Multi Valsalva caused vertigo, IEBT, hearing loss. Would eustachian balloon dilation help prevent it ?

[chaspope]

Hi, I have been snorkelling happily all my life down to 7-8m max with no problem. Recently I got a scuba Adv licence and was taught to 'equialise often'. So one unlucky day last summer I tried to apply that to my snorkelling - and did a series of 20 quick dives to 5-6 m but this time equalising 3 times on the way down. At some point I had vertigo, survived, then 2 days later had a total hearing loss in one ear. I saw multi doctors, advice from DAN, had hyperbaric oxygen, steroids and tons of drugs - in the end my hearing came back but the treble is lost for good.
Since the accident I have been diving with no problem, however I am anxious that as I eq I could end up deaf again, or worse.
I have never failed to eq on any dive, however I notice it kind of takes me stronger blows to do that compared to other folks I am diving with. Also when I was younger I noticed that my ears hurt as a plane lands while others have no problem, so maybe I have tighter tubes or something.

It's been suggested that I undergo balloon dilation to make it easier for me to equalise and reduce risk of new barotrauma.
Does anyone experience with this ? If you have had dilation please share

Lastly as a warning to all - pls note that YouTube has 1000+ videos teaching how important it is to eq often, but I saw none saying that blowing hard too often can make you deaf for good! There is excellent info on DAN about this but the first three ENTs I saw were not aware of how it happens.

 

[GMurphy]

It's one of the many reasons freedivers teach frenzel: valsalva can be too forceful and damage your ears. Definitely worth learning (after you are medically ok to dive again).

 

[Snuffles]

Hi, I have been snorkelling happily all my life down to 7-8m max with no problem. Recently I got a scuba Adv licence and was taught to 'equialise often'. So one unlucky day last summer I tried to apply that to my snorkelling - and did a series of 20 quick dives to 5-6 m but this time equalising 3 times on the way down. At some point I had vertigo, survived, then 2 days later had a total hearing loss in one ear. I saw multi doctors, advice from DAN, had hyperbaric oxygen, steroids and tons of drugs - in the end my hearing came back but the treble is lost for good.

As someone with equalization and infection problems my whole life, I don't know how some people can swim deep and then rapidly come to the surface without equalizing. I assume its genetics, and differences in how the tissues form as a child.

It does seem like inward squeezing on the eardrum without equalizing is less harmful if you're not going huge distances down. A middle ear infection plugs up the eustachian tube with bacteria biofilm, which then blocks air entering, and a loss of hearing occurs as a vacuum develops in the middle ear. There is some discomfort, but nothing too harmful.

If you actively push in air, you have to come up slowly to allow this additional air that you shoved in there to fart its way back out the eustachian tube, or the eardrum inflates like a balloon until it literally pops and tears to release the air. The usual maximum scuba climb rate from depth is no faster than small air bubbles rising, or 30 seconds to ascend 33ft / 10m. I believe middle ear air release is also part of the reason for a recommended 2 minute "Safety stop" at about 15ft / 5m. If you have been apnea free diving with your lungs now clawing for fresh air... good luck with that.


I have tried pursuing the balloon dilation route to try to enlarge my eustachian tubes but the local ear doctor strongly advised me they don't want to do it except in very special conditions. There is a major artery to the brain that directly passes next to the tube and it is possible to restrict blood flow or damage the artery.

https://www.sciencedirect.com/science/article/pii/S2095881119301131

Endoscopic transtympanic Eustachian tube dilatation: An overview of evaluation methods and dilatation technique - September 2019​

"...Safety consideration in regard to avoiding possible injury to the carotid artery has limited the area of instrumentation to the distal end of the tube, probably the least likely obstructed segment."

 

[chaspope]

As someone with equalization and infection problems my whole life, I don't know how some people can swim deep and then rapidly come to the surface without equalizing. I assume its genetics, and differences in how the tissues form as a child.

It does seem like inward squeezing on the eardrum without equalizing is less harmful if you're not going huge distances down. A middle ear infection plugs up the eustachian tube with bacteria biofilm, which then blocks air entering, and a loss of hearing occurs as a vacuum develops in the middle ear. There is some discomfort, but nothing too harmful.

If you actively push in air, you have to come up slowly to allow this additional air that you shoved in there to fart its way back out the eustachian tube, or the eardrum inflates like a balloon until it literally pops and tears to release the air. The usual maximum scuba climb rate from depth is no faster than small air bubbles rising, or 30 seconds to ascend 33ft / 10m. I believe middle ear air release is also part of the reason for a recommended 2 minute "Safety stop" at about 15ft / 5m. If you have been apnea free diving with your lungs now clawing for fresh air... good luck with that.


I have tried pursuing the balloon dilation route to try to enlarge my eustachian tubes but the local ear doctor strongly advised me they don't want to do it except in very special conditions. There is a major artery to the brain that directly passes next to the tube and it is possible to restrict blood flow or damage the artery.

https://www.sciencedirect.com/science/article/pii/S2095881119301131

Endoscopic transtympanic Eustachian tube dilatation: An overview of evaluation methods and dilatation technique - September 2019​

"...Safety consideration in regard to avoiding possible injury to the carotid artery has limited the area of instrumentation to the distal end of the tube, probably the least likely obstructed segment."

Thanks, though your link points to a transtympanic 'trough the drum procedure' , leaves you with a broken drum I guess. I the procedure I meant is through the nose and leaves your drums whole. Not a doctor but I would say most people can come up without inverse squeeze, healthy ears pop by themselves.