Ear Equalization Issue preventing cert: advice?

[markmud]

Hi everyone -

I am one dive away from my PADI open water cert due to a persistent ear equalization issue that has caused me to have to abort many dives. I know there's a lot of advice on this forum already about equalization issues and I've looked at and tried everything I can find, but to no avail. I was hoping to get some help.

Over a year ago I had two terrible ear infections, and have not been able to equalize consistently since. I often can't get below 6 feet on a dive. Sudafed has helped at times. Other times I have descended with no issues and gotten a reverse block later in the dive. I can't freedive below 10 feet since I use up my entire breath hold just trying to equalize. On my last dive (Open Water #4) I descended with no trouble. My instructor had me perform a CESA about 10 minutes into the dive, and then I had to descend again to complete the last skills. On the 2nd descent I couldn't get below 6 feet, even though 10 minutes earlier I equalized with no trouble.

Starting last May I saw an ENT who did tests and said my ears look normal and I shouldn't be having trouble. Since last May I have been trying the following:

• practice equalizing at my desk (10-50 times a day) to train the eustachian tubes. In May I couldn't perform a Valsalva, now I can perform a Valsalva with relatively few issues (but I prefer to use other methods underwater since it takes a huge amount of force for me to Valsalva underwater). I have no trouble equalizing in air anymore
• practice freediving to train ears under pressure (again, can't get below 10 feet and that often hurts)
• try Sudafed before a dive (seems to help) -- I have not tried Afrin yet but I got some to try tomorrow

Unfortunately now my instructor says I may not ever be able to dive again, and won't let me re-do my last dive (the only skill I didn't complete was underwater compass navigation) until I can easily freedive to 25 feet. I was supposed to do my scientific diving training next month and it has been nearly 10 months of this frustration thus far.

If anyone has any advice or suggestions as to where to go from here, I would really appreciate it. I'm really sad at the thought of giving up diving and really want to find a way to work through this issue.

Hi mechnohonu,

As another poster noted, IANAMD (I am not an MD)!

I have equalization problems and your symptoms sound familiar.

I tried the over-the-counter stuff and they helped.

An instructor from St. Croix told me that he had issues also. He said that his problem was permanent nasal congestion. Hmm, that sounds like me; but I did not know it. My sinuses felt normal because they were always clogged, I guess!

He told me to blow my nose underwater on ascent every ten feet. Unfortunately, accomplishing the first descent is an issue. However, I followed his procedure, and after about 3 more dives, I was doing much, much, much better! I felt like I had filled the ocean with snot. On the surface I could, for the first time in my life, breath well through my sinuses.

Towards the end of that trip, I was descending as quickly as my wife, which is really fast.

I added a twist to the Instructor's prescription. I started sucking water into my sinuses while in the shower. Small amounts anyway. I then let that water soak for a few minutes. Then I blew chunky snot out. I did this before I went diving in the mornings.

AND, my ear clearing issues became manageable. Some days are better than others, but I don't have the major issues I had before.

A DM on Bonaire said that he sucks seawater in his sinuses when he has clogged sinuses. I find it difficult to suck in a small amount of seawater while u/w. Sucking in half the Caribbean is very painful; but it really cleans out those sinuses.

Remember, descend slowly, and when you feel pain ascend about 5 feet and try again.

markm

 

[fmerkel]

S

I added a twist to the Instructor's prescription. I started sucking water into my sinuses while in the shower. Small amounts anyway. I then let that water soak for a few minutes. Then I blew chunky snot out. I did this before I went diving in the mornings.

AND, my ear clearing issues became manageable. Some days are better than others, but I don't have the major issues I had before.

Remember, descend slowly, and when you feel pain ascend about 5 feet and try again.

markm

I suggest you just get a Neilmed or Netipot and start doing sinus rinses. Saltwater is full of bugs and not a recommended way to irrigate the nose. Tap water can have bugs also depending on where you live, but more to the point is NOT the same salinity as the body. Tap water is irritating. It may help, but has the potential for making things worse. Normal saline is 'neutral' and not as irritating.

 

[shawnhar]

Tap water can have bugs also depending on where you live, but more to the point is NOT the same salinity as the body.

Tap water is also mildly chlorinated in most parts of the world. It's fine to drink but I wouldn't want even a tiny amount of chlorine in my sinuses!

There are various ways to cheaply remove chlorine from water (I know this from homebrewing - can share details if anyone is interested) but for the small amounts used in rinsing I'd second the suggestion to use something designed specifically for that purpose instead.

 

[markmud]

Tap water is also mildly chlorinated in most parts of the world. It's fine to drink but I wouldn't want even a tiny amount of chlorine in my sinuses!

There are various ways to cheaply remove chlorine from water (I know this from homebrewing - can share details if anyone is interested) but for the small amounts used in rinsing I'd second the suggestion to use something designed specifically for that purpose instead.

Shawnhar,

Yeah, most tap water does have small amounts of chlorine in it. No live germs; that's good. Ingesting chlorinated tap water is even worse; drink bottled water, well water, or other water from a good source.

I have been sinus infection free since sucking shower water into my sinuses everyday. For fifty years of my life I had periodic sinus infection issues. Not for the last 10 years. MDs gave me drugs, bullcrap, and no cure. I'll take the chlorinated shower water any day over what my fellow human beings gave me.

Thanks for giving the OP a heads-up as we don't want him suffering from severe chlorine poisoning.

Hi fmerkel,

Nettle pots and saline solutions work OK. I don't like carrying an RX around the world.

I have been accidentally sucking seawater into my body for about 60 years. I guess I have built up a tolerance to the horrible germs in seawater. Every time I dive I accidentally get a little in my sinuses when water gets in my mask. Also, when doing reg swaps I get seawater in my mouth. I feel for people who may be that sensitive to a little seawater.

I am not being a jerk-off here. Sometimes, people make a mountain out of mole hill. Something has to kill me, a small amount of chlorine and seawater-bugs may as well be my COD.

But thanks for warning the OP that seawater germs may cause him debilitating harm.

Thanks,
markm

 

[fmerkel]

Generally either distilled water, or minimally boiled tap water, with appropriate levels of salt added, are what's recommended. Seattle has particularly good water, and I have a top end carbon filter on the water I use.

You don't need an Rx for a plastic bottle and salt.

 

[markmud]

Generally either distilled water, or minimally boiled tap water, with appropriate levels of salt added, are what's recommended. Seattle has particularly good water, and I have a top end carbon filter on the water I use.

Good advice,
markm

 

[Kayakingphotos]

There are some videos on YouTube that might be helpful. The first one from Dr. Edmond Kay is

The other one is from DAN,

 

[TMHeimer]

If you are forcefully equalizing you are doing it wrong and are liable to injure yourself. Start more shallow, it shouldn’t require forcing it. If it isn’t clearing easily then get shallower. And you may find some days are days you shouldn’t dive. But if you can easily clear on the surface you should generally be able to clear as you descend.

I think he's tried all the accepted methods. The puzzle is why he can equalise no problem sometimes, not at others. Maybe there is something like the deviated septum, but why not all the time?

 

[fmerkel]

Mucous membranes are HIGHLY variable. They can swell and shrink a lot depending on various stimuli and do so rapidly.
The main job of the nose is to humidify all air to 100% and bring up to body temperature. The difference in the job from resting in the tropics at 80* vs. running/skiing/hiking/etc below freezing is significant. Add in different physical states of inflammation, allergy, abuse (poor clearing, chemicals, fumes/boat exhaust, etc.) and you can have a nose that can go from wide open to almost totally plugged in a very short time frame. The Eustachian canals are part of that same upper respiratory tract. It's all a package, all connected, all dependent on all the parts working and all can be affected by other parts.

The videos are an excellent place to review skills and get information. I have recommended Dr. Kay's videos in the past (he's a local diver, previous member of our dive Club, retired now). But....knowing that something can be done, intellectually understanding it, and being actually able to do it are different. I can watch a video on a back flip, know how it can be done, but damned if I can actually do it.
The OP in this case probably needs a multifaceted approach to his problem. It's likely to take a number of things combined to get him diving safely. I'd say ditching the instructor is first on the list.

 

[60plus]

Regarding ear equalisation. Many years ago I and most of the school swimming team got a severe ear infection from the water that caused earache for about 3 weeks. We were warned the damage could be near permanent, or take 20 years for the scar tissue in the eustachian tubes to return to normal. Short term if serious equalization issues continued stints could be inserted.
For sinus try strong mentho lyptus sweets or fishermans friends.

Regarding flushing your sinuses in Caribbean water, I would not do it. In 1994 (I hope things have improved since) I was on St Lucia. We were not allowed in the sea after rain until 24 hours had passed and even then told do not disturb the sea bed. Apparently the plantation / agricultural workers used to crap in the many small streams where they worked using the stream water to clean their backsides. As soon as it rained this all flushed out untreated into the bays where the holiday resorts were.