ENT Divers problems
The most common symptoms reported by divers are associated with changes in the air and water pressure which have particular effect on ears and paranasal sinuses of a diver.
Injuries of sinuses and middle ear Barotrauma is a physical damage of body tissues caused by difference in pressure in the body and in the new surroundings. Middle ear Barotrauma is the most common injury of divers. Sinus barotrauma can less frequently be observed in divers.
How does it happen?
During diving, the task of air spaces in the sinuses and middle ear is to equalise the pressure inside them to the water pressure, which increases with depth. During descent, when the increasing water pressure pushes the tympanic membrane into the outer ear, a divers starts feeling discomfort depicted as headache or ear pain. Pain intensifies with further increase in depth until it becomes very uncomfortable. If despite the pain, diver will continue to descent, the tympanic membrane will rupture. It may occur at depth of 4-5 meters or even in shallower water. During ascent, similar situation takes place, when blocked Eustachian tube cannot release the excess air which is expanding from the middle ear (reverse block). Fortunately, reverse block is very rare and occurs mainly in warm waters. Pressure in the middle ear can be very easily equalised. In fact, there are three ways to do that: The most common method involves blowing the air to the middle ear through the Eustachian tube. In order to equalise the pressure in the middle ear while descending, a diver should plug the nose with the fingers (grab the nose) and try to blow into the nose just as during blowing the nose (Valsalva manoeuvre). Valsalva manoeuvre is the most frequently used due to its best effectiveness but at the same time it is the most radical. Another way, particularly useful for people with very good patency is swallowing and moving the jaw. All those methods can be used together or in combinations but vast majority of divers performs only the Valsalva manoeuvre.
The causes of injures of middle ear and sinuses
The most common causes of ear injuries involve blockage of the Eustachian tube (inflammation, allergy, rhinitis, swelling, deviation of nasal septum) and obstruction of the external auditory canal (foreign body, earwax blockage, too tight-fitting hood of the wetsuit, earplugs). The most common injuries of the sinuses during diving include rhinitis, nose inflammation and runny nose, sinusitis and inflammation of paranasal sinuses, polyps in the nose and paranasal sinuses, very serious nasal septum deviation.
Prevention is the key
The best way to avoid damage to the middle ear or sinuses is to refrain from diving when there is some disease or inflammation in those structures.
If during diving a person feels discomfort, a diver should stop descending and ascend several meters until the pressure will be reduced. Sometimes divers use topically do the nose preparations which narrow the vessels with oxymetazoline hydrochloride, which favourably affect the pressure equalizing mechanism
In order to avoid barotrauma, one should remember:
- not to dive in respiratory tracts and ears are inflamed;
- to control the Eustachian tube patency before diving;
- to often blow the ears staring at small depths (0.5 m below water surface);
- not to allow pain to intensify during descend.
Difficulties in equalising pressure may result from:
- Often ear infections in childhood, severe inflammations which may leave scars in Eustachian tube causing its partial obstruction;
- History of nose fracture or deviated septum which disallows to equalise pressure;
- Hay fever, which can cause swelling of the nasal mucosa and give rise to polyps, which can partially or completely close the sinus cavity or upper respiratory tract.
Main symptoms of middle ear injury during diving include:
- increasing pressure in the ear which turns into piercing pain. Pain can occur even at depth of 1 m
rupture of the tympanic membrane, flooding the middle ear with cold water which can lead to:
- nausea and vomiting;
- loss of spatial orientation (a diver does not know which side is up and which one is down
- serious symptoms of barotrauma include partial or complete hearing loss (often temporary).
Medicines and treatment
In case of any symptoms during diving or directly after it, one should immediately contact otolaryngologist. During the appointment, a physician will examine sinuses and the interior of the ear.Laryngological examination will allow to assess the condition of the tympanic membrane in the ear which continuity could have been affected during a dive. In some cases, it is necessary to administer drugs, such as antibiotics.
Methods applied in surgical treatment depend on the cause of obstruction in the upper respiratory tract. The most frequently used methods in case of diving disorder include functional endoscopic sinus surgery(FESS) and correction of nasal septum (septoplasty). FESS is a modern method of treatment of chronic sinusitis.
Microsurgery of paranasal sinuses with use of endoscopic visualisation is the essence of the treatment. It is conducted intranasally without the necessity to cut the facial skin. Control of the endoscope allows to accurately identify the cause of symptoms and as a consequence to limit surgical intervention only to affected tissues.
By use of FESS correct ventilation of paranasal sinuses is restored by unblocking the so-called ostiomeatal complex, i.e. natural connections of the sinuses with the nasal cavity.
Septoplasty is a correction of the nasal septum. Its aim is to reduce nasal obstruction and restore proper functioning of the ciliary apparatus which purpose is to clean and warm inhaled air. Septoplasty involvesintranasal cutting of the mucosa that allows to correct deformed part of the cartilage and bone of the nasal septum without leaving scars. The procedure is very precise due to the use of endoscopic techniques. It is performed under general anaesthesia and lasts approx. 1 hour. General anaesthesia provides comfort to the patient, enables the appropriate control of the arterial blood pressure, thus reducing bleeding during surgery.