Eustachian Tube dysfunction & Equalizing Middle Ear Pressure & Dealing with Congestion

Eustachian Tube Dysfunction (ETD) can now be treated with Balloon Eustachian Tube Tuboplasty.

The ability to equalize middle ear pressures during descent and ascent is required for scuba divers, whether recreational, military or commercial divers.  Most scuba divers do so with ease either spontaneously or with equalization techniques like the Valsalva and other maneuvers.  However, repeated forceful Valsalva maneuvers can damage or even rupture the eardrum.  Some divers have persistent difficulty despite the use of  decongestants like oral pseudoephedrine (Sudafed®), phenylephrine nasal spray, oxymetazoline nasal spray (Afrin®), antihistamines, steroid nasal drops, or buffered saline irrigation devices (such as NeilMed Sinus Rinse®). 

Until recently there was little that could be done for divers like me who had difficulty equalizing one or both middle ear pressures since they began diving.  That was in 1971 for me and I gave up scuba diving for many years until I began using OTC decongestants and then nasal irrigation.  But now, there is a new minor surgical procedure for treating Eustachian Tube Dysfunction (ETD) called Balloon Eustachian Tube Tuboplasty (https://www.jnjmedtech.com/en-US/treatment/Acclarent-aera-eustachian-tube-balloon-dilation-system).  The potential for complications is very minimal.  An ENT told me that I might start hearing myself breathe to which I responded, “I’m a scuba diver.  I already hear myself breathe.”

In the August 2016 DAN-Europe Alert Diver Cosimo Muscianisi suggested that balloon tuboplasty using a modified PTA catheter could be safely used to cure ETD by improving stenosis (narrowing) of the eustachian tube.  In 2019 Giunta et al reported he was able to improve ETD in 15 of 20 freediving spear fisherman.  In 2020 two clinical studies and one case report were published reporting treatment of ETD in scuba divers.  In 2xxx Tsur err al reported treatment of an Israeli Navy SEAL who had suffered repeated middle ear barotrauma.  He was able to return to diving, but still suffered from middle ear symptoms and barotrauma and eventually was disqualified from further combat diving.

Unger, et al reported outcome of balloon ET tuboplasty in four male divers.  One recreational diver eventually required ventilation tubes insertion and had to avoid diving.  A navy combat diver using CCR…

In 2020 Utz, et al published a retrospective analysis of balloon dilation for ETD in 15 US Navy divers and aviators.  Dilation was effective in restoring 12 of 13 patients to duty in hyper- and hypobaric environments.  One aviator and one diver were excluded from analysis due to failure to undergo a post-dilation baro-challenge.  One patient reported no benefit from balloon ET dilation and did not return to diving.

After dealing with what I now know has been persistent ETD on my right side since I began diving in 1971 and dive limiting difficulty on several dives in 2022, I needed help.  By chance in September 2022 at a dance event near the Smoky Mountain National Park in NC, I met an ENT who told me about a new procedure for ETD.  He had operated on several non-diver patients, but only on one diver.  He had no follow up, but he assumed it had helped him.  He explained there was only one FDA approved device available in the United States: The Acclarent AERA® Eustachian Tube Balloon Dilation System.  There are a patient education video and doctor search at the company website (https://www.jnjmedtech.com/en-US/treatment/Acclarent-aera-eustachian-tube-balloon-dilation-system).  Other devices are available outside the United States.  I was fortunate to find such an ENT nearby and eagerly underwent the procedure on my right ET in December 2022.  

During multiple domestic and international flights in 2023, I was surprised how easily my right middle ear pressure spontaneously equalized on ascent and descent.  My next dive trip was not until late September 2023 and for the first time since I began diving in 1971, I was easily able to equalize the pressure in my right middle ear on descent and ascent!  My dive buddies noticed that they no longer had to wait for me to clear my ears on descent or abort a dive because of me.  Over 25 dives later my ETD is still a thing of the past!  So far I have had no complications or adverse events.

How much does it cost?  Many medical insurance carriers in the USA (including Medicare) cover the procedure with prior approval when it is performed in an outpatient surgical center, but usually not if performed in a physician’s office.  The out of pocket cost without medical insurance for me would have been $548 for the initial office evaluation with an ENT, $237 for “Dilation of canal between middle ear and throat (Eustachian tube) on one side of the body using endoscopy by the ENT (CPT code 69705), $ 2,104 for the anesthesiologist and nurse anesthetist, and $14,453 for the outpatient surgery center fee (69705-SGRT).  The total of all charges was $17,342. Having already met my annual deductibles and after insurer reductions of the billed charges, my out of pocket responsibility was only $791. I consider that a bargain given how much trouble and how many dives I have cancelled due to ETD over my 52 years of diving.

Copyright 2023. David F Colvard. All rights reserved.

       Ten Ways to Equalize Middle Ear Pressure Naturally - 2014 - Duration: 43:29.

Presentation given in January 2014 at C.I.E.E. Research Station on Bonaire by David F. Colvard, M.D.,  Copyright 2014. David F Colvard. All rights reserved.

 Sinus Rinse/Irrigation for Scuba Divers - 2015

Demonstration of the use of high volume, positive pressure, buffered saline nasal-sinus irrigation using Sinus Rinse by NeilMed Pharmaceuticals, Inc. 

Dr. Colvard has been a medical consultant to the company and completed a post marketing study in scuba divers, which showed a decrease in the need for OTC decongestants to help equalize pressure in diver's middle ears and sinuses.

FINANCIAL DISCLOSURES:  Dr. Colvard has been a paid consultant to and representative of NeilMed Pharmaceuticals, the manufacturer of SinusRinse™. 

DISCLAIMER:  All material in this video is provided for educational purposes only.  Consult your own physician regarding the applicability of any opinions or recommendations with respect to your symptoms or medical condition.  Any communication with Dr. Colvard through this website does not establish a physician-patient relationship.

Copyright 2015. David F Colvard. All rights reserved.