Here's a list compiled over the years of commonly asked questions. The list was created by DAN MDs and represent specific, evidence-based recommendations our member should take into consideration.
The negative pressure, in effect, creates suction. This is referred to as “mask squeeze”, which can cause varying degrees of barotrauma to the soft tissues of the face and eyes.
The soft tissue around the eyes swells (periorbital edema) and discolours, manifesting as redness or bruising (ecchymosis). The eyes themselves may appear bloodshot. Unless there is eye pain or visual problems present, there is no specific treatment for facial barotrauma.
The injuries from a mask squeeze can take up to two weeks or more to resolve. The body will eventually reabsorb the ecchymosis and edema. The individual’s appearance may worsen before improving.
A physician or an eye specialist should immediately address any eye pain or visual disturbances, such as blurred vision or partial loss of the visual field. These symptoms are rare with mask squeeze.
The best treatment for mask squeeze is prevention. Exhaling through the nose during descent (as done naturally, for example, with the Valsalva equalisation technique) will minimise the risk of facial barotrauma.
Although nitrogen leaves the body in a much slower fashion than we take it on, it still must leave. After diving, you should be equilibrated to ambient nitrogen in 24 hours.
If the pain can be produced with movement of the affected joint only, then it is more than likely a musculoskeletal strain or injury.
The pain generally associated with decompression illness is not affected by movement or lack of movement and usually remains fairly constant.
The ability to reproduce the symptom with movement indicates a stress or repetitive movement injury.
If you have not seen your personal physician it would be wise to do so.
Appropriate therapy is indicated to prevent permanent injuries.
Soaking the wound in non-scalding hot water to tolerance (43.3 to 45˚ C) may provide dramatic relief of pain from a lionfish sting; is less likely to be effective for a scorpionfish sting, and may have little or no effect on the pain from a stonefish sting, but it should be done nonetheless, because the heat may inactivate some of the harmful components of the venom.
If the injured person appears intoxicated or is weak, vomiting, short of breath or unconscious, seek immediate advanced medical care.
Wound care is standard, so – for the blistering wound – appropriate therapy would be a topical antiseptic (such as silver sulfadiazene cream or bacitracin ointment) and daily dressing changes. A scorpionfish sting frequently requires weeks or months to heal, and therefore requires the attention of a physician. There is an antivenin available to physicians to help manage the sting of the dreaded stonefish.
Following an appropriate time after they have healed, you can return to diving if your physician feels the healing is solid and there is no evidence of Eustachian tube problems.
This usually takes about two months after it is healed.
If the perforation does not heal, then an ear surgeon can repair the damage.
After healing has taken place, the same rules as above apply. It is important to check for chronic nose and sinus problems if there is no healing.
Chronic perforations that do not heal are a contraindication to diving. Some have advocated the use of ear plugs for these individuals, but if there is any water leakage, it could cause a severe infection.
This is because of significant quantities of VGE (venous gas emboli) which increase the right ventricular pressure and force the filter of the lung.
Waiting for the total desaturation time, shown on the Galileo diving computer, is not wrong but very precautionary.
The problem lies on VGE presence which cannot be detected after 3 hours from surfacing, in case of recreational dives. Time should be extended with advanced/tech dives but also in this case, VGE are rarely observed after 4-6 hours.
Regarding return to diving after implantation, a recipient should wait a minimum of 3 months after implantation, be able to autoinflate (equalize) the operated ear, be completely healed, free of symptoms such as vertigo, imbalance and pain and have complete resolution of the post-operative hemotympanum (blood behind the ear drum).
On examination with a microscope, the fistula test should be negative and the TM should not contact the electrode on maximum medial excursion.
(Your doctor will gently puff air into your ear canal to see if it makes you dizzy or if the eardrum touches the CI electrode).
Your neurological examination should be normal. Make sure to discuss these recommendations with your otologist and be sure to follow his/her recommendations.
So the only logical approach is to reduce the saturation – This can be calculated using the depth, dive time and Nitrogen concentration (inert gas) in the breathing mix.
The failure rate was high. It is unlikely that in-water recompression using air is more effective than those old treatment tables. In-water recompression with the diver breathing oxygen instead of standard air has been used successfully in some areas.
However, in-water recompression has its own dangers and should not be attempted without the necessary training and equipment, or in the absence of someone who can assess the diver medically.
The resources required for in-water recompression usually exceed the ability of those at the scene to properly assist the injured diver.
In-water recompression of any type is not currently recommended by DAN.
Middle ear barotrauma can easily damage the tympanic membrane or one of the more delicate internal membranes associated with sound transmission inside of the ear.
Although no one can say for sure, it is more likely that this trapped air - or subcutaneous emphysema - originated from pulmonary barotrauma.
Sometimes the lungs are over-pressurized, for instance, when we have difficulty clearing. This can happen when we attempt to put air into the sinuses and middle ear with more force than is necessary.
This can actually increase the amount of pressure in the air spaces of the lung, which then allows air to escape through lung tissue, where it can travel up to the shoulder, neck or even the face. Subcutaneous emphysema does not require recompression treatment.
However, it is a good idea to be evaluated by your physician to determine the underlying cause of the air bubbles.
The evidence of an increased incidence of DCI on the first day of a dive trip is not sufficient to recommend a 24-hour waiting period before diving after flying.
However, it does indeed support the advice of starting off much more gradually with fewer, shallower, more conservative dives right in the beginning, especially whenever there has been significant travel; the potential for more dehydration; a delay since diving previously; where the use of unfamiliar, rented gear is involved; if there is a lack of familiarity with the dive-site; etc.
Taking it slow also gives divers an opportunity to rest and rehydrate, adjust to a new climate and time zone, and acquaint themselves with the new / rented dive equipment.
Therefore, in your case, the DAN recommendation is to leave a surface interval of at least 18 hours and if any decompression is involved then it will be wise to extend the surface interval to some hours."
You will need to interact with your ENT specialist and, when he/she reports it fully closed, you need to ask how long it will then take for full strength to occur based on the examinations undergone.
Unfortunately, after serious infection damage, the eardrum may not close spontaneously within the expected 6 weeks and some surgery will be required to close it.
After surgery an appropriate healing time must be factored in, till the ear drum can withstand pressure changes.
Although both humans and coral are members of the kingdom Animalia, their tissues and body systems are incompatible.
When you are injured, your body activates, recruits and increases production of leukocytes (white blood cells). This leukocyte production contributes to the pus that can accumulate at wound sites and promotes the elimination of foreign material.
If the body is unable to eliminate foreign material (such as coral), it will wall off the substance with immune cells, forming a granuloma. If this occurs, you may be able to feel a lump under the skin where the granuloma formed.
Keep an eye out for infection (manifesting as redness, swelling, warmth and pain) with such injuries, but rest assured that coral is not growing under your skin.
Irritation can occur in the endothelium (the cells lining the blood vessels) which leads to inflammatory responses that may cause platelets to initiate clotting and white blood cells to accumulate. The inflammation and tissue damage take a while to heal, which is why DCS lasts longer than the time it takes to eliminate inert gas.
Hyperbaric oxygen therapy (HBOT) can be effective for days or even a week or more following a dive, because HBOT has significant anti-inflammatory properties and oxygenates injured tissues, thereby promoting healing. HBOT is frequently administered after tissue damage, inflammation and other injuries have occurred and no inert gas remains.
In these cases, its purpose is only to promote healing. However, HBOT administered very soon after the injury also promotes the washout of inert gas.
This controversy extends to diving with any ear condition that increases the risk of permanent injury
All of us who dive place our hearing at risk and barotraumas (a pressure injury) of the middle and/or the inner ear increases the risk of hearing loss.
While some ENT experts absolutely recommend against diving for individuals with existing ear issues, other ENT experts are of the opinion that patients who understand and accept the potential risks may dive.
Limited studies have described small numbers of people diving after stapedectomies.
The results from these samples indicate that the subjects are not at an increased risk of injury when compared to the control groups of divers, provided they can safety equalize their ears and sinuses with the changes on ambient pressure.
With that said, the consequences of failure to equalise can be greater for those who have undergone stapedectomy procedures.
The inability to equalize the middle ear space effectively, or an attempt to do so too forcefully, may dislocate the prosthetic stapes.
Dislocation can be corrected only in surgery and may result in permanent hearing loss.
Diving after a stapedectomy also carries the risk that the desolation of the prosthesis may damage the round or oval window of the cochlea.
Such an injury can permanently affect both hearing and balance.
Again, it is not that the risk of injury is necessarily greater than that faced by other divers, but rather that there are greater consequences in the event of an injury.
Before deciding to pursue or return to diving, it is clearly in your best interest to candidly review your fitness to dive with a doctor and make a brutally honest risk versus benefit analysis based on the information available.
If the ear canal is uncovered and can transmit that pressure, the water in the ear canal moves easily in response.
A hood that fits snugly against the outer ear can greatly restrict the movement of this water, hampering the diver’s ability to equalise.
An easy remedy to this is to insert a finger under the hood near the ear, which will allow the water to move more easily.
Another solution some divers choose to implement is to cut a hole from the inside of the hood, near the ear canal, through the inner lining and the neoprene but leaving the outer fabric or covering intact.
This hole allows the water to move with little restriction.
Since in most cases an increased blood pressure requires treatment with medication with partly possible significant undesirable side effects, it first needs to be determined whether these medications are compatible with recreational diving.
- Perform the deep phase of the dive first and avoid yo-yo dives (avoid repetitive entry into the 0-10 meter zone)
- Reduce surfacing speed to 5 meters per minute in the upper 10 meters
- Perform a safety stop at 3-5 meters depth for at least 5-10 minutes
- Don’t go to the limit of a no-decompression dive - Don’t perform dives with a decompression stop obligation
- Surface interval of at least 4 hours before the next dive
- Maximum of two dives a day
- Avoid intense skin warming after the dive (e.g.: sunbathing, hot shower, sauna)
- Diving with a Nitrox, using air decompression tables or computer setting, pay attention to oxygen toxicity
- Special underwater computers or software may reduce the risk
Moreover, to decrease the risk of bubbles transfer into the arterial blood stream:
- Avoid strenuous physical efforts during the last 10 metres of surfacing (fining or swimming against current at the end of the dive)
- Avoid exhausting physical activity during two hours following the dive
- It is absolutely prohibited to dive when having a cold. Coughing and forced Valsalva maneuver facilitate bubble transfer into the arterial blood stream.
Nonetheless, the surgery will be effective and after a complete healing you can go back to diving again.
If this condition, although chronical, is characterized by a normal cardiac frequency with no symptoms during the physical exercise, as in your case, then safe diving is still possible.
However I advise you to see a medical doctor before starting diving and to perform a clinical check, especially if you experience any signs or symptoms of low blood pressure (hypotension).
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