Reverse block and flying question

[Albireo]

After seven wonderful dives over the last week, I began to experience troubling signs of a reverse block on the eighth dive: a pain in my left ear (always the one hardest to clear on the way down) during ascent, with much hissing/crackling noise that continued for several minutes even after getting back on the boat. Afterwards it took a couple hours for the tenderness in my left neck/throat, cheek, and back of earlobe (i.e. eustachian tube) to subside enough for me not to sit there cringing at the stinging pain.

And then, just to ensure my award for idiocy, I repeated the farce with two more dives. Same story on both: no unusual problems on descent, but the same pain, noise, and hours of pain afterwards. Except now the pain hasn't fuuly subsided even after nine hours, and the ear sounds blocked.

After a night's sleep, my flight home starts in 13 hours. What should I do to minimize childlike whimpering in mid-air?

The reason I'm confused about this block is that:

- I have not ever had a history of a reverse block, not even when congested
- As far as I can tell, I am breathing freely out of both nostrils and do not remotely feel congested, beyond the obvious sonic blockage in my left ear
- The pressure is gone from the eardrum itself, the pain is rather in the soft tissues of the lft-front part of my neck, the cheek, and the area around the eustachain tube

I've tried taking Sudafed but while the eardrum pressure is largely gone, the problem seems to be elsewhere. I am armed with both Claritin and a 120mg Sudafed if necessary, but I suspect I have some other damage I don't know about.

Any advice would be greatly appreciated!

(Apologies for misspellings. I only brought my iPad with me and can't go back to edit!)

 

[AfterDark]

Have you tried to equalize your ears as you would diving? You might get lucky and relieve the pressure. Go easy don't do any damage. Chew some gum, move your lower jaw around. Hop on one foot and bang your head with your hand just above your ear while tilling your head just kidding.

 

[Albireo]

Have you tried to equalize your ears as you would diving? You might get lucky and relieve the pressure. Go easy don't do any damage. Chew some gum, move your jaw around.

You mean by applying Valsalva while on land? I did not initially, as I thought it would simply aggravate the problem (or more precisely, give temporary relief but ultimately taking a step backward), but I grew so desperate that I tried it anyway. It did give temporary relief, but it caused a brief moment of pain when I stopped exhaling and that hissing/crackling sound as the eardrum re-equalized, and no change in the ache/pain elsewhere in my neck, cheek, and soft area behind my left earlobe.

Also, I should add I experienced no dizziness at any time, further adding to my confusion as to what I am experiencing, complicating my judgements on whether flying will be safe.

Thanks for your help!

 

[Bombay High]

I am no doctor, but try a decongestant such as Sudafed. May help. I had a reverse block from a sinus on a recreational dive last month that caused some blood vessels in my sinus to rupture. Very expensive ....

 

[vladimir]

You mean by applying Valsalva while on land? I did not initially, as I thought it would simply aggravate the problem (or more precisely, give temporary relief but ultimately taking a step backward), but I grew so desperate that I tried it anyway. It did give temporary relief, but it caused a brief moment of pain when I stopped exhaling and that hissing/crackling sound as the eardrum re-equalized, and no change in the ache/pain elsewhere in my neck, cheek, and soft area behind my left earlobe.

Also, I should add I experienced no dizziness at any time, further adding to my confusion as to what I am experiencing, complicating my judgements on whether flying will be safe.

Thanks for your help!

Repost the question in the medical forum. Hopefully you'll get a more authoritative answer.

If you'd like more guesswork by laypeople, however, here's mine: Valsalvas, Toynbees, Frenzels, etc., are a bad idea (unless you need to equalize on the flight), and will likely aggravate the trauma you've already inflicted. A reverse Valsalva would make more sense, but that seems like a bad idea too, for the same reason. I'd make my flight, take the Sudafed and/or the Claritin (Claritin-D has pseudoephedrine bundled in), and add some ibuprofen to the cocktail (after checking to see if there is any bundled in with the others) to address the inflammation.

There was a recent article in DAN by a diver who shrugged off his ear trauma and permanently lost his hearing in the afflicted ear, so I would take it seriously (although the time to do that was after dive #8), even though it's probably no big deal. See an ENT at the first opportunity if the symptoms don't resolve.

 

[Whatevva]

Hop on one foot and bang your head with your hand just above your ear while tilling your head

Please don't do this while flying on a Private Jet (Those that know, will understand)

 

[cmburch]

I have had it where it feels like someone is slowly drilling a pencil in between my eyebrows while flying. I always have time released Sudafed and Afrin in my carry-on and dive bag. Also cracking noises/sensation in the same area when surfacing. As well as popping and gurgling noise from my ears which feels good. I had my sinuses scanned and all is well. I wonder if a couple of shots of Afrin in the nose will help?

 

[Albireo]

I am no doctor, but try a decongestant such as Sudafed. May help. I had a reverse block from a sinus on a recreational dive last month that caused some blood vessels in my sinus to rupture. Very expensive ....

My goodness, this just reminded me: at some point I did indeed notice a tiny taste of blood in the back of my mouth upon surfacing (but not during the dive) and once even had a bloody nose on the boat afterwards. I shrugged it off at the time so don't remember which dive it was: now I wonder if it wasn't the infamous dive 8.

Why was the blood vessel rupturing "very expensive?"

@vladimir: Sometime in the middle of the night I realized I had become more sensitive to the pain so took precisely that cocktail you mentioned. Just before my flight -- which should last 7-8 hours -- I will supplement with the 12-hr Sudafed. Hopefully I can last long enough to drag myself to a dive-savvy ENT.

I'll call DAN in the morning (for a referral; i actually have DiveAssure but they were a bit unhelpful at midnight when I called), but by chance anyone know a good ENT who dives in the Boston area?

Thanks to all for your support. This was definitely not how I wanted my vacation to end!

 

[Bombay High]

The reverse block will cause the bleeding on ascent.

Expensive because I could not work.

 

[Albireo]

Hi everyone,

It's been two weeks since I posted so I thought I'd drop a follow-up. After weighing the advice given here and thinking rationally through my own slightly panicked mental state, I finally realized that the pain in my ear and jaw/neck was not getting worse and so decided to take the flights home. Given the pain I was feeling this was no easy decision, and as the time approached for take-off I did grow increasingly concerned, but on the balance I figured if I had survived three UW ascents then the much milder ascent in an aircraft would probably not be as bad. Also the one or two times I checked I had no problem applying Valsalva so as far as I could see my Eustachian tubes were just inflamed, no totally out-of-service. About an hour before scheduled take-off I took the cocktail of naproxen sodium (Aleve) and 12-hour pseudoephedrine, as noted before.

Luckily, my predictions were correct, but "luck" was the operative word. The first leg from Roatan to Atlanta was heavily delayed, so much so that I began to wonder whether I'd make the connection back to Boston and how that would affect the drugs I had just taken (the 12-hour pseudoephedrine was the last one I had). Well, nothing a pharmacy in Atlanta couldn't solve, I figured. We ended up taking off maybe 1.5 hours late, and my left ear did hurt on the way up during the first flight. However, the pain was more indicative of a slow ascent and was limited to the eardrum itself: there was no jaw/neck/throat throbbing. There was much much less of continuous hissing noise and more of the normal pop-pop-pop, albeit much more frequently and much slower than I would've liked (causing higher levels of pain just before the pops). This was psychologically more manageable. My wife and I also lucked out: the flight from Roatan to Atlanta was so full that we were automatically bumped to the first row of first class (from economy!), so I could massage the back of my ear without as much public embarrassment.

We lucked out again in Atlanta, although only from my perspective. Despite the magic of Global Entry (which eliminated any wait at immigration and sped us through customs on a separate line), Atlanta airport failed us: they couldn't get the baggage out of the plane fast enough. In fact, it nearly took them an entire hour, which torpedoed our connection (we would have easily made it otherwise). For my ears, it was a small break: I'd have another 12 hours or so before the next flight. That made a noticeable difference: during the second flight the next morning the sharp pains during ascent were less intense and the ear equilibrated a bit faster, say half an hour instead of 45 minutes.

Back in Boston I made a call to the Massachusetts Eye & Ear Infirmary (next to the Mass General Hospital, all of which is close to where I work) and was given an appointment the very next morning. My having returned on a Sunday, I couldn't have expected better service! Dr. Goldstein -- who as he humorously put it became a world expert on pressurization of the eardrum in various animals (gerbils were on the long list, I believe) while doing research for the Air Force -- reported that while I had "done a number" on my left eardrum and it was in a slight "negative" position (pushed inward), there was only a touch of fluid behind it and no sign of infection. Great! Because of my own observation that I was hearing myself in my left ear depending on the eardrum's position, and that overall I felt that my hearing had diminished, he called for a hearing test which was fine except for more sluggish movement in the left eardrum (forget the name of the test). By coincidence I had a hearing test done less than a year before for different reasons (earmold for headphones) so I'll try to dig that report up to see what had changed.

As for what caused the blockage, the doc said I probably either over-Valsalva'd on descent, or more likely had a cold I didn't know about. The latter possibility took me by surprise as my breathing and nose were more clear in Roatan than they had been in years. Then it hit me: because I felt so clear I had stopped taking the Claritin that I had been taking since the hay fever season began in Boston. Probably in the long term I wouldn't need it in Roatan, but in the future I'll be sure not to suddenly change my Claritin intake when going diving!

There is another twist to the story. I asked Dr. Goldstein about why my jaw/neck/throat felt so tender and painful after ascent, and his response took me by surprise: it had nothing to do with my Eustachian tubes. Instead, he asked me whether I ground my teeth. I replied that I do, and then it suddenly dawned on me: I do remember chewing quite a bit on my regulator while diving, and especially during those painful ascents. I thought nothing of it at the time since it felt like biting down on a bite guard, but in retrospect it all made sense. And lo: for the first few days after returning to work I actually could not open my mouth fully to, say, bite into a burrito. It has since subsided, but I have become much more aware of my teeth grinding during the day. There's a silver lining to every cloud, it seems!

Now, two weeks later, I woke up today without my eardrum in that negative position -- normally requiring a quick Frenzel to pop back out -- and my hearing has largely returned to normal. Curiously, I heard more tinnitus in my left ear since the accident but today this has suddenly subsided as well (I normally have a touch more tinnitus in my left ear). So I seem to be healing fine!

I've learned several lessons here:

1. Don't suddenly go off allergy medicine just because I change locales
2. Learn how to better equalize my ears on descent
3. Avoid chewing on my regulator.

And always carry some extra 12-hour pseudoephedrine!

Thanks again to everyone for their help. It definitely took the edge off my panic and helped me consider my options more rationally. Like in diving emergencies, that made all the difference.