dizzy under the water. But i have learned to deal with it and just breath through it. I ascend slowly to stop it from happening. My issue is that i want to dive like others and not have my buddies waiting for me to ascend and descend so slowly. I just air freighted an IST Pro Ear Mask in hopes that it might correct this issue. I did call back to my ENT Dr. and they said the only other options are possible surgeries. I dont want to go through a surgery if i dont have to. Besides the IST Pro Ear Mask can anyone else think of anything i should be trying to get my Eustachian Tube to reopen? I have tried Nasal Decongestants with Steriod (Flonase / Nasacort). Allergy pills to dry me up / Nasal wash. All of these my ENT Dr. told me to try.

My biggest problem really is this though. The Eustachian Tubes aren't truly understood as Dr's have spent years and years shying away from Eustachian tube surgery's and such. Instead they go for tubes in our ears (Placed in the Tympanic Membrane) (which for a diver is a bad thing). I feel like I'm at a loss. I sure hope this IST Pro Ear Mask helps me

if anyone else has ever heard of anyone else going through what i am i would love to hear others counsel or stories.

P.S. I did look into the Eustachian Tube Dilation surgery. It looks like it might fix my problem but it sounds like its still experimental.

 

[Duke Dive Medicine]

Hello @Pyde ,

First, I would strongly advise that you not dive until you have this sorted out. If your middle ears are indeed equalizing by extravasating fluid into them, you are causing inflammatory damage to them each time you dive, which can take weeks to months to recover from. Also, you are risking serious, possibly permanent injury to your inner ears, which control hearing and balance.

The Pro-Ear mask is not designed to help you equalize your middle ears or to open your Eustachian tubes up. It is designed to prevent or minimize water entry into the external ear canal. This would be a possible option if you had no other choice but to have tympanostomy tubes placed, but again, it will not help you equalize your ears and may not completely prevent water ingress into the external ear canal.

Balloon tuboplasty is not experimental to my knowledge. I'll tag our resident ENT physician @doctormike for advice on that and for further comment.

Best regards,
DDM

 

[doctormike]

Hey, a lot to unpack in that post! Here's some background on ear physiology to get the terminology correct, etc.....

Bottom line is that you need to be able to equalize your ears to be able to dive safely. I certainly don't recommend "pushing through" ear problems and diving in a compromised state - both because of the safety of the dive and the risk of permanent ear damage.

I'm a pediatric ENT doc, so I don't see a lot of this in my actual practice. But in my experience, for most people who have problems equalizing it's more of a technique thing than an anatomic problem. So it may be worth spending extra time in the pool, trying different methods, etc..

There isn't much evidence that nasal steroid sprays help with Eustachian tube function - they are really for nasal allergies, and may help people who have problems equalizing their sinuses. Same goes for nasal allergy medications and nasal irrigation.

Many people use the Pro-Ear mask and like it. I personally would be worried about using that on a dive. It seems like a crutch that could fail and cause you to have problems at depth which could be serious (sudden vertigo, ear damage, etc..).

If you truly have a mechanical problem with your ETs, there is some evidence that dilation may help (not really a pediatric thing, so I don't do it myself). I don't know anyone in Idaho who does that, but if you are willing to travel, you may find someone who does it for divers. Here is one of my former residents (and a diver) who has been doing this with some success - if you reach out to him, he may know someone closer to you.

Good luck!

 

[jfe]

Hello @Pyde ,

.............The Pro-Ear mask is not designed to help you equalize your middle ears or to open your Eustachian tubes up. It is designed to prevent or minimize water entry into the external ear canal. This would be a possible option if you had no other choice but to have tympanostomy tubes placed, but again, it will not help you equalize your ears and may not completely prevent water ingress into the external ear canal.

Balloon tuboplasty is not experimental to my knowledge. I'll tag our resident ENT physician @doctormike for advice on that and for further comment.

Best regards,
DDM

I have used the pro-ear mask for this reason with success some years ago. Since I have changed over to Docs pro Plugs for the same reason, to limit the amount of water flowing int the external ear channel. To be honest, I've lived with Eustachian tube issues for most of my adult live due to alergies and you'll have to accept it and work around it. Best advice I have for you is start hydrating a day before your dive and in the same time start to equalise on the surface the night before and before your dive to work through the stickiness. I have had to surface many time cause I could not equalise and not able to go beyond the 5m mark, including my checkout dives on the tri-mix training and most recently my first openwater dive with my son after he got his junior open water. Unfortunately it's a price you pay when you have these issues.

 

[wnissen]

Was this ENT recommended or at least referred by DAN (Divers Alert Network)? Because an ENT who is not familiar with the issues specific to diving may not be that helpful.
I personally found that with the traditional Valsalva maneuver (hold your nose and blow gently) that I couldn't equalize at all. It took quite a long time to get down. Personally, I have to tilt my head so that each ear is pointed to the surface. It's not ideal, but it works. I still get slight vertigo when ascending, though luckily most people try to ascend slowly. Have a look at some of the many ways to equalize. Do you have trouble equalizing above the surface, like in a descending car or airplane? Sometimes I will go to the local pool and just practice equalizing in 9 ft of water. That said, not everyone has the physiology to dive. I'm not a doctor, but after my first very difficult dive in the ocean, I was prepared to be told "no". It's a fun sport, but it's not worth risking your hearing, balance, or even life over.

 

[Candiru]

I’d find a good provider in your area that does AERA eustachion tube dilation

 

[tursiops]

Here is the BlueCrossBlueShield of Idaho summary for the procedure. they call it "Investigational," and I can't tell if they will cover it or not.

 

[Candiru]

BCBS is not going to cover it. That doesn’t mean you can’t afford it though. Set up a HSA this year, find an ENT that you trust to do the procedure. They will be used working with BCBS and be able to give you appropriate pricing options.

 

[mike41799]

 

[mike41799]

My last dive with the pro ear mask is above. it works with the hood, I also shave the side of my head and beard. as an extra precaution I wear the Pro Plugs as well. My ears are perforated and this works for me. I have recently modified the pro ear system with a Cressi nano mask. The mask that comes with the pro ear does not fit well and I am constantly clearing water. Once I ave a chance to properly test this I will make another video. I am also modifying the hood so I can attach a snorkel to the outside and sewing some mesh on top so air can escape.