'On Your Ear'
SOME PERSPECTIVES ON PRESSURE IN THE MIDDLE EAR

Imagine for a moment not being able to do that one thing that means the world to you

ok, sorry, for all you guys out there, I'm sure it's the second most important thing, but not by much I can guarantee. Imagine epic diving conditions. Crystal warm waters, flat calm surf and infused with a plethora of good eating and challenging species for you to pursue. Imagine watching all your dive buddies enjoying this bounty and having fun while you either drive the boat, or keep the home fires burning for their return.

Every diver has at some stage suffered the frustrations of sinus squeeze or equalization problems which see you having to sit on the bench for a game or 2. But if you think this suffering is bad, imagine the purgatory of not being able to dive indefinitely! Unlikely you say!? Think again. This hell on earth, the living nightmare of all spearo's could be just around the corner for any of us. And the cause of this predicament is quite simply neglecting to look after your ears and your nose.

Being one of those unfortunate souls who suffers poor eustachian tube function exacerbated by minor sinus problems, I'm all to familiar with the pain, suffering, wailing and gnashing of teeth which come associated with these long spells away from the embryonic embrace of the great oceans. And as spear fishing is my reason for existence, I have had to make a study of the cause of my discomfort in order to better understand and remedy the problem.

Although the middle ear problems I have had have been rather more extreme than most, it never ceases to amaze me how many divers, the good the bad and the ugly who have complained of ongoing problems with their ears and sinuses. It's a common ailment. Further to this, it has stupefied me just how little, or how shallow the understanding of the ear/sinus structure and function is among these guys.

Now here is the thing. And I'm probably going to be shot down in smoke and challenged vehemently on this, but here is a fact that I'm comfortable to stand by: Despite the teachings of Jacque Cousteau in Homo delfinnis, and the basic principles of Darwin's emergent evolution, the current design of the plumbing inside the head of modern man is not conducive to diving depth! If it were, we wouldn't have the global epidemic of ENT (ear, nose and throat) problems associated with diving.

And here's another thing, but this time I'm sure all spearo's will concur with me: Most sports require some degree of skill, luck and physical fitness, and the driving force behind success is passion. For spear fishing it's a little different in that there is a further element over and above these prerequisites which one needs in order to progress and that element is called physiology. Without good ENT physiology, you are going to find yourself stranded on terra firma, as skill, fitness and passion alone is not enough to ensure competent diving. This is what sets spearo's and free divers apart from other sporting disciplines.

So, having made these statements, what is the remedy to ensure or at the very least control good ENT functioning? If you are not fortunate to have been blessed with the God given right to efficient ENT physiology, what can one do to increase ones time in the water and stave off injury or damage to your plumbing?

Sticking with the biblical theme and given that good ENT functioning and physiology is the "Holy Grail", lets look at the important parts of the ear and sinus to have a better understanding of how to manage the problem.There are 3 fundamentally important parts to the middle ear.

• The tympanum (ear drum),
• mastoid and
• eustachian tube.

Let's call these the "Holy Trinity". Cast out from the middle ear are the sinus cavities, dark caverns that can cause untold evil to befall you.

These 2 entities, although separate are intricately intertwined and one cannot function without the other, and a problem in one adversely affects the other. Just as heaven and hell share the same street, so to do the components of your ear, nose and throat.

On visiting an ENT specialist with a related problem, you can bet your bottom dollar that the first thing he will do is gaze into your nose to assess the condition of the sinus cavity. This is always the first line of inquiry as it is undoubtedly the most common cause of diving related problems. Fortunately most of the disorders associated with polyps, deviated septum's and sinus disease are readily treatable if not curable. The first line of defense against possible malfunction is to ensure that your sinuses stay clean and healthy as they can easily compromise good middle ear function.

Problems in the middle ear itself can be much more complicated. There are way more working parts to the "Holy Trinity" and as such it will forever remain an enigma to the layman. One of the most common ailments is barotrauma, the perforation of the tympanum. The cause of this is however most likely sinus related in that the irritated sinus affects the eustachian tube which results in poor eustachian tube functioning.

Another common problem is the mastoid. This is a bony cavity within the middle ear which is supposed to be highly porous, looking a bit like an aero chocolate bar. The importance of the mastoid to divers is paramount, as it acts as a buffer or shock absorber if you will during pressure changes and equalization. Sometimes, due to middle ear disease or repeated infections, the mastoid becomes clogged and this hampers the efficiency of ones ability to equalize the rapid pressure changes experienced during freediving. Finally we have the eustachian tube, and this is a tricky little prophet. On average about 2 to 2.5 cm in length, the eustachian tube is the kingpin of good middle ear function. Just as for Christians, nobody gets to heaven except by Jesus, so with the eustachian tube which is the only portal allowing air to move in and out the middle ear.

Fail your eustachian tube and you fail yourself. The wonders of modern medicine have allowed doctors to literally perform surgical miracles. Modern surgery can: replace your heart with a vibrator, let blind people see, perform brain surgery, replace a hip and even turn boys into girls and vice versa. What modern medicine can't do however is to surgically repair or enhance eustachian tube function. This delicate part of the body is so complex in its simplicity that other than highly dangerous and experimental laser surgery, it is not possible to operate on it in any way. The eustachian tube varies in size and shape and if you have narrow tubes, the only way to ensure the ability to dive, is to effectively manage all the other parts of the middle ear and sinus cavity.

Another common ailment of spearfishermen is a condition called exostoses, or more commonly known as surfer's ear. This condition manifests in the outer ear canal and is characterized by bony growths which can, if untreated, block the entire outer ear canal. Exostoses are caused by repeated exposure to cold water. The outer ear canal is an interesting part of the body in that it is the only place where one will find skin directly overlaying the bony cavity with no fatty tissue in between. The result is that the underlying bone is irritated by cold water resulting in these bony growths. Unfortunately most divers are unaware of this until problems with the outer ear develop as a direct result. The only treatment is a simple surgical procedure in which the exostoses are ground away to open the ear canal efficiently once more.

To prevent exostoses, especially for divers in the colder temperate waters, diving with vented earplugs is recommended. Docs Pro-plugs, available on the internet are designed for divers and surfers and the plugs are 100% safe for freediving use. The idea is that the plugs will keep warm water in the ear canal during the dive. Please ensure that vented plugs are used to prevent a barotrauma.

Spearfishing is not a sport, or even a hobby. It's a lifestyle.

Only the dedicated spearo knows the degree of commitment required to excel. Much of this has to do with "managing the physiology". Poor diet, lack of exercise, alcohol and drug abuse are the sworn enemies of good ENT functioning. Divers who suffer food or nasal allergies need to pay penance to their lifestyle so much more than the "chosen ones". If one takes their spearfishing seriously, sacrifices have to be made, and a routine of ritual has to be observed.

Continued IN NEXT ISSUE "..the essential do's and don'ts..."
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