Forced equalization and middle ear barotrauma Help!

[Ali Elkady]

Hello fellow freedivers,
I started freediving a few months ago and i recently finished my AIDA 2 certification and i started to find myself interested in deep line diving. I am still a beginner though in that matter, my maximum depth was 20 meters, before that i have only dived to 16 meters wich wasn't very smooth in terms of equalization and this was during my AIDA 2 course. Then my next dive was about one month later and i was able to reach 20m and i could have continued to go deeper but the equalization failure stopped me and that's when i wanted to go deeper but one of my wars didnt equalize and i felt some pain and pressure so i forced the equalization and went deeper those couple of meters. I came up okay but after i came out of water i started to feel pressure in my ears and slight pain. I felt i shouldnt dive next day but i didnt listen to my intuition and i did dive a few 15m dives and thats when again i forced an equalization butto the other ear. Then on my way back home a long ride above the mountains i could feel my ears doing crazy popping sounds and hurting me and my hearing was muffed with the change in pressure up the road. Since then and my ears feels stuffed and my sinuses too are hurting me not just my ears. I did some research and i think what happened to me is "middle ear barotrauma" i took an antiinflamatory, decongestant drops, steroid drops through my nose to try and drain the built up fluids, congestion and inflamation but it doesnt seem to be working. Long story short, I wanna ask expert freedivers here is this common among freedivers? Do u think it happened to me because i didnt take my time to adapt my body to the new depth? And is it serious or it is common and nothing to worry about? My buggest concern is my freediving being affected or that i cant dive deep anymore!
Anyway, I will give my body its time to recover and ill take it easy next times with depth progression and will never force an equalization again!
If any of you guys have a similar condition or can give me tips i'd really appreciate it.
Thank u guys and sorry for the long post

 

[Fghxz]

Go see a doctor.

If you don't have an infection, the inflammation and fluid should subside in a week or two.

But seriously, go have a proffesional look at it.

 

[Andrew702]

First let me start off by saying I'm not a medical professional. I will also apologize for the long post and I answered your questions below. I have however had lots of Eustachian Tube (ET) problems from freediving since I began about 4 years ago. I have seen 3 ear doctors in Europe an expert on the Eustachian Tube, another a researcher, professor and ear surgeon and one who’s also a freediver and specializes in freediving related ear problems. After talking with them and lots of independent research on my own I can share quite a bit of knowledge of what issues you can have with your ears. I hope this can save you some time and stress but please consult with a specialist before starting any medication or treatment. I would also recommend seeing doctors who are knowledgeable with freediving or Eustachian Tube issues most ear doctors aren’t well informed in this area. I am not an expert in the this field and I am not claiming I will cite every reason and I could be wrong about a few things.

When your ears are good equalization should be effortless relaxed with no tension. You'll usually hear a clean popping sound. For me I could dive deep one day 50+ then couldn't equalize past 10m the next. I could hear a clean pop on good days. On bad days I hear squeaking, crackling, popping and had vertigo slightly on assent. Also I felt a delay, on ascent, of when the air would escape my middle ear out the ET tube. I would dive for about 3 weeks with a break every two sessions then my ET would completely Dysfunction. I also noticed my ears functioned worst immediately upon waking up and were generally better late afternoon.

The main culprits from Eustachian Tube dysfunction I've found are technical, barotrauma (injury), silent reflux, mucous, diet and anatomical issues. Some of these are interconnected one problem could cause a barotrauma further exacerbating the issue. You need to carefully go through the list of problems specifically technical before assuming there is any physiological problem. This is very common amongst beginning freedivers who assume that something must be wrong with their ears. However this is also the most frustrating problem when something is actually wrong and everyone is trying to tell you that its your technique or this and that. You know your body best and when you’ve reached a certain level of awareness with equalization you can begin to determine what the issue is.

Technique should be your number one culprit and needs to be ruled out before assuming anything else is wrong. If you're not able to equalize past 20m on your most healthy ear day then technique is probably the issue. I think technical issue are too blame in the vast majority of issues. When you dive enough you begin to gain a strange sense of the mechanics of equalization. It was at this time I could tell something was not right. Master equalization even with really bad ears I was able to make it to 40+ but it was not easy. I can't stress enough technical issues need to be first ruled out. I was diving to 50+m easily on frenzel when my ears were good. Then couldn't equalize to 15m another day I knew technical issues were not my problem. Also you should definitely consult with an equalization expert cause through a series of exercises it’s possible to determine if you have some technical issues.

The second most common problem is sinus issues. Personally this was never my issue I was always pretty much clear of mucous and I tried medication to treat this issue. If you have excess mucus this is obviously an issue and can effect the function of ET and Sinus. Generally you'll know if it's sinus cause you'll feel the squeeze in your sinus something I've never experienced. You'll also produce a lot of mucus which is pretty obvious. Also nasal sprays and decongestants will temporarily solve the problem. For me none of this worked and many ENTs will first prescribe a combination of pseudoephedrine, afrin and Flonase (these are brand names). Sinus issues can be related to diet, allergies and illness. If you keep a food log and track what you eat, you may be able to determine what foods produce the most mucous. Allergies can easily be tested for with a doctor.

If it's not the sinus then it could be related to the ET function. When the Eustachian Tube dysfunctions it can lead to Ear Barotrauma, a discomfort in the ear due to air pressure differences inside and outside the ear drum. The Eustachian tube is controlled by two small muscles the TPV and LVP muscles they contract in a wave like pattern to open and shut the tube. This will regulate the pressure in the middle ear and happens automatically under normal circumstances. Unfortunately many things can effect the Eustachian tubal function and cause a barotrauma weak muscles, stomach acids, mucus, diet, metabolism, mood, water temperature, and relaxation. With a ET dysfunction related barotrauma you'll feel a fullness of middle ear and muffled sound (look up more symptoms). If you can equalize it will usually involve squeaking, crackling and popping sounds. For instance I could force air in then it would stay trapped for up to 24 hrs before it slowly escaped the middle ear. I had lots of squeaking, crackling and popping plus it required a very forceful equalization. Equalization during this time is nearly impossible past 15m for me and also quite a struggle.

If you suspect barotrauma you need to then consider why did you get it. Was it a technical issue too forceful EQ? If you over pressure the ears with a forceful equalization it can cause barotrauma in the ear. Sometimes one tube equalizes easier than the other therefore you push too hard and over pressure the good ear. Sometimes mucus can block the tube then you push much harder to open the tube and it results in barotrauma. Did you ride your ears too deep without equalizing? Is your ET inflamed from too much diving, infection, stomach acids, or allergies? Barotrauma is an end result of another issue.

To rule out weak TVP and LVP muscles exercises you should practice BTV (hands free EQ) Exercises. Theses are specific exercises designed to strengthen and build an awareness of the muscles involved in equalization. I also have another exercises that the ET expert said was the best exercise he’d tested, in a laboratory setting, out of all the various BTV exercises. With the exercises you place the tip of your tongue in the middle of the hard bone part in the roof of your mouth. You must keep your mouth open as much as you can with your tongue touching the hard palate. You then swallow and when done right you’ll hear a little pop in your ears as the TVP muscle contracts. My mouth is open the maximum because I can’t swallow but it should be open as much as you can while still swallowing. He recommended short sets of 6-8 a couple times a day. He said that the muscle can tire easily so it doesn’t need to be done many times. He said this was the only exercise it needed and all the BTV exercises weren’t necessary.

If finally we can rule out technical, anatomical, and sinus I might start suspecting laryngopharyngeal reflux or silent reflux. This issue is not widely talked about but in my case played a huge role in my ET function. I had never even heard of it through my countless hours of research until I saw the Eustachian Tube expert and he diagnosed me. Everyone knows about acid reflux and heartburn. Silent reflux is the same thing except you don't have symptoms of heart burn. When you sleep the acid from your stomach travel up the esophagus into the nasal cavity and cause inflammation at the entrance of the Eustachian Tube. You should Google symptoms of this to see if this could fit.

An easy way to determine of this is to reduce your acidic food intake and eat a 20mg omeprazol before bed, in the morning or both. If you notice improvement it could likely be the issue. I tested this theory over a couple months going on and off the medicine. I noticed a major difference when I was on off the medicine especially when comsuming a lot of acidic food and alcohol. I've been diving consistently for the last 3 weeks with no issues except when I've stopped taking the omeprazol. I take 20mg right before bed it works best on an empty stomach and is often prescribed for the morning I however noticed it worked better if I took it at night. I was first prescribe 20mg morning and 40mg at night a very large dose. I was supposed to gradually taper off it. I took a much more conservative approach to see how little I needed to achieve a positive result. You can also try elevating the head of your up 9-12 inches and sleep on an incline (extra pillows won’t work). Again I’m not a doctor and for a true diagnosis you should consult a Gastroenterologist. They can scope down your esphogus to inspect it. There are also PH sensors that can placed in the throat to track PH levels throughout the day or pepsin tests. Eventually I am going consult a doctor as I don’t want to be on omeprazol forever however I only need to take during depth training which isn’t for long periods of time.

***Continued below***

 

[Andrew702]

I have not heard of many freedivers with anatomical blockages. My guess is equalization from the very beginning is nearly impossible so they never try or quit. The entrance of the Eustachian Tube is made up of cartilage and the narrows toward the back by a bone. Sometimes excess cartilage can block the tube or the bone can be slightly large narrowing the tube. You can also have problems with your ear drums. If it's the bone there's nothing that can be done. If it's the cartilage there are some treatments. You'd need to see experts in these treatments to determine if this is an actual problem. I'd suspect though anatomical issues are unlikely if you dive to 20m. Having your Eustachian Tube entrance and ear drum examined can determine if the entrance is obstructed or if there is scarring on the ear drum.

One other interesting thing I would like to mention is that I always dove in a mask until 3 weeks ago. Recently when I’ve trained in a mask my ears didn’t function so well after to sessions. Once I switched to a noseclip everything changed. My ears are much healthier after sessions and I feel like I could dive many days in a row. I however haven’t tested this enough to know if this is anything. I am Asian and because nose pockets are too large for me I never get clean pinch on the nose. I think I could have been EQ with too much for due to a bad pinch on my nse and over pressuring my ears. I will add I think advanced freedivers should be able to dive with a mask to at least 40 meters but that is just my preference.



Now that I have explained all this lets talk about your specific case. First you’ve only been diving a few months. I think it’s likely in such a short amount of time that your technique isn’t very good. The awareness of EQ can take years to understand. You need to spend a lot of time in the water and dry to start to fully understand what is happening.

Second what you are describing is a middle Ear Barotrauma. It most definitely is related to the forceful equalization which should never be done. This is taking one step forward and two back when you need to take time out of the water to allow your ears to heal. This is the same idea when people push to deep too fast and squeeze. Now instead of progressing they need to take time off and rest then restart what they were doing. It’s said over and over again don’t force anything. I ignored this advice and still ignore today but when something goes wrong I can almost always trace it back to I forced a depth a wasn’t comfortable with or forced an EQ.

This injury is very common amongst divers. It’s generally not serious and will usually clear itself up in a weeks or up to a few months. I wouldn’t be too worried about this I had many of these in the past 3 years and I took a few months out of the water and my ears are perfect again. Yeah it sucks not to be able to train depth but the ears need to rest until you feel they are making a clean EQ. In the meantime there’s so much dry exercise and pool you can do that will make huge improvements in your diving.

Well again sorry for the long post. I just dropped all my ear knowledge on you. I felt compelled to give you all the tools I had to help you solve those problems. Ear problems can be the most frustrating problem in freediving made even more frustrating when people think it’s all in your head.

Happy Training,
Andrew

 

[Ali Elkady]

So i went to an ENT and she told me i have an infection.. she prescribed me steroid amd antibiotic :/

 

[Ali Elkady]

It turned out its not only a middle ear barotrauma but also a middle ear infection and i think what happened was during equalizing i pushed some water from the mask to my eustachian tubes and when the barotrauma took place my middle ear got congested and retained that water which stayed there trapped and caused an infection. So what i've learned is always have a good seal mask to prevent water from entering the eustachian tubes or better switch to a nose clip, always have clear and clean sinuses before diving because what could have happened is that leaked water in the mask moved to my sinuses, carried the microbes with it and then was pushed to my middle ear, never force an equalisation and always respect ur body and listen to it, if ears aren't equalising just go up clean and try again slowly even if it means ending the dive that should be okay.

 

[Ali Elkady]

I have not heard of many freedivers with anatomical blockages. My guess is equalization from the very beginning is nearly impossible so they never try or quit. The entrance of the Eustachian Tube is made up of cartilage and the narrows toward the back by a bone. Sometimes excess cartilage can block the tube or the bone can be slightly large narrowing the tube. You can also have problems with your ear drums. If it's the bone there's nothing that can be done. If it's the cartilage there are some treatments. You'd need to see experts in these treatments to determine if this is an actual problem. I'd suspect though anatomical issues are unlikely if you dive to 20m. Having your Eustachian Tube entrance and ear drum examined can determine if the entrance is obstructed or if there is scarring on the ear drum.

One other interesting thing I would like to mention is that I always dove in a mask until 3 weeks ago. Recently when I’ve trained in a mask my ears didn’t function so well after to sessions. Once I switched to a noseclip everything changed. My ears are much healthier after sessions and I feel like I could dive many days in a row. I however haven’t tested this enough to know if this is anything. I am Asian and because nose pockets are too large for me I never get clean pinch on the nose. I think I could have been EQ with too much for due to a bad pinch on my nse and over pressuring my ears. I will add I think advanced freedivers should be able to dive with a mask to at least 40 meters but that is just my preference.



Now that I have explained all this lets talk about your specific case. First you’ve only been diving a few months. I think it’s likely in such a short amount of time that your technique isn’t very good. The awareness of EQ can take years to understand. You need to spend a lot of time in the water and dry to start to fully understand what is happening.

Second what you are describing is a middle Ear Barotrauma. It most definitely is related to the forceful equalization which should never be done. This is taking one step forward and two back when you need to take time out of the water to allow your ears to heal. This is the same idea when people push to deep too fast and squeeze. Now instead of progressing they need to take time off and rest then restart what they were doing. It’s said over and over again don’t force anything. I ignored this advice and still ignore today but when something goes wrong I can almost always trace it back to I forced a depth a wasn’t comfortable with or forced an EQ.

This injury is very common amongst divers. It’s generally not serious and will usually clear itself up in a weeks or up to a few months. I wouldn’t be too worried about this I had many of these in the past 3 years and I took a few months out of the water and my ears are perfect again. Yeah it sucks not to be able to train depth but the ears need to rest until you feel they are making a clean EQ. In the meantime there’s so much dry exercise and pool you can do that will make huge improvements in your diving.

Well again sorry for the long post. I just dropped all my ear knowledge on you. I felt compelled to give you all the tools I had to help you solve those problems. Ear problems can be the most frustrating problem in freediving made even more frustrating when people think it’s all in your head.

Happy Training,
Andrew

Thank you so much Andrew for your support, I really appreciate it
I think my issue is a mixture of these factors all together. Chronic sinus congestion which is very slight but it always comes and goes especially when vaping, smoking or using the AC, technical issue, I am sure I still way too far till i master the equalisation and gain a better awareness of my middle ear muscles, forcing the equalisation i am sure also contributed to the congestion and the barotrauma, middle ear and sinus infection with mucous secretion. I still feel mucous dripping down my throat till now. What I've noticed is vaping really increase my mucous secretion and increases the sensation of fullness in both my middle ears and my sinuses. it is really frustrating that it is taking that long to heal and it makes me worried. I will abstain from vaping, continue taking the prescribed medications, go visit the ENT soon and see what she will say after she checking me up.

 

[Andrew702]

No problem Ali goodluck with your diving. There are a few things I forgot to mention in my post before. Foods high in histimines can effect ET function. Also if all this other stuff fails there are surgical options that MIGHT help but no guarantees. I'd exhaust all non surgical options first. I can detail these later in a more organized post.

 

[zazuge]

I found this yesterday, and i thought i should post it here, in case someone is interested:
https://wefreedive.com/reads/55-nora-galgoczy-outer-ear-inflammation-and-infecton-in-freediving

 

[Freedive N Egypt]

Hello fellow freedivers,
I started freediving a few months ago and i recently finished my AIDA 2 certification and i started to find myself interested in deep line diving. I am still a beginner though in that matter, my maximum depth was 20 meters, before that i have only dived to 16 meters wich wasn't very smooth in terms of equalization and this was during my AIDA 2 course. Then my next dive was about one month later and i was able to reach 20m and i could have continued to go deeper but the equalization failure stopped me and that's when i wanted to go deeper but one of my wars didnt equalize and i felt some pain and pressure so i forced the equalization and went deeper those couple of meters. I came up okay but after i came out of water i started to feel pressure in my ears and slight pain. I felt i shouldnt dive next day but i didnt listen to my intuition and i did dive a few 15m dives and thats when again i forced an equalization butto the other ear. Then on my way back home a long ride above the mountains i could feel my ears doing crazy popping sounds and hurting me and my hearing was muffed with the change in pressure up the road. Since then and my ears feels stuffed and my sinuses too are hurting me not just my ears. I did some research and i think what happened to me is "middle ear barotrauma" i took an antiinflamatory, decongestant drops, steroid drops through my nose to try and drain the built up fluids, congestion and inflamation but it doesnt seem to be working. Long story short, I wanna ask expert freedivers here is this common among freedivers? Do u think it happened to me because i didnt take my time to adapt my body to the new depth? And is it serious or it is common and nothing to worry about? My buggest concern is my freediving being affected or that i cant dive deep anymore!
Anyway, I will give my body its time to recover and ill take it easy next times with depth progression and will never force an equalization again!
If any of you guys have a similar condition or can give me tips i'd really appreciate it.
Thank u guys and sorry for the long post

Well before answering this question, i have to ask which equalization technique were you using?