Ear equalisation help

[dangerousdan]

Hope everyone is well lately. No doubt a great many of you missing being able to dive for the last year. Hopefully you'll be able to get back to it soon. It is very quiet here for the last year.

I thought I would give an update to my ear problems. I had a couple of visits to an ENT consultant on the NHS now, which included checking up my nose at the eustachian tube openings, looking into my ears (obviously) and hearing tests and tympanograms (pressure response tests).

At my last visit back in June 2020 I was prescribed a steroid nasal spray called Avamys which contains the ingredient fluticasone furoate. This is meant to reduce inflammation. Ive been taking it daily for the last 7 months now.

I previously would have graded my ability to pop my ears (either manually or passively, i,e through yawning etc) at a 1 out of 10. Now, after using this spray for a while, I would say its improved to say a 4 or 5 out of 10. My left ear now pops far more frequently when yawning, but my right ear is still very variable. I still struggle to manually pop both ears, they are just stuck shut most of the time, I appear to have no/little voluntary control over it.

The consultant today said both eardrums were still visually retracted and that that would never change, because they have moulded into that position over decades now. However in my left ear, the tympanogram test was normal. Type A symmetrical around the 0 position. This is an improvement from last time and consistent with my own experience that it does now pop far more frequently. Unfortunately my right eardrum's pressure response was a type C, negative pressure response. Again consistent with my experience that I find it very difficult to pop this ear. Going into today's appointment my right ear has been pretty stuck now for several days. Perhaps if it had been recently popped, the tympanogram result might have been a bit better, but I couldn't get it to pop at all and its still stuck.

The consultant believes that the eustachian tube dilation operation wouldn't do anything for me, because he believes that the issue is to do with recurring inflammation of the tissue lining deep inside the eustachian tube. This is why the steroid spray is helping a little, reducing the inflammation sometimes. There could be narrowness in there at the bony portion but they don't know this for sure.

We had a good discussion about why my ability to pop my ears is so inconsistent. For example my ears might pop fine one day, yet the next are completely stuck. If the lining of the tube becomes inflamed then it just blocks it up basically, and even if the yawning/throat muscles are pulling at the tube openings, its not enough to break through the inflamed area. Quite why it should be getting inflamed, no-one knows, as I don't have any allergies.

They are discharging me now, and if I have hearing deterioration in future I need to go back through my GP. Its a little disappointing, as I feel that having seen some improvement using the spray, that I was edging towards a better solution. I can continue taking the spray at the same dose indefinitely, it will be added as a repeat prescription for me. When I try to pop my ears I often feel that the eustachian tubes are so close to breaking through, but they just won't quite go. I'm going to continue exercising them, using the spray, perhaps look again at some of the other muscular/throat manipulation techniques. It doesn't really matter that my eardrums are retracted, they're retracted on the surface and they'll be retracted under water, I just need to find a way to get those pesky tubes to open more reliably and let some air in. Haven't given up quite yet, because I know that my eustachian tubes are capable of working when they want to (I did dive to 14m successfully during the course). I just need to carry on searching for a combination/set of techniques that pops those bloody tubes open better.

On a positive note, if I'd have never learnt to dive I'd have probably not discovered this issue until my hearing had deteriorated much worse. So at least now I will be aware of that and on top of it as I get older.

[gobfish1]

DP see below

[gobfish1]

M8 of mine can blow bubbles out both ears in the pool
When diving he has a set of ear protection and has no problems diving to his qualification depth of about 40m
Ist Dolphin Tech Pro Ear ME55

[barnaby_s]

M8 of mine can blow bubbles out both ears in the pool
When diving he has a set of ear protection and has no problems diving to his qualification depth of about 40m
Ist Dolphin Tech Pro Ear ME55

Isn't that the opposite problem though, he must have a hole in the eardrums so no need to equalise?

I managed to blow bubbles through one ear after forcing an equalisation, fortunately it has healed and been fine since.

[gobfish1]

I'd think the mask would keep pressure on both sides of the ear drum the same so would help some one that can't do that by other means. Worth a punt in stead of spending hours on post in this thread . May not solve all his problems but would get him in the water with less worry . Maybe it won't help but for the price why not give it a try . Got to be better than all this forcing of airways he's been doing .

[dangerousdan]

I'd think the mask would keep pressure on both sides of the ear drum the same so would help some one that can't do that by other means. Worth a punt in stead of spending hours on post in this thread . May not solve all his problems but would get him in the water with less worry . Maybe it won't help but for the price why not give it a try . Got to be better than all this forcing of airways he's been doing .

Thanks for your reply, but sorry that's not how this works. Your friend clearly has no problems pushing air up his eustachian tubes and out through what must be a perforated eardrum. My problem is the opposite, I cannot get air up my eustachian tubes at all.

The ear mask product does nothing to change pressure differentials. Its physically impossible. All it does is keep dirty water out of your ears, which if you have a perforation would get into your middle ear cavity and possibly could cause an infection. Some people are also prone to outer ear canal infections which the ear mask would also help with.

[gobfish1]

Looks to me that the mask has two small air tubes
So if you snort through your nose it will add air to the ear protection and keep the ambient pressure the same both sides of the ear drum .

No matter just thought it was worth a punt . Good luck

[Tim Digger]

Sorry Gobfish Dangerousdan has a much better idea of what's going on in his ears than you. He has learnt a lot from various professionals over the 2 years or so he has been posting. He has as I have said to him a difficult and largely intractable problem that may well prevent him from diving. I doubt very much if the Pro Ear mask will help him sadly, but it will do no harm. It is a reasonable solution to your mates bilateral perforations as these are chronic and there is not an issue over any water induced infections preventing healing.

[dangerousdan]

Yeah I could probably write a book on this topic now. Feels like it should be so easy to solve doesn't it. It's just a 1.5" long tube linking my middle ears and nose cavity. How such a simple thing cannot work properly, or be fixed/cleared if its blocked, is very frustrating, and to be honest with you, still difficult for me to accept.

I've asked for a copy of my file from the hospital, I still might consider whether I have any private options.

Its also difficult to practice this. Trying to equalise a few times a day at atmospheric pressure is obviously not doing much, and its not practical to regularly jump into a pool and give my ears some prolonged time at a greater than atmospheric pressure. I think this might actually be a solution that might work though. I was thinking of trying to hire a home hyperbaric chamber and seeing if I could expose my ears to some higher pressures for half hour a couple of times a day. A home chamber can operate I believe at around 1.5 atmospheres which is about 5m water pressure, which would be plenty high enough for me to try and train my eustachian tubes. I know it will sound a silly thing to try at home but it could work. After all, we train with weights or for fitness and we work our way up.

[Tim Digger]

Sadly, I don't think it will help, you have difficulty with equalization at normobaric pressures experience says it is more not less difficult at hyperbaric. You have a good idea when it is happening as you have learnt how it feels so I don't see a chamber would help. From your account of partial improvement with long term steroid use it seems there is a permanent narrowing rather than one which is amenable to decreasing inflammation/congestion. Whether balloon dilation of Eustatian tubes would help I don't know I have no experience but if you must persist with this and it is bordering on an obsession I would find an ENT specialist who does this and consult them privately rather than trying to purchase a hyperbaric chamber.