[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”]Zapobieganie – Uszy i nurkowanie[/vc_column_text][vc_column_text el_class=”claim”]

Uszy i nurkowanie

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JAK UNIKAĆ URAZÓW USZU I ZATOK

[/vc_column_text][vc_empty_space height=”60px”][vc_column_text el_class=”page-text”]Urazy ciśnieniowe uszu i zatok mogą być spowodowane zmianami ciśnienia otoczenia.

Podczas zanurzania, kiedy ciśnienie wzrasta, nurek musi wyrównywać ciśnienie w przestrzeniach powietrznych zatok i ucha środkowego do wartości ciśnienia otaczającej wody. Opuchnięte, uszkodzone tkanki mogą ograniczać przepływ powietrza przez kanały powietrzne umożliwiające wyrównywanie ciśnienia. Kiedy ciśnienie w przestrzeniach powietrznych nie może być wyrównane, nurek może doświadczać dyskomfortu i bólu. Podczas wynurzania, jeśli rozszerzające się powietrze nie może znaleźć ujścia, objętość gazu w przestrzeniach powietrznych wzrasta, wywołujące jeszcze więcej dyskomfortu i bólu.
Najczęściej zgłaszanymi do DAN urazami są te związane z ciśnieniem (urazy ciśnieniowe, barotraumy) urazy uszu i zatok. Na szczęście, łatwo ich uniknąć i dzięki edukacji i zdrowemu rozsądkowi można zrobić wiele dla eliminacji tych problemów. Kampania ”Uszy i nurkowanie” jest nakierowana głównie na właściwą edukację a internetowe seminarium „Uszy i nurkowanie” jest dostępne bezpłatnie dla członków DAN (również osoby nie będące członkami DAN mogą brać w nim udział za drobną opłatą).[/vc_column_text][vc_empty_space height=”60px”][vc_column_text el_class=”page-text”]

URAZ CIŚNIENIOWY USZU I ZATOK

[/vc_column_text][vc_accordion active_tab=”false” collapsible=”yes” style=”accordion”][vc_accordion_tab title=”1. Uraz ciśnieniowy ucha środkowego”][vc_column_text el_class=”page-text”]Uraz ciśnieniowy ucha środkowego jest najczęstszym urazem nurkowym i może być powodowany przez stosowanie niewłaściwej techniki wyrównywania ciśnienia lub z powodu nurkowania z przeziębieniem. Ucho środkowe jest przestrzenią zamkniętą połączoną z górną częścią gardła trąbkami Eustachiusza. Te kanały są bardzo wąskie i normalnie zamknięte. Kiedy wykonuje się jedną z technik wyrównywania ciśnienia, trąbki otwierają się i pozwalają powietrzu o wyższym ciśnieniu z gardła przepłynąć do ucha środkowego, wyrównując ciśnienie. Te kanały mogą być łatwo zablokowane przez śluz lub z powodu przeziębienia, uniemożliwiając wyrównanie ciśnienia w uchu środkowym. Podczas zanurzania, gdy ciśnienie wzrasta, w uchu środkowym będzie niższe ciśnienie, i jeśli nie zostanie wyrównane, będzie to prowadziło do dyskomfortu lub bólu ucha i może czasami skutkować rozdarciem błony bębenkowej.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”2. Uraz ciśnieniowy zatok”][vc_column_text el_class=”page-text”]Uraz ciśnieniowy zatok również występuje, choć znacznie rzadziej. Zatoki to przestrzenie wypełnione powietrzem w kościach otaczających jamę nosową. Każda z zatok jest połączona z nosem wąskim kanałem (ujście zatokowe), przez które zatoka jest stale połączona z otaczającym powietrzem. Kiedy te kanały zostaną zablokowane (zazwyczaj ze względu na katar na skutek alergii, palenia, infekcji lub nadużywania leków miejscowo zmniejszających przekrwienie, stanów zapalnych zatok lub nosa, polipów lub korków śluzowych) nie ma możliwości wyrównania ciśnienia w zatokach. W efekcie nurek czuje ból powyżej oczu, na kościach policzkowych, przy górnych zębach i/lub głęboko w czaszce, w zależności od tego, które zatoki mogą napełniać się krwią w celu wyrównania różnic ciśnienia podczas nurkowania.[/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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Recent cold or congestion

 

History of ear infections or even one severe infection

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History of a deviated septum or a broken nose, preventing one ear or set of sinuses from clearing as fast as the opposite side

 

Allergies, which may produce swelling of the mucus membranes or cause nasal polyps that can partially or completely close a sinus airway

[/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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