Since is has been a no dive zone for me lately I have been trying to find out some answers to questions I have had. Sinus issues are always lurking around for me. But what is barotrauma and how does it affect me as a diver? The most common barotrauma symptom a diver experiences may be mild discomfort to intense pain in the sinus or middle ear – this is usually the first indication of a problem in equalizing. I get it after longer dive trip when I am overdoing it. Middle ear barotrauma may also include symptoms of ringing or hearing loss. As blood or fluid accumulates in the middle ear a diver may experience a partial, complete or muffled hearing loss as well as damage to the inner ear. I have many times had a little pop go and my ear had cleared and my hearing has doubled as if a plug was pulled out of my ear. Roaring in the ear, nausea, vomiting, dizziness, a sensation of spinning and decreased hearing may also indicate inner ear barotrauma, which requires urgent specialized treatment. I thankfully have not had this but one a dive in LDBS after Rich had some bloody mucus in the mask he was ill for two days. Loss of appetite, nauseau and complaints of feeling weak. Needless to say he didn’t dive and I went out and picked up a dive with someone on shore looking for a buddy.
Blood from the nose or in the sputum is also an indication of barotrauma and does not have to be associated with other symptoms. These are symptoms that should probably end the day’s – and possibly the week’s – diving. Continuing to dive with barotrauma may result in serious injury. Fortunately we have not had this issue!
To avoid barotrauma, remember:
•Test your ears and sinuses by equalizing prior to entering the water or prior to your descent;
•Descend at a slow, steady pace and keep up with your clearing maneuvers;
•Do not continue to descend and forcefully clear if you’re having difficulty – stop your descent before you experience ear or sinus pain (waiting until you feel discomfort to begin clearing means you’ve waited too long);
•Descend and equalize in a feet-first position; it is easier than head-first;
•If you do experience pain or discomfort, ascend until it is relieved;
•Equalize early and often to stay “ahead” of barotrauma.
What if you can’t equalize? First, don’t dive until the problem is resolved. If a diver has trouble equalizing the sinuses and middle ear, there may be some pre-existing problem – the most common is diving with a cold or flu. Frequently the mucous membrane will retain fluid and swell, partially occluding the air passages to your sinuses and the Eustachian tube going from the back of your throat to the middle ear. This not only makes clearing difficult, but it may prevent it altogether.
Read my section Equalize me Baby! for more info on great equalizing tips.
Other recognizable factors in equalizing problems are if you have had:
•a history of childhood ear infections or even one severe infection that may leave the eustachian tube scarred and partially occluded;
•a history of a broken nose or a deviated septum that prevents one ear or set of sinuses from clearing as fast as the opposite side. Rich has had several broken nose issues from playing rugby and soccer.
•hay fever, which may produce swelling of the mucous membranes or cause nasal polyps that can partially or completely occlude a sinus cavity or airway.
If you have a history that includes these conditions and want to dive successfully, it may require referral to an ear, nose and throat physician or allergy specialist who is familiar with these conditions.
Treatment and Medication
If you experience any symptoms during or after a dive, then you should consult a physician to determine the extent of the injury, or if there is some treatable condition causing the problem. Your physician can determine the correct treatment and medication for sinus or middle ear barotrauma and refer you to an ear, nose and throat specialist if necessary. Proper care and medication under a physician’s supervision can reduce the time divers experience barotrauma symptoms – and the sooner they can get back into the water to enjoy diving.