Hi new here and have questions about equalization

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Hi guys,
My name is Jen, I'm a 27 year old wife and mom to 2 girls. I've always loved the ocean and would love to eventually start diving one day. As of late, I've been looking around these forums for an answer to a question that I feel possibly one of you divers may have experienced. Here goes: I got a sinus infection last January with led to my Eustachian tube,especially the left, being blocked for 6 months. I finally found an ENT who did a newer, less traumatic procedure called Eustachian tube dilation to reopen the blocked tubes. After about a month of swelling and everything settling, I was back to 100%. Now comes the question. I woke up 2wks ago Friday with that scary cloggy feeling in my left ear. I tried to be calm and performed a gentle valsalva to make sure that both tubes were able to open. They were. Try as I might (gently of course) no amount of equalizing could rid me of the pressure feeling in my left ear. I moved on from valsalva to. Toynbee and even flexed my tubes open. Nothing changed the pressure feeling. Called my ENT and he set up an appt for the following Monday. Meanwhile, I was instructed to see my PCP just to rule out an ear infection. My PCP found no infection or fluid in the middle ear. He asked me to do a valsalva and a toynbee while he observed each of my ear drums. Both moved when I equalized. He concluded that my allergies were flaring and causing inflammation in the sinus cavities which in turn was putting pressure on the Eustachian tubes. He Rx'd a 60mg prednisone taper for 6 days. I completed the pred with no change in the pressure feeling. When I saw my ENT on Monday, he did pneumatic otoscopy of my ear drums and found both to vibrate freely and easily. He also found no fluid. Upon inspecting my nose, he saw a heavy post nasal drip and some yellow mucus way up in my nose. He examined my lymph nodes and found a swollen one just under the left side of the neck. He told me he suspected sinusitis, but couldn't be certain if it was bacterial or viral, so he decided to Rx augmentin 875 for 10 days with a follow up on the 15th. He also sent me for a tympanogram to check my middle ear pressure, and I did the exam when the ear was feeling pretty pressurized, but it came up normal. There was only a slight (5daPa) positive pressure in both ears. So now I'm waiting till the 15th. I was told to continue to gently equalize a few times everyday and to add sudafed to my regular daily dose of Zyrtec. I decided to post here even though I'm not a diver yet because I was hoping someone here may have experienced something similar. Has anyone been able to equalize just fine but still have the feeling of pressure for some reason? If so, what did your ENT say and did it go away? I greatly appreciate you welcoming me into your community and any advice you may have to offer me.
-Jen
 
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moved to diving medicine - one of our medical moderators will likely see this soon.
 
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First I want to complement you on maintaining such a thorough history on this matter.

It does seem that once you are accustomed to equalizing it can be a very tolerant process, at least for me. In other words I can not use the ability to execute a gentle valsalva as an indication of wellness.

I also deal with seasonal allergies and stay on Alavert, that sort of preventive medication is not uncommon among divers.

As for your present condition I have nothing to offer as I'm a medical zero.

Good luck resolving this, there are some class acts watching this forum.

Pete
 
Hi Jen,

Ditto spectrum - thanks for the detailed history. Absent any blockage (and it sounds as if you've had a pretty thorough workup), the feeling of pressure may just be related to edema in the area. If that's all it is, it will probably resolve when your allergies subside. Keep in mind that you may have a "new normal" after your dilation procedure.

A steroid taper is pretty aggressive for a simple allergy flareup... are your allergies unusually severe? If so, this will be something you have to contend with when diving. It also sounds like you're familiar with at least three equalization techniques, which should serve you well if/when you learn to dive.

That aside, the only way to really find out whether you can equalize during diving is to try it, perhaps on a breath-hold in a pool initially. If you can equalize on a breath-hold you can do it on SCUBA. Use all of your equalization techniques, "preload" your ears before beginning your descent, equalize early and often, stay ahead of the descent, and halt your descent immediately if you can't equalize. If you continue descending without equalizing, it will collapse the proximal ends of the Eustachian tubes and make it even more difficult to clear. You should never feel pain in your ears during descent.

I'm sure I haven't covered everything here. DrMike is a pediatric ENT surgeon and a frequent poster; he may have more specifics for you. If he doesn't jump in soon, he's very approachable and will answer private messages.

Best regards,
DDM
 
Hi Jen,

What I would suggest is that you try to find one of the DAN approved Hyperbaric Physicians Like Dr Mario Cote in Quebec Canada
(obliviously not him personally, I doubt that your in Quebec, but any of the DAN approved guys have to be pretty good)
He was the last Dr. I used for my yearly Hyperbaric Physical for working as a Diver
Hyperbaric medicine is a pretty specialized subject, and can address your concerns a lot better than a regular ENT Specialist.
(although from your description, they sound very competent)

Link: http://www.cmpq.org/index.php/home.html
 
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Thanks for the advice. I appreciate it more than you can imagine. If you don't mind me asking, since I'm not very computer savvy, how am I able to pm the peds ent that you said is on this board? I'd love to get some insight since I just came back from Eustachian tube function testing and it came back normal. Still feeling that ear pressure though. Starting to worry about patulous Eustachian tube but I have no autophony and don't hear my own breathing. Don't really know what the heck is going on. Hopefully I can pm this ent on here and will see my ent on Monday and get some answers. Thanks guys!
Jen
 
Jen, I sent you a PM just now and copied doctormike. I got his user name wrong in the post above. There are a few ways to send a private message. You can click on User CP at the top of the page, then click on "Send New Message" under the "My Messages" heading. You can also click on a user name in a thread; a menu pops up, and "send private message" is one of the options.
Best regards,
DDM
 
I can relate actually. I had to dive in some icy waters in Alaska one time when I was tapering from Prednisone actually. Seriously follow a slow taper down and I personally went from 80mg, 60, 40, 20, 10, 0 each week with my dosage. The side effects were pretty bad for a couple days, but day three I felt almost no side effects at all.
 

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