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The inability of children to equalize pressure in the middle ears while flying as passengers in commercial aircraft is a significant problem. As a result, there are numerous studies of this inability of children to clear. Basically, the overwhelming majority of kids under age 12 cannot equalize pressure in the middle ear, especially when the pressure in the middle ear is "negative" (middle ear pressure is less than the ambient pressure in the outer ear). Since the pressure changes involved in scuba diving are greater than those seen in commercial aircraft flights (an adult can rupture an ear drum in approximately eight feet of water and I personally know someone who lost their hearing as a result of a surface dice in a pool while a child), it seems reasonable to believe this inability to ?clear? would be a problem in diving. Basically, in children, the Eustachian tube is small, flat, and horizontal (compared to an adult?s). This orientation makes it difficult for the ear to drain and, as a result, ear infections are more common in kids than adults. This condition, in very small kids, has been termed ?glue ears.? In addition, the Eustachian tube closes when a child swallows, as compared to opening with an adult. Under so-called "negative pressure," the tube closes and then air movement becomes impossible.
Now, let?s add to this the emerging work on Patent Foramen Ovale (PFO?s) and scuba diving. There are too many references on this topic to put in one slide, so see the CNS reference list at the end of this article. We could spend hours on this topic alone. In the interest of time, I will mention only the study by Germonpre that suggests a correlation between forceful Valsalva and cerebral DCS. I would also like to suggest that every instructor, or anyone interested in the PFO question, read the review on PFO?s and diving by Krooss (see CNS reference list, below).
Briefly, in the womb, we all had an opening in the heart that allows blood circulation to by-pass the lungs. In the womb, we had no need for the lungs because ?mom,? via placenta, took care of oxygenation, delivery of foods and removal of cellular waste. At birth, this opening in the heart begins to seal. In about 25-30% of adults (PERHAPS more in kids), this opening has not totally sealed (patent means ?open? and foramen ovale refers to an oval shaped aperture that lies in the secondary secondus of the heart, the green arrow, below, roughly illustrates the location). Typically, this does NOT have much clinical relevance in terms of impaired function, but can be a problem in diving because under increased thoracic pressure (common in a Valsalva maneuver), this defect can allow bubbles (which form on every dive) to move into arterial circulation. There is a growing body of evidence that suggests this is of concern to divers. The theory is that the bubbles, once passed into arterial circulation, can lodge in areas of the central nervous system and, over time, lead to deficits in nervous system function.
The airway passages of a child are smaller in comparison to cavity space of the alveoli compared to an adult.
My concern: The narrower airways suggest an increased risk to barotrauma. The magnitude of this increase, if any, is unknown.