Right TM rupture question

[toxdoc1947]

I got open water certified on August 15. A couple of weeks later I celebrated by not paying good attention to clearing, and producing a pinhole rupture in my right TM. Stopped my dive buddy - did a "look at this" sign, and proceeded to blow bobbles out out my right ear. He was sort of unimpressed and told me later he'd seen lots of people do that.

History: 15 (dunno, maybe 20 or 25) years ago I fell when water-skiing and landed on my right ear - if I hadn't had a flotation device, I wouldn't have known which way was up - extreme vertigo. Drained several ounces of lake water out of my ear. Eventually (over several weeks) healed.

maybe 10 years ago I was snorkeling in Puerto Rico, and pushed a little two hard - got a pinhole rupture in right TM that healed over a couple of weeks.

This time, same thing - a "queep! sound, cold water in middle ear and a little vertigo. Saw doc a day later - he did the steroid-antibiotic drops and some antibiotics systemically thing. Also insisted that I have a tympanogram before diving again (he's a wuss - made me have a stress test before taking the open-water course).

Anyway, visit to ENT for tympanogram is scheduled for tomorrow. TM is healed best I can tell by clearing pretty hard.

Problem: I've not had much trouble clearing with valsalva manouver or swallowing in the past - problem is that SCUBA air is so dry that I lose the moisture to swallow after 15-20 minutes. Should I leak some water around the mouthpiece so I have something to swallow, or what? Have tried extending neck. massaging area of e tubes, and thinking pure thoughts.

An reluctant to try decongestant drugs because of the issue of negative block if they wear off during the dive. BTW I am a pharmacist, clinical pharmacotherapist, and clinical toxicologist, so don't spare the advice.

Am wavering between just having not taken the time to clear since I was following a really experienced diver; versus looking for a better way to clear.

Have watched the video

Any other thoughts? I'm not about to give SCUBA up, it's 'WAY too positively reinforcing (not to mention the investment in equipment so far). Help me find a way, please!

Thanks

John

 

[doctormike]

Anyway, visit to ENT for tympanogram is scheduled for tomorrow. TM is healed best I can tell by clearing pretty hard.

Problem: I've not had much trouble clearing with valsalva manouver or swallowing in the past - problem is that SCUBA air is so dry that I lose the moisture to swallow after 15-20 minutes. Should I leak some water around the mouthpiece so I have something to swallow, or what? Have tried extending neck. massaging area of e tubes, and thinking pure thoughts.

An reluctant to try decongestant drugs because of the issue of negative block if they wear off during the dive. BTW I am a pharmacist, clinical pharmacotherapist, and clinical toxicologist, so don't spare the advice.

Am wavering between just having not taken the time to clear since I was following a really experienced diver; versus looking for a better way to clear.

Have watched the video

Sounds like you have covered most of the bases... really just a question of you getting better at clearing (early and often) so you don't stress out that TM of yours again! If you are a pharmacist, then you probably know about this:

Practice Guidelines - June 15, 2004 - American Family Physician

Swallowing seawater is probably not the best idea, would make most people sick if they had to keep doing it to equalize. Here is one product that is supposed to help with dry mouth and might make it easier to swallow:

Apollo Bio-Filter Regulator Moisture System from LeisurePro.com

I think that Sherwood regulators have some sort of internal fins that they claim helps to retain moisture...

Good luck!

Mike

 

[DocVikingo]

Hi toxdoc1947,

Those experiencing dry mouth while diving may wish to experiment with the following:

1. It is always a good idea to stay well hydrated while diving and this will help, although not eliminate, dry mouth.

Avoiding caffeine, sugar-containing products, alcohol and smoking, especially prior to diving, will assist in good hydration and help reduce dry mouth.

2. Purchase a reg with "moisturizing fins" in the second stage, such as the Oasis & Blizzard made by Sherwood (Welcome to Sherwood Scuba!).

3. Purchase the Apollo reg which has a "moisturizing chamber" into which you place a small, damp sponge. Or get one of Apollo's new in-line moisturizers (Bio-Filter; (Apollo Sports: Dive Gear: Regulators: Bio-Filter).

Neither the regs nor the inline moisturizer work miracles, but can provide some relief.

Be aware that the Bio-Filter (Apollo Sports: Dive Gear: Regulators: Bio-Filter) needs regular servicing and does represent another potential failure point in the reg system.

4. Since the trusty old "Scuda" is no longer on the market, I now recommend a "Camelbak," nifty little sports canteens which allow you a squirt of fresh water, or whatever ever other liquid you desire, where & when you want it. CamelBak Better Bottle w/ Bite Valve models in various capacities have a bite valve as well as a loop at the top for rigging and work very well u/w (Water Bottles from Backcountry.com).

5. Periodically tickle the roof of your mouth with your tongue, or run it along your teeth, as this will trigger salivation.

6. Rub a very small bit of toothpaste in your mouthpiece prior to entry.

7. Although it is unlikely to come to this, there are artificial saliva products, both OTC & prescription, in various forms that are primarily designed for those with severe & chronic dry mouth secondary to particular diseases or medications/medical treatments. I have suggested these to divers who are post-radiation therapy of the head and neck and they have reported reasonable relief. However, used occasionally and as directed they should do no harm to healthy individual. Examples of OTC products are Entertainer's Secret, Glandosane, Moi-Stir, Optimoist, Saliva Substitute, Xero-Lube Artificial Saliva & MouthKote.

Helpful?

Best regards.

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[knotical]

Have tried extending neck. massaging area of e tubes, and thinking pure thoughts.

A couple of other passive equalizing techniques you might want to try:

Jaw Thrust: Without otherwise moving your head, shove your chin toward your computer monitor. Farther. Do you feel it in your ears?

Polite Yawn: Harder to describe and to do, but can be effective. Yawn, but only open your mouth as wide as a mouthpiece. If you do it right, you’ll feel it in your ears.

Practice on dry land. Practice some more.

Best wishes.

 

[doctormike]

Problem: I've not had much trouble clearing with valsalva manouver or swallowing in the past - problem is that SCUBA air is so dry that I lose the moisture to swallow after 15-20 minutes. Should I leak some water around the mouthpiece so I have something to swallow, or what?

I just got a sample of this in the mail... not sure if it works or not, but might be worth a try. It looks like this thing sticks to the roof of your mouth!

OraMoist disk

Clever idea...

Mike

 

[DocVikingo]

OraMoist disk

Hi Mike,

Clever idea as long as they can't come loose and be aspirated by the diver.

Regards,

DocVikingo

 

[doctormike]

OraMoist disk

Hi Mike,

Clever idea as long as they can't come loose and be aspirated by the diver.

Regards,

DocVikingo

Yes, the same thought occurred to me... but if it really is just a small, dissolvable tab, probably not too much risk, even if it does come loose. I might order a few just to check them out!


Mike

 

[gert7to3]

I have gone over to using saline nasal irrigation spray. I just flood my sinuses and it seems to help in several ways. It gets my sinuses used to water going in; it hydrates my sinuses; it flushes my sinuses out so they are clearer.

I take my regulator out of my mouth during my dive and work up enough saliva to spit. This is a good time to test your secondary/alternate reg too. It also gives you

confidence and practice for how it feels to have your reg out of your mouth.