By Joel Dovenbarger, DAN Director of Medical Services
(First appeared May/June 1999 – DAN Alert Diver magazine)
Question: I am in good health and have had occasional problems clearing my ears because I had a broken nose with a deviated septum. I was diving recently and had a little trouble clearing my ears during my dives. I also had sinus congestion from a recent cold.
After surfacing from my final dive, my ears felt blocked (like they had cotton in them), and voices seemed muffled. I began taking decongestants. They helped, but as the blocked / pressure sensation got better I noticed a ringing in both of my ears. I saw an ear, nose and throat physician who put me on prescription medication, including steroids and a strong decongestant. I have had excellent hearing in the past, but a recent test showed that I had severe to moderate hearing loss in both ears.
The doctors told me that the ringing may be permanent and that I should not continue scuba diving, but he is not a diver. Can I continue to dive with ringing in my ears?
Answer: Your doctor is probably correct – you should consider discontinuing diving. Sinus and middle ear barotrauma are the most common dive-related injuries. Injury to the soft tissue lining of these air spaces in the body is an inherent problem in scuba diving because of the changing volumes of gas while descending and ascending. Improper clearing (equalizing technique) can lead to these types of injuries and is the most common contributing factor among new divers. Other contributing factors may be a history of sinusitis, allergies and childhood ear infections. Any chronic irritations or infections may damage the soft tissue lining (mucous membrane) of the sinuses and especially the Eustachian tube, connecting the middle ear with the pharynx. A deviated septum can also cause difficulty in clearing. Divers who continue to descend when they cannot equalize pressure risk several consequences: pain, fluid accumulation and bleeding into the cavity, whether it is the ears or the sinuses. Infection of the fluid can ensue and persistence of fluid in the middle ear is one possible reason for impaired hearing. Rupture of the eardrum can also occur, and more serious is damage to the small membranes in the inner ear: the round or oval windows. Although spontaneous healing of these structures can occur, and surgical repair may be possible, permanent loss of hearing can result.
Over-the-counter medication used for the symptoms of congestion can be very effective for some divers and can help with pressure equalization. However, the mucous membrane may not fully recover from a viral infection or head cold for several weeks after initial symptoms begin – this is why DAN advises divers not to dive with any symptoms of a cold.
When barotrauma has occurred in the middle ear, it is not unusual for the diver to have a sensation of pressure or fullness and decreased hearing. Ringing (tinnitus) represents the stimulation of the nerve fibres responsible for interpreting sound. In your case, a similar episode of barotrauma could lead to further damage and additional impairment. Your physician may probably feel that this risk is not worth taking, and you will have to consider whether some degree of permanent hearing loss is an acceptable risk for you.
DAN recommends that divers wait until symptoms of viral illnesses and head colds have completely resolved before planning a dive. Although decongestant medications may be helpful in salvaging a diving vacation if symptoms are mild, they do not necessarily prevent serious sinus or ear barotrauma. If you cannot equalize pressure in the middle ear cavities or sinuses, you should not continue to descend.
It’s a good idea to "pre-clear" before you go under: hold your nose and swallow to see if you get that characteristic release.