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NAUI Master Scuba Diver 126 Diving Physiology Ruptured Ear Drum First Aid: If you have trouble clearing your ears on descent, ascend a bit and try to equalize again. Swallow to use the muscles that open your Eustachian tubes. Yawning, wiggling your jaw, or stretching your neck sometimes helps. Ascend completely if necessary. Clear your ears, then resume descent. If you have trouble clearing on ascent, descend several feet, try to clear again, and slowly re-ascend. If you can’t equalize, you may have to surface with a reverse ear squeeze and get prompt treatment from an ear, nose, and throat physician who understands diving injuries. On the way to care, it can help to inhale warm, steamy air and use “hot cups.” Hot cups are paper cups with hot, wet cotton balls in the bottom. If you have access to one, microwave them briefly so that they become little steam chambers. Hold one over each ear like earmuffs. Be careful not to tilt them too far and scald your ears. Hot cups also work well in airplanes if you are having trouble equalizing. Don’t use hot cups with a broken eardrum. Underwater, if you break an eardrum, you may become dizzy when water floods your middle ear, cooling your inner ear. Dizziness subsides when water in your middle ear warms to your body temperature. Hold on to a stationary object, if available, until you regain equilibrium. Stop your dive and get medical attention. Prevention: Don’t dive when your ears are too stuffed up to equalize easily. Practice equalizing on the way to the dive site. Stay away from exhaust fumes, which can affect the functioning of your Eustachian tube so that you can’t equalize. Begin equalizing before you descend. Descend slowly, feet first. Equalize gently and frequently. Don’t wait for your ears to hurt before equalizing. Try gentle alternatives to the Valsalva maneuver. In the Toynbee maneuver, you swallow with your mouth and nose closed. Other helpful maneuvers are jaw movements, yawning with your mouth closed, or a combination of maneuvers. Another ear clearing alternative for the Valsalva is the Frenzel maneuver, a technique developed by the Germans for WWII Stuka pilots. You seal your nose and mouth, contract muscles in your mouth to open your Eustachian tubes, and use your tongue as a piston to push air up the tubes. The Frenzel maneuver is gentle, and like the Toynbee, leaves your hands free for scuba tasks. Inner Ear Barotrauma Inner ear barotrauma usually means damage to either of two delicate structures separating your middle and inner ear, your oval window and your round window. Uncontrolled middle ear squeeze or too vigorous a Valsalva maneuver can transfer pressure against your oval or round windows, distending or rupturing them. Inner ear barotrauma may also refer to decompression sickness of your inner ear (figure 4-14). Effects: Pain and tissue damage. You may have hearing loss, tinnitus (ear ringing) and vertigo (whirling sensation), or permanent hearing loss. First Aid: For inner ear squeeze or rupture, end your dive and go immediately to a good diving ear, nose, and throat specialist. Round window rupture requires surgical repair. For ear bends, go immediately to a hyperbaric treatment hospital. Prevention: Avoid forceful, prolonged attempts to clear your ears. Ear clearing alternatives for the Valsalva maneuver are described above in “Middle Ear Barotrauma.” Practice equalizing on the way to the dive site. Begin equalizing before you descend. Descend slowly, feet first. Ascend slowly. Take safety stops on all your dives. Middle Ear Oval Window Fluid Round Window Eustachian Tube to Throat FIGURE 4-14. THE RUPTURE OF AN EAR DRUM IS A SERIOUS AND AVOIDABLE INJURY.


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