I treat many patients with ear and sinus problems resulting from either scuba diving (or snorkeling, or just plain diving into the water) or frequent air travel. Changes in altitude or changes in the depth of the water that you reach are tied to changes in the pressures that your body experiences. With these changes, all of the cavities in your body need to equalize with the outside pressure. However, when any cavity in your body is closed, such as a sinus cavity, or the middle ear (when a eustachian tube is closed) or even
a tooth with a filling (if a small air bubble is inadvertently trapped), this equalization may not take place. As a result, there is an abnormal pressure gradient that can cause tearing of the membranes. In the sinuses, this can cause mild to excruciating pressure or pain called sinus squeeze. In the ear, it can cause ear squeeze. This can feel as if someone were stabbing you in these locations. The torn nasal membranes can lead to nosebleeds. When it occurs in the ear, you can end up with temporary or permanent hearing loss, ringing in the ears (tinnitus), or vertigo (dizziness).

Divers and frequent flyers know to equalize their sinuses and ear cavities by swallowing, chewing, or opening the mouth (yes, you can do this under water), or by squeezing the nose and blowing, causing an opening of the sinus cavity or the eustachian tube. It is important for divers and flyers to make sure that their sinuses are working properly so that they can continue to equalize their ear and sinus pressures. When patients have sinus problems, often an eustachian tube is swollen and can cause ear problems.

In addition, even if you have minor inflammation when you start out, both flying and diving can worsen the swelling and cause closure of the sinus cavities and eustachian tubes. When you are on a plane, you are exposed to very dry air, which contains bacteria, viruses, and/or fungi circulating on the plane. Your sinuses may become infected and inflamed, causing swelling and possibly closure, preventing you from equalizing. When the inflammation causes swelling of the eustachian tubes, you may develop problems equalizing your ears. And when the cabin pressure changes, you can develop terrible ear pressure and pain, and/or sinus pressure and pain. For these instances, I have developed quick-and-easy tips to make your flying and diving experiences much more pleasant.

1. Stay well hydrated. Drink plenty of water for at least 1 day before diving or flying.

2. Do not drink alcohol, smoke, or take nonprescription drugs before or around the time of diving or flying.

3. Use plenty of nasal saline spray before and after flying and before diving. You can even bring it on the plane and use it during the flight.

4. Find a method that allows you to open up your eustachian tubes and continue to use it while you are changing altitude. Some methods are swallowing, opening your mouth and moving your jaw around, and (when flying, not diving) chewing gum.

5. Try equalizing your ears by the Valsalva maneuver. The Valsalva maneuver is done by pinching the tip of your nose to close your nostrils, preventing air from escaping. Then blow air into your nose but don’t let the air out of your nostrils, thereby forcing the air to open up your sinus passageways and your eustachian tubes. This should lead to a popping of your ears - thus equalizing the pressure. In diving language, this is called clearing your ears.

6. Some flyers and divers take an oral decongestant and others use a nasal decongestant spray before their excursion. This can work, but I caution that these products can also dehydrate you, negating some of the effect. Furthermore, they may interact with your heart, raising your blood pressure and heart rate, which may not be such a good idea, especially before diving. Certainly people with heart disease should refrain from using these decongestants.

If you chronically need to take decongestants before diving or flying, I suggest that you consult with an otolaryngologist (ENT specialist) who understands these particular issues. Preferably, you should find a physician who dives. The Divers Alert Network (DAN) is a nonprofit medical and research organization associated with the Duke University Medical Center that is dedicated to the safety and health of recreational scuba divers. It operates the only 24-hour diving emergency hotline. DAN also operates a diving medical information hotline that can help you find a medical professional in your area who is familiar with diving. These physicians should also understand your problem. Contact DAN through their website (www. diversalertnetwork. org).

The warning signs that tell you that you need to seek help and should not fly or dive before seeing your ENT physician include:

■ A recent sinus or ear infection leading to congestion of your nose, sinuses and/or ears, preventing you from clearing your ears

■ Difficulty equalizing pressure in your sinuses or ears when in an elevator

■ Problems popping your ears with the Valsalva maneuver

Sinus Tips:
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