Remedies for Slosh Ear

[Tom Nic]

Yes, this is potentially a VERY helpful thread. Thanks Lynne and Dave and all...

The ibuprofen is a fairly easy "no-brainer"... even taking some prophylactilly (sp?) if you're going to be diving hard.

At the risk of being redundant I will also mention again Dmitchell's experience with the ear wax remover, which took care of a big problem that HE DID NOT THINK HE HAD... (which for me makes it a significant story) which also makes it a worthwhile thing to add to your tool bag of things to look into if you have ear issues on a trip and you're trying to save your diving.

[mattwave]

Thanks Lynne, seems to be almost gone.

[Celeus]

So, lots of good info here- a couple of things.

I have sinus "issues". I know this means I probably shouldn't dive, however I've convinced a Doc to say "sure, why not", so that was good enough for me. This means that if I don't equalize- a lot, I get a squeeze and used to get lots of Middle-Ear barotrauma.

I also get water stuck in my ears, that won't drain for hours. I get this in the shower sometimes.

I never have gotten swimmers ear, I hope not to.

What I've learned is this:

Middle-Ear Barotrauma takes a while to go away. Decongestants and Ibuprofen/Alleve may help, at least with some of the symptoms. I'm a bad person, and keep diving with it if it isn't bad. It's never gotten worse for me by doing this, but I equalize like crazy if I ever get it. Perhaps this is tempting fate.

Clearing water from the ear- I use AuroDry, and there are others. This is just Rubbing alchohol with a bit of glycerin in it. Works well.

Swimmers ear- as a prophylaxis, a 50-50 mix of Rubbing Alchohol and Vinegar is what DAN seems to recommend, at least once a day, for something like 5-10 minutes lying on your side letting it stay in each ear. I tend to use this mix to clear my ears after each dive as well, and the mix breaks up the surface tension of the water in my ears, and dries them faster.

General sinus/ear happiness: I take a 12 hour sudafed (the real stuff) at the beginning of the dive day. And a single red tab new-sudafed before each set of dives on a liveaboard, or effectively every 3-4 hours of diving. I use Afrin no-drip before each set of dives, or if I feel any congestion. I nasal irrigate (oh my, you don't want to know about this, but yet it is such a great thing for sinus problems) at least twice a day on trips. If I plan to dive with a high-PO2 for a fair bit of the dive, or if I plan to go deeper than around 120, I may skip the Sudafed mix.

I've found that since I read the Dive Alert article on Middle-Ear Barotrauma and realized that was what I was doing, I now equalize a lot more, and I don't get it any more.

Just what I've learned.

[Nwbrewer]

General sinus/ear happiness: I take a 12 hour sudafed (the real stuff) at the beginning of the dive day. And a single red tab new-sudafed before each set of dives on a liveaboard, or effectively every 3-4 hours of diving. I use Afrin no-drip before each set of dives, or if I feel any congestion. I nasal irrigate (oh my, you don't want to know about this, but yet it is such a great thing for sinus problems) at least twice a day on trips. If I plan to dive with a high-PO2 for a fair bit of the dive, or if I plan to go deeper than around 120, I may skip the Sudafed mix.

Ohhh, your gonna die for sure.


In the winter I have chronically stuffed sinuses. Not really noticable in day to day activities, but I can feel it a little on ascent, so I take one of the new sudafed tabs before diving, and it seems to help.

Hope you're recovering Matt.

Jake

[Tangfish]

I get crazy slosh ear from diving the CCR. I guess it's from the high% O2 being metabolized in the sinuses after diving. The only way the body can compensate is by draining fluid into those cavities. The only time I don't get it is if I dive early in the day (which is not often) and equalize on the surface all day long afterward.

[Sounder]

General sinus/ear happiness: I take a 12 hour sudafed (the real stuff) at the beginning of the dive day. And a single red tab new-sudafed before each set of dives on a liveaboard, or effectively every 3-4 hours of diving. I use Afrin no-drip before each set of dives, or if I feel any congestion. I nasal irrigate (oh my, you don't want to know about this, but yet it is such a great thing for sinus problems) at least twice a day on trips. If I plan to dive with a high-PO2 for a fair bit of the dive, or if I plan to go deeper than around 120, I may skip the Sudafed mix.

This seems like awfully heavy medicating to me... where did this recommendation come from? Does it seem out of place to suggest that if someone requires this level of medication to dive that perhaps they shouldn't dive that day?

[Celeus]

This seems like awfully heavy medicating to me... where did this recommendation come from? Does it seem out of place to suggest that if someone requires this level of medication to dive that perhaps they shouldn't dive that day?

It certainly isn't out of place to suggest it- or I might say it wouldn't be out of place to suggest that someone should seriously consider the risks and effects of doing so, and make a rational evaluation- which is how I interpret your comment.

In my case, not using a cocktail of this sort would effectively eliminate me from diving 90%+ of the time. Given that diving is one of the things that I genuinely enjoy and has a tremendous positive impact on my overall happiness, well being and in many ways health, there is a strong positive side to diving. I have only had a reverse squeeze once, during one of my earlier dives, but I was consistently having trouble getting down, and forcefully equalizing to do so. This, combined with my predilection to middle-ear barotrauma (which has gone away with my constant equalization descents and this cocktail) made me decide to research and evaluate whether to use a cocktail. I spent a lot of time on the net, including some PM conversations with diving docs, biochemists and otherwise smart people. I talked with my GP, my ENT (who dives) and my Allergy/Immunologist/Sinus Infection doc (who did some research). They all seemed to think that since it seemed to be working for me, and I was careful about it, there was nothing to massively contraindicate diving. I ended up deciding that it was safe enough for me- but that I should add that to my mental evaluation of whether to make a dive or not.

Here is what I've learned about each of these medications and their interactions with diving.

Pseudoephedrine (PSE) is widely used, especially among divers. Next time you are on a liveaboard, ask around, you may be surprised to find how many people are taking it on a regular basis. There are some suggestions that it can increase the risk of high PO2's, but there is as best I can tell little lab, anecdotal or study based evidence to support that theory. The argument is that CNS stimulants- which most decongestants are- cause you to be at greater risk of ox-tox siezures. It seems safe to take relatively low doses while diving, especially if not using a high PO2. I take a time released 12-hour tablet, which means the total amount in my bloodstream at any given moment is less than that which most people who take a single sudafed tablet have during their dive. It also means that the PSE is in my system throughout the dives, reducing the risk of a reverse squeeze.

Phenylephrine is the new "replacement" for Sudafed. It works in a different way than PSE, but is also a CNS stimulant. I find that it has less of an overall stimulant effect on me, but it is generally regarded as a greater CNS stimulant than PSE. For me, I prefer to have low doses of two drugs than a higher dose of one, and higher doses of PSE, such as I take regularly when I have sinus infections, give me side affects I do not care for. Most informed people would tell you that if you were going to take just one "sudafed" pill while diving, they would recommend using a PSE pill.

Oxymetazoline is what Afrin has in it. The effects of using it locally on your nose are very small on your overall system. Everything I have read, experienced or talked to knowledgeable people about this leads me to believe that for me, this is a quite safe medication to use while diving.

All of these will likely raise your blood pressure. If you have high blood pressure or such, you probably want to consider that. For me, I've used this cocktail many times, in various dive conditions, and it has worked well with no negative effects I or my buddies can notice. I have no idea if I have ever gotten close to Ox-Tox, but I've never experienced any of the warning signs that I am aware of. My own opinion, is that for me, staying hydrated and not drinking alcohol on a dive trip seem to have a substantial impact on the narcosis I experience and the "sluggishness" I feel after diving, whereas the only effects I have observed with these meds are that I've been able to clear more easily and not had sinus headaches after every dive like I used to. Between my constant equalization and aggressive hydration, people have joked that I'm easy to find above or below the water- I either have my hand on my nose under the water or a water bottle in my hand on the boat.

It may not be for everyone, but I think that there is a set of people for which the risks/benefits are worth it.

One last bit of information- I've had _bad_ experiences diving with Guaifenesin (the stuff in Mucinex or in some decongestant syrups). All of these meds do increase the level of dehydration, but Guaifenesin is in my experience the worst for that, and my dives on it were not good. Everyone is different though.

The only firm advice I would give to anyone else is that you should understand the effects of what meds you take, the amount of sleep you get, the amount of water you have and lots of other things before you make a dive. I've had this reinforced on me not just by people more experienced/smarter than me, but by personal experience.