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mild barotrauma when equalizing and looking up?

Discussion in 'Diving Medicine' started by oppo, Jul 17, 2019.

  1. oppo

    oppo Barracuda

    # of Dives: 1,000 - 2,499
    Location: Paris
    Hello all,

    I work as an instructor-guide, with a minimum of 600 dives per year and have not had any major ear issues.
    I also got a full check-up by a physician specialized in dive-medecine 2 years ago, no issues.
    I have no problem equalising my ears in general, no infections etc.

    Just to make it clear, I am not asking for a medical opinion online, just trying to understand what the mecanism at play could be in this situation.

    Over the past few years, I've had a couple of mild ear barotraumas while working, always in the same situation: equalizing while looking up to check on a customer above me. It's happened maybe 4 times.

    I always feel a sort of diffuse burning pain in the ear, quite similar to that one gets when some seawater reaches the sinuses - fullness in the ear (as if had filled with liquid) and there seems to be something going on in the eustachian tubes as I get a taste in my mouth, like there's something in my saliva (no blood though).
    Discomfort lasts maybe 48 hours and then goes away.

    I equalize gently, usually with a Frenzel manoeuver, and have no other issues, apart from this very specific situation.
    Every single time I have had this I equalized while looking up (so head tilted back), on descent, in less then 10m of water.
    I've had this yesterday again, I think it's my 4th time this has happened.

    I was doing a Bubblemaker program, so less than 2m depth, I was under the customer and helping him stabilise himself (BCD was a little big) while descending slightly. I equalised in this position, looking up as I was descending, and there it was again, same burning pain, then discomfort and fullness in the ear.
    I'm wondering if it could be a sinus issue, maybe seawater reaching the sinuses and fluids draining which affects the equalising - and it definitely feels like something's happening with the estachian tube...
    Ear still feels a little sore this morning (day off), no hearing problems.

    Again, I dive everyday with no ear issues, but the only time I've had such a problem was looking up when equalising my ears. Not sure if is always the same ear, it was the right ear yesterday.

    Any idea what could be at play here? What could be the issue with looking up while equalising? Could this position (looking up, so head tilted back, reg in the mouth) cause pressure differences affecting the process and stressing the eardrum?

    PS, I'm currently working in a remote area of Indonesia, so seeing an ENT specialist is not really an option.

  2. fmerkel

    fmerkel Loggerhead Turtle

    # of Dives: 1,000 - 2,499
    Location: Salish Sea (Seattle)
    Looking up stretches the EC. Generally this facilitates equalization for those having trouble. The only thing I can think of is that you have some pressure building up and looking up suddenly releases it into the ear as a shock wave.
  3. flyboy08

    flyboy08 ScubaBoard Supporter ScubaBoard Supporter

    # of Dives: 500 - 999
    Location: NYC
    Don’t look up while equalizing. Your body is clearly talking to you, which is a good thing.
    BenjaminF and Duke Dive Medicine like this.
  4. Duke Dive Medicine

    Duke Dive Medicine Medical Moderator Staff Member

    Looking up changes the orientation of the Eustachian tube - it would become more horizontal. It could be that you're introducing mucus or sea water into the middle ear. Just a guess, not having looked into your ear afterward. And, ditto what @flyboy08 said above :)

    Best regards,
  5. oppo

    oppo Barracuda

    # of Dives: 1,000 - 2,499
    Location: Paris
    Interesting thanks - wonder if I'm the only one with this issue...

    Yeah, I'll surely try not looking up when equalizing, as it's far from a pleasant experience :)
  6. Morne Christou

    Morne Christou Angel Fish

    # of Dives: 1,000 - 2,499
    Location: South Africa
    Here is a great video to look at.


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