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DIVING WORLD

• Each diver must learn how to equalize the pressures between his middle ear and his external auditory canal, or external ear. Good knowledge of Physiology and Tubal Dynamics is required to understand the role of the Eustachian tube in maintaining this balance and the integrity of all the hearing organs during a dive.

• If from a physiological point of view, an analogy can be established with the constraints imposed on the ears of aircraft pilots, certain specificities appropriate for the aquatic environment should be clarified. With the diver, the external ear is immersed in water which, by definition, is an incompressible liquid. The variations of pressure on the eardrum are more important and occur faster at different diving depths than those calculated in terms of atmospheric height. This means the diver risks much more otological or ear complications. In addition to the danger of hearing loss, imbalance or dizziness may occur, or the more serious occurrence of sudden loss of consciousness. This obliges every diver, no matter how experienced, to monitor his tubal function before and during every dive.

• When a diver has experienced such ailments as intermittent or sporadic tubal dysfunction, he has had to make a decision of whether or not to dive. Until now, wisdom has dictated the postponement of the dive under these circumstances.

• However, in many cases, the wisdom may also consider some new possibilities. New, conservative, preventive therapeutic procedures and plastic reparative surgery, associated with basic tubal video feeback training sessions now enable divers to push the limits of tubal performance farther than they have ever been pushed in the past.

Easy tricks and solutions >

First of all, we always warn divers suffering from seemingly minor tubal dysfunction ; for example, during a common cold, or for some women, during menstruation or pregnancy (even early pregnancy) to avoid taking decongestant medication just before the dive as its fast action and efficiency is misleading. The brief duration of its action can falsely reassure the diver. Problems frequently arise at the end of a dive, more particularly during the ascent. Their action can suddenly disappear and cause a serious danger to the ears. An anti-inflammatory treatment of corticosteroid is sometimes indicated, by endonasal or general administration as an anti-allergy treatment in cases of established allergies. The action of these medications is longer lasting and more stable and does not cause rapid or dangerous variations of tubal function during the dive. On the other hand, this kind of treatment must be nessarily associated with sustained tubal rehabilitation beginning several days preceding the dive.

Practice the Valsalva maneuver (breath in, block nostrils and close the mouth. Push air into the nasal cavity and swallow) only for the duration of the dive, as you have learned in training. Not only it is an artificial method of equilibration but it also generates a micro trauma in the middle ear which, in the long run, can lead to a worsening of tubal dysfunction. Many people abusing the Valsalva maneuver develop permanent and uncontrollable Patulous Eustachian Tube problems.

We are able to give our patients and divers a whole program of tubal rehabilitation, to acquire or improve their own tubal proprioception and dynamic physiology.

It is possible to learn to voluntarily open your Eustachian tubes at any time, even separatly. More and more divers are mastering this technique of voluntary tubal opening (Béance tubaire volontaire).

Free diving in apnea  >

The tubal rehabilitation program is particularly indicated in the preparation and training for free diving in apnea, even in the case of no pre-existent tubal dysfunction. This type of dive, which is becoming more and more popular, is characterized by extreme pressure gradients applied to the eardrum within a very short time period. The tubal competence is no longer a mere safety factor, but also a factor of performance. Once the voluntary tubal opening technique is learned, with some practice, it is possible to master pressure equilibration.

During the descent, the eardrum tends to be pushed inside the middle ear.

To thwart this imbalance repeated air insufflations using the classic Valsalva maneuver are no longer possible because of the limitations of the air reserve which is specific to the free diver in apnea and the relative decline in residual respiratory volume in the lungs during a rapid and deep descent.

Free diving in apnea, tricks >

During the ascent, the eardrum will tend to bulge outwards.

To counteract this relatively high pressure in the middle ear Toynbee’s maneuver allows the emptying of excessive gas through the tube towards the rhinopharynx. Pinch the nose, close the mouth, and try to inspire all the air available in the mouth and the nose while swallowing. A real valve effect is produced.

In case of failure of all conservative measures, notably tubal rehabilitation, go first to submit a specialized exam to detect any basic ENT disorders (allergy, chronic infection, reflux, and so on) that may be treated. If no solution seems to work, or spontaneously, we welcome anyone who wants to do a complete exam of his Eustachian tubes in order to check for a tubal dysfunction, to clarify its exact nature and to find some solutions. According to the diagnosis we propose various reconstructive micro endoscopic surgeries. For far abroad visitors, we propose different options to undergo the check up, the surgical treatment and its initial follow up during a single stay in Geneva.