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[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_1722437043275{background-image: url(https://microfilladev.com/daneurope/wp-content/uploads/2024/07/PRV-SC-ED-Header-1920×1080-1.jpg?id=2090) !important;}” z_index=”” el_class=”page-header”][vc_column][vc_row_inner row_type=”row” type=”grid” text_align=”left” css_animation=”” el_class=”container-header”][vc_column_inner offset=”vc_col-lg-offset-1 vc_col-lg-10″][vc_column_text el_class=”titolo txt-white”]Prévention – Les oreilles et la plongée[/vc_column_text][vc_column_text el_class=”claim”]
Les oreilles et la plongée
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ÉVITEZ LES LÉSIONS AUX OREILLES ET AUX SINUS
[/vc_column_text][vc_empty_space height=”60px”][vc_column_text el_class=”page-text”]Pendant la descente, lorsque la pression augmente, les plongeurs doivent équilibrer la pression de l’air contenu dans les cavités des sinus (via l’ostium, un passage qui relie les voies nasales aux sinus) et de l’oreille moyenne (via les trompes d’Eustache) avec la pression de l’eau environnante.Des tissus gonflés ou endommagés peuvent restreindre le passage d’air à travers les conduits qui permettent l’équilibrage. Si la pression à l’intérieur des cavités aériennes ne peut être équilibrée, le plongeur risque de ressentir une gêne et de la douleur. Pendant la remontée, si le gaz en expansion dans les cavités aériennes ne peut s’échapper (situation que les Anglo-saxons appellent “reverse block”), la douleur et la gêne augmentent.
Les incidents les plus couramment signalés à DAN sont les lésions liées à la pression (barotraumatismes) aux oreilles et aux sinus. Heureusement, ceux-ci sont faciles à éviter avec un peu de bon sens et en étant correctement informé. La campagne relative aux oreilles et à la sécurité de la plongée est principalement axée sur la sensibilisation des plongeurs. Un séminaire en ligne intitulé “Les oreilles et la plongée” est disponible sur le site Web de DAN Europe. Il est accessible gratuitement pour les membres DAN et moyennant un petit prix pour les non-membres.[/vc_column_text][vc_empty_space height=”60px”][vc_column_text el_class=”page-text”]
LES BAROTRAUMATISMES DES OREILLES ET DES SINUS
[/vc_column_text][vc_accordion active_tab=”false” collapsible=”yes” style=”accordion”][vc_accordion_tab title=”1. Barotraumatisme de l’oreille moyenne”][vc_column_text el_class=”page-text”]Le barotraumatisme de l’oreille moyenne est l’accident de plongée le plus fréquent. Il peut survenir suite à l’utilisation d’une mauvaise technique d’équilibrage ou en plongeant avec un rhume. L’oreille moyenne est un espace mort relié à la partie supérieure de la gorge par les trompes d’Eustache, des conduits fins et généralement fermés. Lors de l’utilisation d’une technique d’équilibrage, les trompes d’Eustache s’ouvrent et permettent à l’air de la gorge, soumis à une pression plus élevée, d’entrer dans les oreilles moyennes afin d’équilibrer l’espace mort. Les trompes peuvent toutefois se retrouver obstruées par du mucus en raison d’un rhume, rendant impossible l’équilibrage de l’oreille moyenne. Pendant la descente, la pression environnante augmente et devient supérieure à la pression à l’intérieur de l’oreille moyenne. Si celle-ci n’est pas équilibrée, le plongeur ressent une gêne et une douleur dans l’oreille, pouvant aller jusqu’à une rupture du tympan.
[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”2. Sinus 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”]During ascent, air in the middle ear will expand as the pressure decreases, if the Eustachian tubes become blocked; it makes it impossible for the expanding air in the middle ear to be released. It is possible vertigo can be experienced because of the pressure on the balance mechanism in the inner ear, if this continues the expanding air can cause severe pain and damage to the ear drum. Reverse Block is usually the result of diving whilst using decongestant drugs that wear off at depth, poor equalising on descent or diving with a cold. A similar case can occur with the sinuses when the Sinus Ostium gets blocked at depth. This will result in pain in the affected sinus with or without a nosebleed and could lead to a sinus rupture in severe cases.
[/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
[/vc_column_text][vc_column_text el_class=”card-text”]Jutting jaw forward plus Valsalva/Frenzel
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Miscellaneous
[/vc_column_text][vc_column_text el_class=”card-text”]Swallowing, wiggling jaws (good for ascent)
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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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