Dr. Taffet's SCUBA
Tips
DAN
One of the best things any diver can do for his
health is to join Divers Alert Network.
This is an organization devoted to diver safety and development of
good diver education and guidelines. To join call 800 446
2671.
Nosebleeds While Diving
Do you get nosebleeds while scuba diving?
Nosebleeds during diving are of no importance. If
they don't stop, use any nose drops such as Neosynephrine 1/2 %, put
it on cotton, and place the cotton in the nose where it is bleeding
and press gently. This usually stops the bleeding. Should the
bleeding continue on a daily basis, get Neosporin Ointment, the 15
gms tube. This has a pointed tip that you can insert into the soft
part of the nose, squeeze some ointment in, pull the edge of the
outer nostril down to seal the nose and gently milk the ointment
into the nasal cavity.
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Seasickness
Do you get seasick on the boat or in the water?
Seasickness is a particular problem for divers.
They are not permitted to take over the counter anti-seasickness
medications. This is because these all have a side effect of
drowsiness, which can add to nitrogen narcosis at depth. For every
33 feet you descend it is like having a Martini. Thus if you add the
sedative effect of Antivert or Dramamine you may have a problem.
You can take Emmetrol, however. This is an over
the counter antinausea liquid, essentially a sugar solution. Often
this takes care of the nausea and dizziness. Take a teaspoon on
arriving at the boat and keep sipping it as needed. Another trick is
to fool your body into thinking you are in an automobile. You have
learned to accommodate to the car stop and go and no longer get car
sick. Turn your head so that the motion of the boat is like the
direction of the car.
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Trouble Clearing Your
Ears
A common problem is
difficulty with the ears during descent. When this occurs at 5 feet
depth there may be a closure or obstruction of the Eustachian tube.
At 15 feet, in a person otherwise healthy, I usually find slow
mucociliary flow and correction of this problem allows the diver to
continue diving.
Eustachian tube function (ETF) has been shown to
be directly dependent upon mucociliary clearance (MCC), the function
of this cilia. Serous otitis is significantly present with decreased
MCC. In hyperbaric chamber treatment, where hyperbaric oxygen is a
known inhibitor of MCC, the incidence of serous otitis is so high
that placement of middle ear drain tubes is often necessary. In
scuba diving, if the instructor remains in the water in the back of
the boat while the motor is idling, he will have difficulty making
his next dive because the fuel exhaust that he inhales will impair
his ciliary function.
For divers who cannot clear at 15 feet, try lots
of hot tea, proteolytic enzyme
tablets, one every four hours, dissolve in mouth between the
cheek and the gums. Start proteolytic
enzyme tablets the
day before diving. Don't smoke and avoid boat exhaust fumes. If
still not clear, use the pulsating nasal irrigation device daily;
start 5 days before diving, and use the morning of the dive. More
men than women have this difficulty because more men have a deviated
septum or they blow their nose too hard. Blow gently. For regular
nasal congestion I usually recommend Zephrex LA taken twice a day.
Some of my divers take this regularly when diving.
For most divers it is best to start proteolytic enzyme tablets the day
before diving. For someone who has a history of difficulty in
clearing the ears, start 3 days before the dive. Proteolytic enzyme tablets can be found
on the web and in some stores, but be sure to check that the enzymes
are calibrated in enzyme activity units - otherwise they may do no
good.
On descent, try to go down on a line feet first,
never head down.. Try to clear about every 5 feet. Be gentle.. If
trouble clearing, hold the nose and force air very gently. Or go up
a few feet. Another technique is to lift the tongue against the roof
of the mouth and swallow. All beginning divers have some difficulty
in equalizing, so don't be embarrassed.
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Ear Pain While
Diving
Ear pain while
diving can come from several sources:
Ear Drum Pain (Myringits)
If you hit the
water with your head to the side, you can slap your ear drum and
this can be painful. This is called a myringitis or pain of the ear
drum . After diving, this is a common cause of ear pain, the eardrum
has been shoved around so much with clearing too hard, or striking
the water too hard, or just a lot of up and down action. Sometimes
plain olive oil or baby oil will relieve it. Any soothing ear drop
such as auralgan is good. Prevention consists of wearing a hood
while making a leap from the boat and clearing the ears GENTLY.
Outer Ear Infection (External Otitis)
Ear
pain, especially after several dives, is most commonly caused by an
irritation of the ear canal. The problem here is that once the canal
starts to swell, it is surrounded by bone and this acts like a
pliers squeezing on the sore ear canal. Generally pain here is 3x
greater that the same swelling on your hand or cheek. If the canal
swells completely shut it is VERY painful. Fortunately the severity
of the pain doesn't mean it is more serious, just that the swelling
is in a tender sensitive area.
You can prevent outer ear pain by NEVER washing
your ears with soap and water. You need the wax in your ear to
protect you from the ravages of swimming and diving. Alcohol and
peroxide both take away natural wax and make one prone to outer ear
infections. I advise my divers to always put baby oil or olive oil
in the ear canal before washing the hair and any activity where soap
or water can enter the canal. Because of the shape of the ear canal,
like a bent baby bottle, once the soap gets in there, you cannot
take it out and it just lays there and reduces wax and oil
formation.
Treatment should be started at once. Do not put
heat to the ear. The pain is due to the swelling, so heat will cause
it to swell more. Take an antihistamine such as chlorpheniramine 4
milligrams (no prescription)4 times a day. Proteolytic enzyme tablets are good for reducing
swelling (Papaya Enzyme) The doctor may elect to give an antibiotic.
Ear drops such as Cortispoin Otic Solution are good. If the canal is
very painful and swollen we generally put a wick or drain in. This
allows the drainage to come out and the medicine to go in. It is
important to clear this type of condition as quickly as possible
because the longer the outer ear infection stays, the more tendency
to reoccur. Therefore you should stay out of the water until clear.
Once you have had this type of infection I advise my divers to take
an antihistamine the moment they feel this coming on. Do not take
antihistamine while diving. Any antihistamine can make you drowsy
and add to nitrogen narcosis -remember, every 33 feet is equal to
one martini.
Middle Ear Infection
Ear pain can come from
the middle ear. This may be a regular middle ear infection (otitis
media.) Except for when the ear drum is bulging outward severely,
this type of infection is not especially painful. In children is
painful because pus builds up and bulges the ear drum. It may be
caused by blowing the nose too hard and forcing the nasal pus up the
eustachian tube into the middle ear cavity where the bacteria
multiply. If there is heavy phlegm or pus in the nose, using the
pulsating sinus
irrigator daily 5 days before diving may prevent
eustachian tube blockage.
Blockage On Descent.
Water presses on the
ear drum because the ear doesn't equalize. The drum becomes
irritated just like having a 15 pound weight on your eyeball would.
Once your down, if the ear blocks, the air can expand and if the
pressure is not relieved could rupture the ear drum. A ruptured ear
drum as a rule is not painful and is not a medical emergency. Just
avoid putting drops in the canal which can carry bacteria into the
middle ear. 90% of ruptured ear drums heal without problems.
Rupture of the Round Window
A rupture of the
round or oval window of the inner ear, also called a perilymph
fistula, is never painful. This leaves an opening so that inner ear
fluid escapes and can cause permanent hearing loss. This is caused
by forcing the blocked ear open with too much pressure. Therefore
always be gentle. If you can't clear, go up 5 feet and try
again.
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Perilymph Fistula or Round Window
BlowoutPerilymph fistula (PLF) is one
of the serious complications of diving. When the diver blows his
nose too hard or forces air into the eustachian tube from his nose
as hard as he can in order to clear his ears, the pressure may blow
out his ear drum. He will feel cold water enter his ear and probably
feel dizzy due to the cold hitting one ear while the other eardrum
is intact. This complication is not serious and the ear drum
generally heals O.K. without any permanent damage.
But if the pressure in the middle ear makes a
hole in the round window of the inner ear, this is very serious and
can cause a permanent damage. There are two openings to the inner
ear, both very very tiny. One is connected to the Stapes bone. When
the ear drum vibrates, the stapes moves in and out, sending a wave
of water in the inner ear. The stapes moves in causing a wave. This
same wave travels round and round and pushes the round window out.
This is the basis of the hearing mechanism. When a hole in forced
into the round window, the fluid of the inner ear can leak out and
cause deafness. This hole is called a PLF.
The PLF is not painful. When the doctor looks in
your ear he sees an intact drum. The only signs may be hearing loss,
tinnitus and dizziness. Sometimes only one of these symptoms is
present.
The best treatment in my experience is surgery.
We lift up the ear drum and plug the hole. There isn't universal
agreement as to the best treatment. Some doctors feel the person can
be put to bed, with the bad ear up in order to lower the pressure
and help the healing. Others go for medicine such as cortisone.
What is important is that if PLF is suspected,
call DAN for a referral to an Ear Nose and Throat specialist. Do not
inflate the ears- this will make the hole bigger.
Sometimes it is hard to make the diagnosis. If
the ear drum is red from diving, the diver will say he can't hear. A
special hearing test - an audiogram- done is a sound proof booth is
necessary to determine if the hearing loss is due to the ear drum
being swollen, the eustachian tube being blocked or fluid behind the
ear drum. In my practice, if there is a history of difficulty
clearing, even if I see a red drum, fluid behind the ear drum, I
still do an audiogram because there could still be a PLF present,
behind all these things.
One test we do is to seal the ear canal, bring
up the pressure in the canal and if this makes the patient dizzy, it
indicates a hole in the inner ear - PLF.
Prevention: Do not force hard to clear your
ears. Go down feet first. Clear every 5 to 10 feet. If you can't
clear, go up 5 feet and try again.
You can also get a PLF by heavy straining. Head
stands - remaining upside down is a cause. Also, straining to put
the motor cycle onto the tail gate of a car. Diving for pennies in
the pool can do it. Even straining for a bowl movement.
Once the hole has been sealed, we recommend the
diver not dive again because the same conditions that made the hole
in the first place, may cause a recurrence. However, several of my
patients did return to diving and have been O.K.
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