Facial neuralgia and related medication

[tucsonjenn]

I was recently diagnosed as having trigeminal neuralgia. Before diagnosis, I would have "spells" of blinding pain behind my eyes going all the way down to my upper teeth. I would also have facial swelling, and sensitivity to touch as well as light. My neurologist has started me on Tegretol (200 mg x 3/day), Flexeril (10 mg at night), and ibuprofen every day to try and keep the swelling down. This treatment hasn't helped (yet) in the spells of pain, but I'm noticing less facial swelling and sensitivity.

I went diving shortly after one of these spells (before taking ibuprofen and flexeril). My left ear suddenly wouldn't equalize during a dive, and I had to abort the dive. I went on a month of steroids with no relief. I ended up having an ear tube put in June, 2000. I have had no trouble since clearing my ears on planes, and high elevations.

I would like to try to dive again. I haven't been able to find out if Tegretol could affect my diving. But I know having an ear tube is a no-no during diving (I could have it taken out if I need to). I just don't know if the observed decrease in swelling I'm noticing now means I could dive even if I have a recent pain episode.

 

[Dee]

We have some excellent doctors here on board, but I'd still call DAN 1-919-864-2948. That's the number for non-emergency diving questions. They will be able to tell you if your medication is approved for diving as well as opinions about your ears.

As for the ear tubes, the docs will have to address that one.

 

[John Reinertson]

Traditionally, tubes in the ears have been viewed as a contraindication to diving.
You certainly don't want sea water to get into the middle ear. The fact that you can equalize easily on a plane is not any real help, because for that ear, the hole in the PE tube does the equalizing for you. There is normally an air space behind the eardrum that must get its air supply by way of the Eustachian tube, which opens into the back of your nasal passages just above your palate. When there is a small hole in the eardrum, the ear can equalize without getting air from the eustachian tube. This source of air is not available underwater.

On the other hand, if your eustachian tube allows easy clearing, you can put an occluding earplug in the side with the eardrum hole. There are two significant problems with this;
One, you will need to equalize with a bigger volume of air, since the eustachian tube will be allowing pressurization of the external ear canal by way of the PE tube.
(Note-- never use occluding ear plugs when the eardrum is intact.. you'll get a very painful ear canal squeeze and potentially rupture the eardrum.)
The second risk is that normally the pain of a stretching eardrum reminds a diver to go back up and equalize.
There will be no eardrum stretching with the occluding earplug and PE tube, and your first onset of pain may be when you damage the round window, which can lead to permanent injury and severe vertigo while still underwater.
I know people that have dived with an earplug and a ruptured eardrum and they said they were able to tell when they needed to equalize, but there is a real risk that you may not choose to take.

Another issue regarding your trigeminal neuralgia (tic doloureux) is that if an attack occurs at depth, when task-loading is high and there's not much margin for error, will the pain be the last straw that takes away your ability to function logically?
I've seen people with this squirming in pain and totally unable to concentrate. That would not be a good situation at 100 ft with a current and a buddy.

I hope to see you diving, but more importantly hope to see you well and safe.
John Reinertson

 

[zman]

Hi Tucsonjenn:

I was recently diagnosed with trigeminal neuralgia, and have been on Tegretal 100mg x2/day. I understand your pain however, after all the testing was completed, I went to my dentist to have a wisdom tooth extracted at my request. Since this was done about 1 week ago absolutly no pain. I am staying on medication as I must undergo a root canal as well. I hope this was just a miss diagnosis for me. Though you would like to know. zman
PS I'll post my future results as I get them

 

[DocVikingo]

Hi zman,

I have somewhat of an interest in various pain syndromes, and it is my understanding that occasionally TN-like conditions can be both relieved & caused by the extraction of wisdom teeth. While the vast majority of cases of TN have no relationship to dental abnormalities, it surely would be nice if the extraction freed you from what I suspect was excruciating & largely intractable pain.

BTW, it does seems prudent to continue to follow your physician's orders until they are altered.

Best regards.

DocVikingo

 

[zman]

Hi Doc,

I understand what your saying! Believe me the pain was excruciating. Twice on my own power to emergency, once by ambulance. I am still taking my meds and will contiue to do so until I see my ENT ( ear nose and throat) for those who don't know. Thanks for the feedback!