DIVE DOC­TOR: Med­i­cal Q&A

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Dr Oliver Firth has gained con­sid­er­able ex­pe­ri­ence in the field of div­ing and hy­per­baric medicine since join­ing LDC in 2006. He is an Ap­proved Med­i­cal Ex­am­iner of Divers for the UK HSE, and a med­i­cal ref­eree for the UK Sport Div­ing Med­i­cal Com­mit­tee. He is in­volved in the man­age­ment of all types of div­ing-re­lated ill­ness, in­clud­ing re­com­pres­sion treat­ment, as well as pro­vid­ing hy­per­baric oxy­gen ther­apy for non-div­ing con­di­tions. He re­mains a pas­sion­ate diver and has par­tic­i­pated in var­i­ous expeditions and con­ser­va­tion projects through­out the globe.

Q: Hi. I’ve re­cently started tech div­ing and have just done the TDI ex­tended range course and am div­ing around 45m - 65m on air. I have no­ticed some­thing rather strange when I go beyond 45m: I hear a very loud beat in my head. If I clear my ears with a small blow, the sound dis­ap­pears, and once I as­cend, it stops. I’ve just done a cou­ple of 30m dives and no beat in my head. It has only started since I’ve done deep dives - I’d never heard it be­fore. The sound is like a pro­pel­ler: thud, thud, thud. It sounds like it’s my heart beat or pulse, but re­ally loud, and it gets louder the deeper I go (be­low 45m). Is this nar­co­sis, O2 tox­i­c­ity or (as my buddy thinks) could my Eus­tachian tube be press­ing on a vein due to the in­creased pres­sure? Do you have any other ideas as to what it could be?

A: From your de­scrip­tion of the sound, it would ap­pear to be a height­ened aware­ness of your pulse, tech­ni­cally termed pul­satile tin­ni­tus. Quite why this should have arisen now and not on pre­vi­ous dives is any­one’s guess, but with in­creas­ing depth your Eus­tachian tubes are likely to be com­pressed nearer to the blood ves­sels that are caus­ing the sound, and so I can see some merit in your buddy’s ex­pla­na­tion. It tends to be louder with ex­er­tion (as your blood is be­ing pumped around with more force), which would also tie in with deeper div­ing. If you have any mid­dle ear con­ges­tion, then the sound will get louder too, as the con­ges­tion con­ducts sound much bet­ter than air. It can some­times be due to high blood pres­sure, or rarely to vas­cu­lar tumours in the mid­dle ear – but in these cases I’d ex­pect you to be aware of the symp­toms much more fre­quently, in­clud­ing at night, and when you’re not div­ing. So on bal­ance I don’t think you need worry unduly. A lot of peo­ple get this from time to time, non- divers as well as divers, and it is sim­ply an el­e­vated per­cep­tion of the big ar­ter­ies puls­ing away in the neck. It is, ba­si­cally, noth­ing to worry about.

Q: I’ve been get­ting some symp­toms dur­ing and after div­ing which are wor­ry­ing me. I went on a Red Sea live­aboard a month ago, which I’ve done many times be­fore. The first cou­ple of days were fine, great in fact, but from day 3, after each dive I started to no­tice slight bubbling/gur­gling sounds in my ch­est. These got worse over the week, and I started get­ting burn­ing pains as well. By the end I had to bail out of the last 2 dives as my ch­est was so sore. I felt sick too, and half the time couldn’t sleep as ly­ing down made it worse. I’m only 40 years old so I was look­ing for­ward to a lot more div­ing. Hope­fully this doesn’t mean the end?

A: Don’t panic, this is ac­tu­ally quite a com­mon com­plaint and thank­fully it’s un­likely to end your div­ing ca­reer. These are the typ­i­cal symp­toms of gas­tro-oe­sophageal reflux disease (GORD), which are of­ten ex­ac­er­bated by div­ing. Think of your stom­ach as a wine bot­tle filled with acid, and your oe­soph­a­gus (food pipe) the long neck of the bot­tle. Nor­mally a handy lit­tle sphinc­ter at the base of the bot­tle neck stops acid en­ter­ing the oe­soph­a­gus. How­ever, in some sit­u­a­tions (like be­ing hor­i­zon­tal in the water), the acid re­fluxes through this sphinc­ter, up the long neck of the bot­tle, and causes heart­burn and nausea. Pretty un­pleas­ant dur­ing a dive. The risk fac­tors for GORD are nu­mer­ous: cer­tain foods, cer­tain drugs, obe­sity, ad­vanc­ing age and tight cloth­ing are those most preva­lent in the div­ing com­mu­nity. If any of these ap­ply then ad­dress them. Luckily there are also plenty of medicines to help. Some coat the lin­ing of the oe­soph­a­gus, oth­ers stop the acid se­cre­tion from the stom­ach, and some­times a course of “triple ther­apy” will erad­i­cate pesky bac­te­ria that can con­trib­ute to the symp­toms. So be­fore your next dive ask your GP to give your gul­let the once-over.

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