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September 2008    Download the Entire Issue (PDF) Available to the Public Vol. 23, No. 9   RSS Feed for Undercurrent Issues
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Having Trouble Equalizing? Try Sinus Surgery

from the September, 2008 issue of Undercurrent   Subscribe Now

Some lucky folks are born with sinuses and Eustachian tubes like storm drains. Mine are like cocktail straws. I had always been able to equalize but in the past few years, my sinuses and ears got worse. Since my generation is spending the most on diving and aging simultaneously, the issue is indeed germane to most of you. The sad truth of sinus and equalizing problems is that they get worse with age.

Through a Divers Alert Network referral, I met Paul Alberti, M.D, an ear, nose and throat specialist in New Haven, CT. Also a dive instructor and hyperbaric chambercertified operator, Dr. Alberti understands why diving is an essential part of life and not something one just gives up. When a regimen of daily sinus rinses and topical cortisone sprays didnt do enough, a CT scan revealed my sinuses were filled with sludge and diseased tissue and my nasal septum was impressively deviated. I arranged for surgery in late 2007.

The latest and least invasive surgery is done endoscopically through the nose, with no incisions and no bruising. After full sedation and intubation (necessary since my airways would be filled with instruments), Alberti trimmed my septum, debrided the diseased tissue, and inserted balloons in each sinus to clean them out. Afterwards it was a lousy and painful week to recover.

But four weeks later, I went to Bonaire to dive again. Snorkeling went well, so I donned my gear. The dive was, well, strange. I descended slowly, gently clearing with the Valsalva maneuver, and heard squeaks and popping sounds. At 30 feet, my maxillary sinus hurt and I realized that, for the first time, I had sinus squeeze. Though my gut told me to pop to the surface, my training told me to ascend slowly. As I climbed the ladder, I felt a pop, removed my mask, snorted into my hand, and saw blobs of mucus exactly the shapes of a maxillary sinus and the tube leading from it. Seems I had cleared out the remaining gunk.

I e-mailed Alberti who suggested I wait a day before another dive. That second try was a revelation. My ears cleared well, my sinuses seemed fine and I emerged from the water a happy diver. This continued for the rest of the trip and Im fully healed.

I have learned a few things: A deviated septum affects how easily you can clear your ears but when its fixed, both sides of the nose and throat pass the same amount of air, easing the job of formerly overworked tubes. I use my throat muscles more to equalize because they help flex the Eustachian tube openings naturally without putting pressure on them. Over-the-counter sinus rinses like NeilMed are great because they clear things out, moisturize tissues and have no side effects. And I no longer descend headfirst like a dropped weight belt but go slowly, equalizing gently. Not only has diving improved, Ive even been told my voice is more resonant.

If you have a chronic problem, call DAN for a referral. Treatment really helps for equalizing-challenged divers who want to get wet without worry.

- - Mel McCombie

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