OBUSAC

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Ear Clearing
(The following article is adapted from the BSAC website)

If you have problems clearing your ears on descent, then you are having difficulty inflating your middle ear via the Eustachian tube which connects it to the back of the nose. Provided you have normal hearing on the surface, then your Eustachian tubes must be working properly as the air in your middle ear is continually being absorbed and replaced by fresh air coming down the tubes.

There are several things you can do to help make it easier to clear your ears. Firstly, practice inflating your ears several times a day for three to four days before you intend diving but don't do this if you have a cold as pushing infected mucus into the middle ear is not a good idea. Regular use tends to open up the Eustachian tubes. Next, when in the water, start inflation from the surface downwards and for the first few metres with each breath. Never wait until there is a pressure on your ears and, if you can't clear or if there is pain, go back up until the pain and pressure has gone and try again.

Never, whatever happens, go on down in the face of increasing pain or pressure on the ear drum. If you ignore this advice, if you are lucky, you will get seeping of serous fluid into the middle ear, leaving you mildly deaf for a few days. If you are not so fortunate, a burst ear drum may result, or if the worst happens, a ruptured round window or intralabyrinthine membrane with hopefully short term tinnitus, vertigo and almost certainly lifelong high note deafness with inability to hear such things as telephones, doorbells and violins. If you are unfortunate enough to suffer tinnitus, vertigo, and deafness after a dive, and you think that it might be diving related, seek the advice of a diving medical physician immediately - time here is of the essence.

If you are diving from a boat down an anchor line or down a well secured shot line, then it often helps to pull yourself down feet first at least for the first ten metres. That way the column of air in your chest and throat exerts positive pressure to help open the Eustachian tubes.

Medication, in the form of a tablet of Sudafed taken half to three quarters of a hour before entering the water, may help and is safe to take when diving to a depth shallower than about 30 metres. Sudafed is an "over the counter" drug. However, this drug is absorbed into the body and occasionally produces side effects. It is wise therefore to try it out a day or two before diving. Ephedrine 1% nasal drops used before diving may also be helpful and should be available over the counter. Do note, however, that medication wears off in time and if this happens your 'tubes' may become blocked again while you're underwater increasing the possibility of Reverse Block occurring.

Lastly, if all else fails, there is surgery. Many people with poor Eustachian function have abnormal bony spurs extending into the back of the nasal cavity and removal of these often cures the problem. Others have a crooked nasal septum which can be straightened surgically.

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Sea Sickness
(The following article is adapted from the BSAC website)

The problem with sea-sickness medication is that some of these tablets may make you drowsy and may therefore predispose you to nitrogen narcosis.

It is strongly advisable to find the medication which best suits your body. First, you should purchase a type recommended by your local pharmacist (e.g. Stugeron), and take a test dose at a time when you are not driving or diving. If you become drowsy, you will know the medication does not suit you, and you must then try another type. This procedure should be repeated until you find one which does not make you drowsy. It is important to note that the one which suits you best may not suit your buddy at all. This is nothing to worry about and is due to differing body metabolism.

Your initial dives on this medication should be shallow and depth should be gradually increased over subsequent dives in order to minimise the possibility of adverse effects on a deep dive. Beware of the possible additive effects of this medication with prolonged use. If any drowsiness is experienced, you should not take a dose on that day.

At the start of a new diving season, prior to diving, it is advisable to retest yourself in this way to ensure that your chosen medication still suits you.

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Preventing Ear Infections
(The following advice is adapted from Dr Jules Eden in the Independent on Sunday 20.04.01)

Ear Infections are caused by water-borne bacteria that become more plentiful the closer you dive to coastal conurbations and areas where tidal flow is poor. As a consequence you have to be very careful in areas such as the Mediterranean. Likewise, in some developing countries the sewage outfall from a hotel or resort is often only yards off the shore and onto the reef where people dive.

The key to avoiding outer-ear infection, called otitis externa or OE, is through prevention. Although OE is not likely to cause you any long-term harm it can cause you to lose several precious days diving.

Always dry/clear your ears properly after your last dive of the day - using a drying agent to help if necessary. This could be a cocktail of 5% acetic acid in propylene glycol or a propriatry item such as Swim-EAR. In addition, you should take antibiotic ear drops i.e. Gentisone after each day's diving.

If you do get an infection, Gentisone is particularly good as it contains a small amount of steroid which will help reduce inflamation - the main cause the pain. If OE has set in only drops will work. It is common for oral antibiotics to be used but they don't work as they are not concentrated in the tissues of the ear canal in high enough doses. If OE doesn't clear up quickly, then insist that your GP takes an ear swab to identify the bacteria because there are some more unusual bacterial causes, such as pseudomonas, which may need far stronger antibiotic treatment.

Note that Gentisone are prescription-only drops so you'll need to ask your GP for a prescription - which will have to be a private one as you're taking them 'just in case'.

Summary:

Swim-EAR after each dive, plus a couple of antibiotic drops at the end of the day should see you well on your next trip.

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Decompression Sickness

To be completed - In the meantime please see the BSAC Sports Diving manual (2000 Ed) pp104-109

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Flying & Diving
(The following advice is taken directly from the BSAC Club & Sports Diver Student's Studybook)

Flying soon before, or after diving exposes the body to a further drop in pressure, and therefore nitrogen release, which can provoke decompression illness. You should not dive within 10 hours of flying, or fly after diving until your current tissue code is B or less. On a diving holiday, build in a safety factor and plan your last dive to give a surface interval of 16 hours + before your flight home.

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Glasses:

It is not possible to use glasses inside a mask effectively so you should either buy a mask into which prescription lenses can be fitted - or use soft contact lenses (if you can). Glasses in a mask will rattle around and move as you turn/angle your head and will be lost if you lose (or remove) your mask. If you can't see when you replace your mask 'cos you've lost your glasses, you'll become a liability to your buddy! Getting lenses fitted to a mask will add a little to the price (approx. £50) but is considerably cheaper than buying contacts.

Contact Lenses:
(The following advice is adapted from Dr Jules Eden on www.e-med.co.uk/diving)

The good news is that it should be fine to dive in contacts. There are situations in swimming pools where there are bacteria that could infect your eyes but this is not very common. We suggest you use softer lenses and after diving in the pool wash them thoroughly before replacing them. If you develop any redness in your eyes afterwards then go and see your doctor to rule out any conjunctivitis.

As for diving in the sea, again stick to soft lenses and if you get any reaction because of the salt water then perhaps its time to try a prescription lens mask.

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Diabetes:
(The following advice is adapted from Dr Jules Eden on www.e-med.co.uk/diving)

The good news is that being a diabetic, whether insulin or non-insulin dependent is no bar to diving. What is a bar, though is being a hopeless diabetic with no idea of control, how to run a sugar a bit high before a dive, and not being able to recognise a low sugar situation. There are many issues with the diabetic diver to consider before they are allowed into the water, but on the whole a well controlled diabetic who is bright enough to understand how to run a sugar high before exercise, when they are getting a low sugar and the implications of this is often considered fit to dive.

The UKSDMC, a committee of doctors that pronounce on medical problems and diving have quite a good set of rules and advice on diabetes and diving. Check out their website and find out what they say.

Ultimately, the bottom line is that if you have good sugar control (found out using a blood test called HBA1C), are responsible enough and can dive with a buddy with at least Rescue Diver skills then go and see a diving doc for assessment. You could be diving sooner than you think.

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Epilepsy:
(The following advice is adapted from Dr Jules Eden on www.e-med.co.uk/diving)

Bad news I'm afraid; diving is a non-starter for individuals who currently suffer fits or are currently on medication. Whether petit mal, grand mal or any other of the varieties that can occur is absolutely forbidden for anyone who wants to dive - there are no exceptions. The reason is obvious: a fit underwater will be fatal, not just endangering your life but that of your buddy as well.

Even those on low dose medication (such as epilim, lamotrigine, lanzarote or tegretol retard) must not dive as anti-epileptic medication can itself bring on nitrogen narcosis at a very shallow depth.

BUT

…there may be hope on the horizon - if you stay fit-free and off medication for five years it is deemed that you are a low enough risk of having another fit, that you are then allowed to learn to dive.

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Deafness:
(The following advice is adapted from Dr Jules Eden on www.e-med.co.uk/diving)

The decision of whether or not you will be able to dive depends on the underlying condition that caused your loss of hearing.

In a nutshell any cause that involves:-
- tinnitus and/or vertigo (such as Menieres disease)
- an untreated auditory nerve tumour
- destruction of the ear drum or middle ear allowing inflow of water or inability to equalise
…would prevent diving.

Some deafness is a simple affair, present from birth and in these situations you may well be fine to dive. Get advice on the exact nature of the deafness, you could well be fine to dive.

If you get the OK to dive, do note that there are issues relating to communications underwater that need to be addressed with your buddy: You should always stay close to your buddy and agree an alternative way of communicating in case of an emergency. Also think about your ascents where a boat is coming in, perhaps you should to always come up under a hearing buddy in case you miss boat props as you surface.

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Blood Donors:
(The following advice is adapted from Dr Jules Eden on www.e-med.co.uk/diving)

When you go to give blood the transfusion service always do a haemoglobin test to make sure that your blood is not too thin or anaemic. Having said that, when the blood is drawn (about 400mls in all) this is about a tenth of your circulating volume. The actual fluid volume in your vessels is replaced fairly quickly by what we call extra-cellular fluid being drawn into your veins and arteries, but the replacement of the red blood cells takes longer. A hormone called "erythropoetin" or EPO, is released which makes the bone marrow step up production of the red cells. It takes from 4 to 7 days to fully replace the missing cells and that governs your ability to dive again.

So despite probably being fine the next day, I would really only recommend you could safely dive a week after giving blood.

See also: Links to Diving Medicine sites on the Links page

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