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Ohren und Tauchen
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WIE MAN VERLETZUNGEN DER OHREN UND NASENNEBENHÖHLEN VERMEIDET
[/vc_column_text][vc_empty_space height=”60px”][vc_column_text el_class=”page-text”]Barotraumata der Ohren und Nasennebenhöhlen können durch Veränderungen im Umgebungsdruck ausgelöst werden.
Wenn während des Abtauchens der Druck zunimmt, müssen Taucher den Druck in den Lufträumen der Nasennebenhöhlen (durch die Öffnung, die die Nase mit den Nasennebenhöhlen verbindet) und in den Lufträumen der Mittelohren (durch die Eustachischen Röhren) an den Wasserdruck der Umgebung anpassen. Geschwollenes oder verletztes Gewebe kann die Luftdurchlässigkeit der Öffnung einschränken, die für den Druckausgleich zuständig ist. Wenn der Druck in den Lufträumen nicht ausgeglichen werden kann, kann es beim Taucher zu Schmerzen und Beschwerden kommen.
Die Verletzungen, die DAN am häufigsten gemeldet werden, sind Druckverletzungen (Barotraumata) der Ohren und Nasennebenhöhlen. Glücklicherweise lassen sich solche Verletzungen einfach vermeiden und ein bisschen Weiterbildung und gesunder Menschenverstand können zur Vermeidung viel beitragen. Die “Ohren und Tauchen”-Sicherheitskampagne hat ihren Schwerpunkt hauptsächlich auf die richtige Weiterbildung gelegt und auf der Website von DAN gibt es für DAN-Mitglieder ein kostenfreies Online-Seminar mit dem Titel “Ohren und Tauchen” (auch Nicht-Mitglieder haben Zugriff – gegen eine geringe Gebühr).[/vc_column_text][vc_empty_space height=”60px”][vc_column_text el_class=”page-text”]
BAROTRAUMATA DER OHREN UND NASENNEBENHÖHLEN
[/vc_column_text][vc_accordion active_tab=”false” collapsible=”yes” style=”accordion”][vc_accordion_tab title=”1. Mittelhor-Barotrauma”][vc_column_text el_class=”page-text”]Das Mittelohr-Barotrauma bzw. die Baro-Otitis ist die am häufigsten auftretende Tauchverletzung und kann durch schlechte Druckausgleichsmanöver verursacht werden, oder durch das Tauchen mit einer Erkältung. Das Mittelohr ist ein Totraum, der durch die Eustachischen Röhren mit dem oberen Teil des Rachens verbunden ist. Diese Röhren sind eng und normalerweise geschlossen. Bei Anwendung einer Druckausgleichsmethode öffnen sich die Röhren und die Luft mit dem höherem Druck kann aus dem Rachen ins Mittelohr gelangen. So wird der Druck im Totraum ausgeglichen. Diese Röhren können jedoch bei einer Erkältung leicht durch Schleim blockiert werden und der Druckausgleich des Mittelohrs wird damit unmöglich. Während des Abstiegs, wenn der Druck zunimmt, ist der Druck im Mittelohr geringer und wenn er nicht ausgeglichen wird, kommt es zu Beschwerden und Schmerzen im Ohr. Manchmal kann das sogar zu einem Trommelfellriss führen.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”2.Nasennebenhölen-Barotrauma”][vc_column_text el_class=”page-text”]Sinus barotraumas also occur, but are less common. Sinuses are air filled cavities within the bones surrounding the nasal cavity. Each sinus is connected to the nose through a narrow opening (Sinus Ostium) making it possible for the sinuses to be permanently open to the atmosphere. When these openings become obstructed (usually due to congestion resulting from allergies, smoking, infection or overuse of topical decongestants, sinus or nasal inflammation, polyps or plugs of mucus) the sinuses can no longer be equalised. As a result, pain will be felt above the eye, at the cheek bone or at the upper teeth and/ or deep in the skull, depending upon which sinus is involved. Small nose bleeds during or after ascent are frequently experienced. This can be because the sinuses might be filling up with blood to equalise the pressure difference during the dive.
[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”3. Middle Ear or Sinus Barotrauma on ascent, or Reverse Block”][vc_column_text el_class=”page-text”]Während des Aufstiegs, wenn der Druck abnimmt, dehnt sich die Luft im Mittelohr aus. Und wenn die Eustachischen Röhren blockiert sind, kann die ausgedehnte Luft nicht aus dem Mittelohr entweichen. Aufgrund des Drucks, der auf den Gleichgewichtsmechanismus im Innenohr einwirkt, kann es zu einem Schwindelanfall kommen. Und falls der Zustand andauert, kann die sich ausdehnende Luft starke Schmerzen verursachen und das Trommelfell beschädigen. Zu einer Umkehrblockierung kommt es meist dann, wenn während des Tauchens abschwellende Mittel verwendet werden, deren Wirkung in der Tiefe nachlässt, bzw. wenn der Druck beim Abstieg nicht richtig ausgeglichen oder mit einer Erkältung getaucht wird. Ein ähnlicher Fall kann bei den Nasennebenhöhlen auftreten, wenn das Sinus Ostium in der Tiefe blockiert wird. Dies führt in der betroffenen Nasennebenhöhle zu Schmerzen (mit oder ohne Nasenbluten) und kann in schweren Fällen zu einer Nasennebenhöhlenruptur führen.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”4. Inner Ear Barotrauma”][vc_column_text el_class=”page-text”]If the stress on the Middle Ear becomes too great (from not equalising or trying too hard with a Valsalva technique) it can cause damage to the Inner Ear (to the hearing and balance structure), which in some cases can be permanent. Deafness, ringing in the ears (tinnitus) and Vertigo can be experienced.
[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”5. Outer Ear Barotrauma”][vc_column_text el_class=”page-text”]Outer Ear Barotraumas can occur when the ear canal becomes blocked, trapping air between the blockage and the ear drum. This can create excess pressure or a vacuum in the air space as the diver changes depths. Blockages can be caused by excess wax, non-vented ear plugs or an extremely tight fitting hood. Due to the increasing pressure and squeeze in the outer-ear, the surrounding tissues can fill the canal with blood and fluid or the eardrum can rupture. Pain and discomfort will be noticed and after a release of pressure (due to the eardrum rupture), the cold water entering the middle ear may lead to vertigo.
[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”6. External Ear infection – Otitis Externa”][vc_column_text el_class=”page-text”]With frequent immersion, water swells the cells lining the ear canal. Eventually, these cells pull apart – far enough for the bacteria normally found on the surface of your ear canal to get underneath the skin, where they find a nice warm environment and start to multiply. Next thing you know, your ear canal itches, is sore and becomes inflamed. If left untreated, the swelling can spread to the nearby lymph nodes and cause enough pain that moving your jaw becomes uncomfortable. At this point, the only treatment is antibiotics, and diving is definitely out. In some cases a discharge coming out of the external ear can be noticed. Pain with ear tugging distinguishes external ear problems from middle ear infection, where this is painless.
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Symptoms and medication
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Symptoms of barotraumas of the ears and sinuses
- Presence of mild discomfort to severe pain in the sinuses or ear
- Ringing or roaring in the ear
- Muffled hearing, partial or complete hearing loss
- Nausea, vomiting, dizziness (especially after experiencing ear pain)
- Blood coming from the nose or present in sputum (even if not associated with other symptoms)
- Pain felt above the eye, at the cheek bone or at the upper teeth and/ or deep in the skull
Divers with these symptoms should probably end the days, and possibly the week’s diving as continuing to dive might result in severe injury.[/vc_column_text][vc_empty_space height=”20px”][/vc_column_inner][vc_column_inner el_class=”page-text” width=”1/2″][vc_column_text el_class=”txt-white”]
Treatment and medication
If you experience any symptoms during or after a dive, consult a physician (preferably an Ear, Nose & Throat specialist) to determine the extent of any injury. There may be some treatable condition causing the problem. The physician can determine the correct treatment and medication. If medication is prescribed, then check with your physician if it will interfere with safe diving. Proper care and treatment under the supervision of a physician can reduce the recovery time from symptoms of barotraumas, allowing you to return to diving sooner.
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Prevention
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How to prevent ear and sinus barotrauma
- Equalise before you enter the water or descend and make sure you hear the “pop” or “click” in both ears. This means the Eustachian tubes are open.
- Descend slowly and equalise in a feet-first position and if needed extend your neck (looking up) as this tends to open the Eustachian tubes.
- Equalise early and often (every 0.3-0.5m, especially in the beginning of the dive) until you reach the deepest point. If you feel discomfort, you may have waited too long to equalise.
- If you can’t equalise or experience pain and discomfort during descent, then ascend slightly until the discomfort is relieved and attempt to clear again; do not forcefully clear or attempt to descend unless your ears and sinuses have equalised.
- Don’t dive with a cold or whilst congested.
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- Do not use not-vented earplugs or a hood that is too tight as it does not allow water /air to enter the external ear.
- If you experience pain and discomfort during ascent, you should stop or descend slightly (or point the affected ear towards the bottom) and use of one the equalising techniques to open the Eustachian tubes; ascend as slowly as possible. If you still can’t equalise you will have to endure the pain in order to reach the surface.
If you could not equalise during a previous dive then you should not be diving until the problem is resolved. It may indicate a pre-existing problem, most commonly from infection or allergies. The mucus membrane will retain fluid and swell, narrowing the pathways to the sinuses and the Eustachian tubes. This not only makes clearing difficult, but it may prevent it altogether. Some divers use nasal sprays or oral medications to temporary shrink swollen mucus membranes and aid sinus and middle ear equalisation. These medications however can wear off at depth, possibly leading to complications on ascent.[/vc_column_text][vc_empty_space height=”20px”][/vc_column_inner][/vc_row_inner][vc_empty_space height=”60px”][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern” css=”.vc_custom_1722439666055{background-color: #f6f6f6 !important;}” z_index=”” el_id=”techniques”][vc_column][vc_empty_space height=”60px”][vc_row_inner row_type=”row” type=”grid” text_align=”left” css_animation=””][vc_column_inner][vc_column_text]
EQUALISING TECHNIQUES
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Although ear problems might be caused by a cold, it is also possible that the diver is not using the correct equalising technique.
Divers should know, practice and use the “clearing” or equalising manoeuvre that works best for them
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Valsalva
[/vc_column_text][vc_column_text el_class=”card-text”]Hold nose and breathe against a closed throat
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Toynbee
[/vc_column_text][vc_column_text el_class=”card-text”]Swallow with mouth and nose closed (good for ascent)
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Frenzel
[/vc_column_text][vc_column_text el_class=”card-text”]Valsalva while contracting throat muscles with a closed throat
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Lowry
[/vc_column_text][vc_column_text el_class=”card-text”]Valsalva plus Toynbee – holding nose, gently trying to blow air out of the nose while swallowing
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Edmonds
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Miscellaneous
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Equalisation becomes more difficult as the pressure gradient between middle ear and the environment increases. Frequent gentle equalisations are more effective and less likely to cause injury than forceful equalisation, especially after significant pain has occurred. For many divers a combination of techniques works best. Since the pathway to the sinuses is normally open, sinus equalisation typically does not require any special manoeuvres.
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Possible reasons for difficulties in equalising
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[/vc_column_text][vc_empty_space height=”20px”][vc_column_text el_class=”txt-white”]A diver with a medical history may require referral to an Ear, Nose and Throat (ENT) Physician or Allergy Specialist.
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