When Jim first experienced ear pain on a dive, he motioned to his buddy to ascend a bit. They did, and the pain ceased. Upon descending again, the ear pain recurred. He couldn't clear with the Valsalva maneuver or the head tilt, or even both together. The pain persisted. He remembered a friend stubbornly continuing with pain and suffering a perforated eardrum. He signaled to end the dive.

Ear and sinus barotraumas are the most common injuries reported by divers; DAN receives more calls regarding ear problems than any other health concern. The good news is that ear barotrauma rarely causes chronic or permanent injury, but it's important to take care of your ears and to take action if you feel pain on a dive.

Before You Dive

Before you even enter the water, focus on your ears. Take care of yourself; colds and other common ailments can cause congestion that could affect your ears on a dive. If you have allergies, confer with your physician to find what medication or other therapy best controls your symptoms; if your physician is unsure about whether a particular medication is appropriate for use while diving, have him call the DAN Medical Information Line at +1-919-684-2948. You can always call us as well. Doctors trained in diving medicine typically recommend being on any new drug for at least 30 days before diving on it. This gives you time to know how you'll feel on the drug and to experience any side effects on land.

Dive Day

If you are a diver who takes a decongestant prior to diving, take it about an hour before entering the water to ensure it takes full effect. Also be sure to incorporate into your dive plan the fact you're taking a decongestant; if the effects of the drug wear off underwater, you could have trouble returning to the surface.

(NOTE: DAN does not recommend taking decongestants as a means of equalizing. If you are ill, do not dive. If you suffer a chronic condition, consult a physician before diving.)

Beyond that, the best thing you can do for your ears on dive day is to have a thorough knowledge of the methods of equalization. Follow these tips during the dive:

- Use a gentle Valsalva maneuver while at the surface.
- Practice good buoyancy control.
- Descend feet first.
- Tilt an ear that won't equalize toward the surface.
- While descending, try to equalize every 1 to 2 feet or with every other exhalation.
- If you feel pain in your ears, stop, ascend a few feet (or descend, in the case of a reverse block), equalize and re-attempt the descent.
- After the dive, dry your ears thoroughly. (Some use the cool or warm setting on the hair dryer.)

If Symptoms Occur

If you experience pain in your ears while diving, and you're unable to equalize no matter what you do, end the dive.

Listen to your ears; don't ignore such things as pressure buildup or ringing sensations, as they generally do indicate an issue that needs to be addressed. Again, ear barotraumas don't usually cause permanent injury, but because they can, they do require immediate attention.

If an ear injury occurs, see a qualified medical practitioner. Your recovery can be affected by how quickly you seek treatment. Not diving for the day or while on a vacation is disappointing, but the consequences of worsening symptoms can affect travel home and, potentially, future diving. If you need assistance in finding medical care, call the DAN Emergency Hotline at +1-919-684-9111.

Want More Info?
Check out the online seminar, "Ears and Diving," at www.DiversAlertNetwork.org. It's free to DAN Members! ■

Article courtesy of Diver's Alert Network

"You can't dive with diabetes."

In the past, that phrase went hand-in-hand with a diabetes diagnosis, but recent studies have changed this perception. Living with diabetes doesn't necessarily mean a life above sea level. Diabetes is a disorder of the endocrine system, wherein the body produces insufficient insulin or cells are unable to use the insulin efficiently, depriving the body of energy.

A survey DAN conducted in 1996 revealed that many divers diagnosed with diabetes were continuing to dive against doctors' orders. This new information prompted DAN to conduct a study re-evaluating the risks related to diving with diabetes.

From 1997 through 1999, DAN gathered data about insulin-requiring divers. Using this study, DAN developed guidelines to help insulin-dependent divers make informed decisions regarding their diving.

What is the Concern?
According to a report by the Center for Disease Control, about 7.8 percent of the population in the United States has diabetes.

Some symptoms of diabetes can often be overlooked: increased urination and appetite, unusual thirst, weight loss, fatigue and irritability. Other symptoms may include blurred vision, slow recovery from cuts and bruises and tingling in extremities.

The primary concern regarding insulin-dependent diabetes is the potential for hypoglycemic episodes. Warning signs of a hypoglycemic event can start with sweating, nervousness, heart palpitations, nausea and faintness. Symptoms may progress to affecting mental status, causing individuals to experience confusion, seizures and even loss of consciousness. A hypoglycemic episode in a diving situation could be deadly for both the diver and his buddy as a loss of consciousness may lead to drowning.

But there are ways to mitigate these risks, and diabetes may not preclude you from continuing your diving adventures.

Make a Plan
In addition to following traditional dive safety guidelines, diabetic divers need to take extra precautions. Make a more conservative dive plan, accounting for factors that could provoke a hypoglycemic episode. Avoid prolonged, strenuous or deep dives to prevent overexertion.

In addition, hypoglycemic episodes may look similar to nitrogen narcosis. To avoid confusion, dive shallower than 100 feet.

Tell your dive buddy about your condition and how he should respond in the event of an emergency. Should a serious issue arise in a diving situation, medical attention may be delayed; quick response by your buddy could make all the difference in an emergency.

Prior to the dive, practice with your buddy in the pool. Make sure you discuss hand signals to convey a hypoglycemic event underwater. If an emergency occurs, tell your buddy, consume glucose and safely terminate the dive. Both you and your buddy should carry glucose paste in your BCDs during the dive. Consider practicing self-administration of glucose in a pool setting. After you are safely out of the water, check your blood glucose levels.

The ability to dive with diabetes must be evaluated on a case-by-case basis. Some of the most important considerations are whether you have experience managing the illness in the context of exercise and recognizing in yourself the onset of hypoglycemia.

Talk to your doctor about diving with diabetes and any medications you are taking. Manage your diabetes according to the specific dive plan you and your doctor develop. Monitor any changes in the disease or your treatments and periodically reassess your diabetic dive management plans with your physician.

If you have any questions or would like an evaluation by a diving doctor, contact the DAN Medical Information Line at +1-919-684-2948 or at www.Dan.org. DAN is also available to provide a consultation to your doctor.

If you experience a diabetic emergency while diving, call the DAN Emergency Hotline at +1-919-684-9111.