Comprehensive information about diving and undersea medicine for the non-medical diver, the non-diving physician and the specialist.
Most ENT problems related to diving are due to barotrauma. Barotrauma is tissue damage that results from the changing volume in air-filled spaces associated with descent and ascent in the water column. This a direct result from the effects of Boyles' Law. Divers describe the effects of this barotrauma as a squeeze of the sinuses or ear.
The most frequent problem for all divers and swimmers, this is an infection of the ear canal caused by water which makes the normally acid environment alkaline.It iis treated simply by changing the pH with an acid solution or treating with an antibiotic that is alkaline. Divers prone to this condition should use an acid-alcohol drop after diving in order to dry the ear canal. (One third vinegar and two thirds rubbing alcohol).
If a diver perforates his TM, he should wait at least six weeks after the perforation has healed so that the edema has resolved completely. Treatment with systemic decongestants such as Sudafed, 60 mg. orally three times daily and topical decongestant drops, for not longer than three days.
There is really no difference between the damage and pain with descent or ascent. It occurs in both flyers and divers and the pathophysiology is the same--the inability to equilibrate the air pressure as it changes, up and down.
All of this depends mainly on the function of the mucosa of the nose and sinuses. Some people secrete large quantities of mucus, either in response to allergy or to milk drinking. Others have a definite correctible problem, such as nasal septal deviation, polyps or tumors, resulting in blockage of the ostia (openings) of the sinuses.
The frontal sinuses are the most frequently involved, probably because the nasofrontal duct is longer and more tortuous. The damage that is done by the pressure change leads to a series of changes within the sinuses consisting of air absorption, decreased pressure in the sinus; swelling, engorgement, inflammation and fluid collection in the sinus cavity. This decrease becomes greater with descent (as with flying) the changes become greater, more painful and often associated with bleeding into the sinus cavity. On ascent, there is one-way valve blockage of the ostia, resulting in more barotrauma. The next step after all this is usually infection, which increases the blockage by causing it's own swelling and purulent discharge.
Common causes of all this include, allergy; chronic irritation, such as smoking, diesel fumes, chemicals, prolonged use of nose drops or nasal sprays; mechanical blockage; vasomotor problems from chronic tension, stress or anxiety.
It should be obvious that what should be a very simple problem can be stubbornly difficult to diagnose and manage.