Telinga adalah organ kompleks yang memungkinkan orientasi dalam ruang, aktivitas fisik sehari-hari, dan komunikasi sosial. Sementara anatomi telinga mungkin menakutkan sampai batas tertentu, kami telah mencoba memberikan gambaran yang disederhanakan namun jelas untuk meningkatkan pemahaman Anda tentang proses penting untuk menyelam.
Penyamaan tekanan di telinga tengah adalah keterampilan yang paling penting bagi penyelam. Jika tidak dikuasai dengan baik, penyelam bisa terluka dan terkadang cacat permanen. Pada penyelam dengan telinga yang sehat, barotrauma telinga dapat dicegah. Penyelam harus menginvestasikan waktu dan upaya untuk menguasai teknik penyamaan tekanan (ekualisasi).
Telinga adalah organ pendengaran dan keseimbangan. Ini terdiri dari rongga dalam struktur tengkorak yang dilapisi dengan jaringan lunak, yang membungkus tiga ruang khusus yang diisi dengan udara atau cairan (telinga luar, tengah dan dalam); ruang-ruang khusus ini menampung mekanisme transmisi suara dan aparatus sensorik.
Struktur
Telinga luar meliputi pinna (daun telinga) dan saluran telinga hingga gendang telinga (membran timpani), yang memisahkannya dari telinga tengah. Lapisan telinga luar adalah kulit yang kaya dengan kelenjar yang menghasilkan kotoran telinga.
Telinga tengah adalah rongga di tulang temporal yang dilapisi dengan lapisan tipis jaringan yang mirip dengan yang ditemukan di hidung dan tenggorokan. Ini dipisahkan dari saluran telinga oleh gendang telinga dan terhubung ke tenggorokan melalui tabung Eustachius. Ini mencakup tiga tulang kecil (tulang pendengaran) yang membentuk rantai yang melekat pada gendang telinga di satu sisi dan ke membran jendela oval di sisi telinga bagian dalam. Ruang telinga tengah diisi dengan udara pada tekanan sekitar, yang perlu disetarakan ketika tekanan sekitar berubah (seperti yang terjadi pada menyelam atau terbang). Hal ini dicapai dengan menggerakkan udara masuk atau keluar melalui tabung Eustachius, yang menghubungkan tenggorokan ke telinga tengah, menggunakan teknik pemerataan seperti manuver Valsava.
Telinga bagian dalam, atau labirin, termasuk koklea (organ pendengaran) dan vestibulum dan saluran setengah lingkaran (organ keseimbangan). Koklea dan ruang depan adalah asal saraf pendengaran dan vestibular.
Fungsi
Gelombang tekanan yang ditransmisikan oleh udara atau air disalurkan oleh pinna dan liang telinga ke membran timpani. Gelombang tekanan menyebabkan membran timpani bergetar, yang menyebabkan tulang-tulang pendengaran bergerak secara simultan sebagai respons. Stapes (tulang terakhir dalam rantai) mengenai jendela oval koklea. Karena ini adalah sistem tertutup, ketika jendela oval didorong ke dalam, jendela bundar mendorong ke luar. Cairan di dalam koklea mengirimkan gelombang tekanan ke saraf pendengaran, yang pada gilirannya, mengirimkan sinyal ke otak yang ditafsirkan sebagai suara.
Bagian dari ruang depan adalah proyeksi yang dikenal sebagai kanal setengah lingkaran. Cairan dalam sistem ini bergerak sesuai dengan gerakan kepala. Di dalam kanalis semisirkularis terdapat struktur seperti rambut yang disebut silia. Silia mendeteksi pergerakan cairan melalui kanal dan mengirim sinyal melalui saraf vestibular ke otak, di mana gerakan tersebut ditafsirkan dan digunakan untuk membantu menentukan posisi kepala dalam ruang tiga dimensi.
Ekualisasi Telinga Bagian Tengah
Pemerataan telinga tengah adalah keterampilan dasar penyelam yang diperlukan yang memungkinkan pemerataan tekanan di sinus dan ruang telinga tengah dengan tekanan sekitar.
Prosedur dalam Praktek
Saat penyelam turun di kolom air, tekanan lingkungan meningkat secara linier dengan kecepatan satu setengah pon per inci persegi (PSI) untuk setiap kaki (0,1 kg/cm2)2 for each meter) and transmits across the body tissues and fluids. Boyle’s law describes how the volume of the gas decreases when pressure increases, if the amount (mass) of gas and the temperature remain the same. The middle ear is a rigid cavity with the exception of the eardrum. So when pressure increases, the only way for the volume to decrease is the bowing of the eardrum toward the middle-ear cavity (unless gas is added to the space). After the eardrum stretches to its limits, further reduction of middle-ear cavity volume is not possible; if descent continues, the pressure in the middle-ear cavity remains lower than its surroundings. Modest pressure difference will cause leakage of fluid and bleeding from the eardrum and mucosa lining the middle-ear cavity (ear barotrauma O’Neil grade 1). When the pressure difference reaches 5 PSI (0.35 bar), the eardrum may rupture in some divers; at a pressure difference greater than 10 PSI (0.75 bar), rupture will occur in most divers (ear barotrauma O’Neil grade 2). In addition, sudden and large pressure changes may cause inner-ear injury.
Jadi sekarang Anda mengerti mengapa saat turun Anda harus membiarkan lebih banyak gas masuk ke telinga tengah Anda untuk menjaga volume gas tetap konstan dan menyamakan tekanan. Telinga tengah yang normal hanya memiliki satu komunikasi fisik dengan sumber gas tambahan, yaitu tuba Eustachius yang menghubungkan rongga hidung (rhinopharynx). Dalam keadaan normal, saluran Eustachius tertutup, tetapi setiap kali kita menelan atau menguap, otot-otot di tenggorokan kita memungkinkan pembukaan sementara kecil yang cukup untuk ventilasi telinga tengah kita dan mengkompensasi tekanan.
Nothing challenges our ears and Eustachian tubes more than scuba and breath-hold diving. To become a safe scuba diver and avoid middle-ear injuries, it is essential that you understand the effects of Boyle’s law and learn how to actively let air into your middle ears via the Eustachian tubes. In the following sections, you will find different equalization techniques for you to try.
Saat pendakian, tekanan di sekitarnya berkurang dan tekanan di tengah tetap lebih tinggi jika gas tidak bisa keluar dari rongga telinga tengah. Ketika tekanan di telinga tengah melebihi tekanan di sekitarnya sebesar 15-80 sentimeter air (cm H2O) yang sesuai dengan pendakian di air 0,5-2,5 kaki, tabung Eustachius terbuka, dan kelebihan gas keluar. Jika telinga Anda tidak menyamakan pada tingkat yang sama dan perbedaan tekanan mencapai sekitar 66 cm H2O (2 kaki), vertigo karena stimulus tekanan yang tidak seimbang (vertigo alternobarik) dapat terjadi.
Infeksi saluran pernapasan atas, hay fever, alergi, obat-obatan yang mendengus, merokok atau septum hidung yang menyimpang dapat mengganggu pemerataan tekanan. Jika digunakan dengan benar, teknik berikut ini efektif pada telinga tengah dan tekanan sinus pada subjek yang sehat.
Teknik Pemerataan Tekanan (Ekualisasi)
Pasif: Tidak membutuhkan usaha. Terjadi selama naik ke permukaan.
Pembukaan tuba secara sukarela: Cobalah menguap atau menggoyangkan rahang Anda. 30 persen penyelam berhasil menguasai teknik ini.
Manuver Valsava: Jepit lubang hidung Anda, dan tiup dengan lembut melalui hidung Anda.
Manuver Toynbee: Jepit lubang hidung dan menelan (teknik yang baik jika ekualisasi diperlukan selama naik).
Manuver Frenzel: Jepit lubang hidung sambil mengencangkan otot tenggorokan, dan buat bunyi huruf “k”.
Teknik Lowry: Jepit lubang hidung Anda, dan dengan lembut coba hembuskan udara dari hidung Anda saat menelan (pikirkan manuver Valsava sesuai dengan manuver Toynbee).
Teknik Edmonds: Dorong rahang Anda ke depan, dan lakukan manuver Valsava atau manuver Frenzel.
Manuver Toynbee adalah teknik yang efektif untuk menyamakan telinga Anda selama naik ke permukaan
Kiat untuk Ekualisasi
Sebelum turun, saat Anda mengapung secara netral tanpa udara di perangkat kontrol daya apung (BCD), kembangkan telinga Anda dengan lembut dengan salah satu teknik yang tercantum. Ini memberi Anda sedikit udara ekstra di telinga tengah dan sinus saat Anda turun.
Turun dengan kaki terlebih dahulu, jika memungkinkan. Hal ini memungkinkan udara untuk melakukan perjalanan ke atas ke dalam tabung Eustachius dan telinga tengah, arah yang lebih alami. Gunakan tali pemandu atau tali jangkar untuk mengontrol kecepatan turun.
Kembangkan telinga Anda dengan lembut setiap beberapa kaki selama 10 hingga 15 kaki pertama.
Sakit tidak dapat diterima. Jika ada rasa sakit, Anda telah turun tanpa menyamakan tekanan secara memadai. Naik beberapa kaki sampai rasa sakitnya berhenti.
Jika Anda tidak merasakan telinga Anda terbuka, berhentilah dan coba lagi; Anda mungkin perlu naik beberapa kaki untuk mengurangi tekanan di sekitar Anda. Jangan memantul ke atas dan ke bawah.
Mungkin berguna untuk memiringkan telinga yang tersumbat ke arah permukaan.
Jika Anda tidak dapat menyamakan tekanan, batalkan penyelaman. Konsekuensi dari turun tanpa menyamakan tekanan dapat merusak keseluruhan perjalanan menyelam atau menyebabkan kerusakan permanen dan gangguan pendengaran.
Decongestants and nasal sprays may be used prior to diving to reduce swelling in the nasal and ear passages. If your doctor agrees with your decision to use decongestants, take them one to two hours before descent. They should last from eight to 12 hours, so you don’t need to take a second dose before a repetitive dive. Nasal sprays should be used approximately 30 minutes before descent and usually last 12 hours. Take caution when using over-the-counter nasal sprays; repeated use can cause a rebound reaction resulting in increased congestion and possible reverse block on ascent. Decongestants may have side effects. Do not use them before dive if you do not have previous experience.
Jika sewaktu-waktu selama menyelam Anda merasa sakit, mengalami vertigo atau kehilangan pendengaran mendadak, batalkan penyelaman. Jika gejala ini berlanjut, jangan menyelam lagi dan konsultasikan dengan dokter Anda.
Ear injuries are the leading cause of morbidity among scuba divers. The most common injury is middle-ear barotrauma (MEBT). Most cases of MEBT are mild, heal spontaneously and are never reported. In more serious cases, divers seek medical attention, and some call DAN. Various surveys indicate that more than 50 percent of all divers experience MEBT at least once. In contrast, only 4.4 percent of divers experience DCS in their lifetime.
Divers are affected by various other ear injuries, many of which are preventable, detailed in the chapter that follows.
Middle-ear barotrauma is the accumulation of fluid and blood in the middle ear or rupture of the eardrum as a consequence of failed equalization of pressure in the air space of the middle ear during diving or flying.
Mekanisme
The air pressure in the tympanic cavity — air-filled space in the middle ear — must be equalized with the pressure of the surrounding environment. The Eustachian tube connects the throat with the tympanic cavity and provides passage for gas when pressure equalization is needed. This equalization normally occurs with little or no effort. Various maneuvers, such as swallowing or yawning, can facilitate the process.
An obstruction in the Eustachian tube can lead to an inability to achieve equalization particularly during a descent when the pressure changes fast. If the pressure in the tympanic cavity is lower than the pressure of the surrounding tissue, this imbalance results in a relative vacuum in the middle ear space. It causes tissue to swell, the eardrum to bulge inward, leakage of fluid and bleeding of ruptured vessels. At a certain point an active attempt to equalize will be futile, and a forceful Valsalva maneuver may actually injure the inner ear. Eventually, the eardrum may rupture; this is likely to bring relief from the pain associated with MEBT, but it is an outcome to be avoided if possible.
Factors that can contribute to the development of MEBT include the common cold, allergies or inflammation — conditions that can cause swelling and may block the Eustachian tubes. Poor equalization techniques or too rapid descent may also contribute to development of MEBT.
Manifestasi
Divers who cannot equalize middle-ear pressure during descent will first feel discomfort in their ears (clogged ears, stuffed ears) that may progress to severe pain. Further descent only intensifies the ear pain, which is soon followed by serous fluid buildup and bleeding in the middle ear. With further descent, the eardrum may rupture, providing pain relief; this rupture may cause vertigo, hearing loss and exposure to infection.
Penanganan
While diving: When feeling ear discomfort during descent, you should stop descending and attempt equalization. If needed, ascend a few feet to enable equalization. If equalization cannot be achieved, you should safely end the dive.
First aid: When feeling fullness in one’s ears after diving, abstain from further diving. Use a nasal decongestant spray or drops. This will reduce the swelling of nasal mucosa and Eustachian tube mucosa, which may help to open the Eustachian tube and drain the fluid from the middle ear. Do not put any drops in your ear.
Treatment: Seek a physician evaluation if fluid or blood discharge from the ear canal is present or if ear pain and fullness lasts more than a few hours. If vertigo and dizziness are present, which may be a symptom of inner-ear barotrauma, you should seek an urgent evaluation. Severe vertigo and nausea after diving require emergency medical care.
Kebugaran Untuk Menyelam
Return to diving may be considered if a physician determines that the injury is healed and the Eustachian tube is functional.
Pencegahan
Do not dive with congestion or cold.
Descend slowly. If unable to equalize after a few attempts, safely end the dive to avoid significant injury that may prevent you from diving the rest of the week.
Tympanic Membrane Rupture (Perforated Eardrum)
Tympanic membrane perforation is a tear of the eardrum, which can occur while scuba diving due to failed middle-ear pressure equalization.
Mechanism
The tympanic membrane (TM) is a tissue separating the external ear from the middle-ear space. It is attached to a chain of small bones (auditory ossicles) located in the middle ear. The TM also serves as a barrier between the sterile middle-ear space and the ambient environment.
Eardrum rupture may be caused by descending without equalizing the pressure in the middle ear, by a forceful Valsalva maneuver, explosion, a blow to the ear/head, or acoustic trauma. It is usually accompanied with pain; rupture relieves the pressure (and pain) in the middle ear and may be followed by vertigo. There may be some bleeding in the ear canal.
Contributing factors include congestion, inadequate training and excessive descent rates.
Manifestasi
Ear pain during descent that stops suddenly
Clear or bloody drainage from ear
Hearing loss
Ringing in the ear (tinnitus)
Spinning sensation (vertigo)
Nausea or vomiting that can result from vertigo
Penanganan
Most perforated eardrums will heal spontaneously within a few weeks. It may be necessary to treat nasal and sinus congestion. If the tear or hole in your eardrum does not heal by itself, treatment will involve procedures to close the perforation. These may include:
Eardrum patch: An ENT specialist may seal the tear or hole with a paper patch. This is an office procedure in which an ENT applies a chemical to the edges of the tear to stimulate growth and then applies a paper patch over the hole to provide a support structure for the growth of eardrum tissue.
Surgery: Large eardrum defects may be fixed by surgery (tympanoplasty). An ENT surgeon takes a tiny patch of your own tissue and plants it over the hole in the eardrum. This procedure is done on an outpatient basis, meaning you can usually go home the same day unless medical conditions require a longer hospital stay.
For an ENT referral in your area, email or call the DAN Medical Information Line at +1 (919) 684-2948.
Kebugaran Untuk Menyelam
If your physician feels the healing is solid and there is no evidence of Eustachian tube problems, you can return to diving within several months. Chronic perforations that do not heal are a contraindication to diving.
Pencegahan
Do not dive with congestion. Maintain a comfortable rate of descent, and equalize as needed.
O’Neill Grading System
The O’Neill grading system is a new way to grade the severity of middle-ear barotrauma. It is simplified and is expected to provide more consistent diagnosis with sufficient details to direct the treatment.
Grade 0 Eustachian Tube Dysfunction
Baseline photo depicting anatomical appearance of the TM before exposure to pressure
Symptoms with no anatomical change (no trauma) from baseline
Grade 1 Barotrauma
Erythema increased from baseline
Fluid or air trapping (visible bubble) in the middle-ear space
Grade 2 Barotrauma
Any bleeding noted within the tympanic membrane or middle-ear space
Perforation
Barotrauma Telinga Bagian Dalam
Inner-ear barotrauma is damage to the inner ear due to pressure differences caused by incomplete or forceful equalization. A leak of inner-ear fluid may or may not occur.
Mechanisms of injury
The inner ear is separated from the external world by the middle ear. It is the organ for hearing and balance. When the pressure in the middle-ear space is properly equalized, the risk of inner-ear barotrauma is extremely low.
If the pressure in the middle ear is not equalized during descent, the water pressure on the eardrum transfers inward through the middle-ear ossicles to the oval windows, and the round window bulges outward. The pressure itself may damage sensitive inner-ear structures. If the pressure is excessive, either the oval window or, more commonly, the round window may tear, and the inner-ear fluid (perilymph) may leak into the middle ear (perilymph fistula).
The Valsalva maneuver increases the pressures in cranial tissues and circulation, which may transmit to the cochlear fluid, causing an outward movement of the round window. Pressure waves alone can cause damage to the inner ear without window rupture. If the rupture occurs, the loss of fluid from inner ear leads to damage of the hearing organ and sometimes of the balance organ. If the leak is not stopped soon by spontaneous healing or surgical repair, permanent hearing loss may occur.
Manifestasi
Divers may experience:
Severe vertigo
Hearing loss
Ears roaring/ringing (tinnitus)
Involuntary eye movement (nystagmus)
Fullness of the affected ear
Symptoms of middle-ear barotrauma are almost always present. Vertigo is usually severe and accompanied by nausea and vomiting. Hearing loss can be complete, instant and permanent, but divers usually lose just the higher frequencies. The loss becomes noticeable only after a few hours. You may not be aware of the loss until you have a hearing test.
Penanganan
In case of vertigo underwater, abort the dive, and obtain assistance to reach the surface safely. Begin surface oxygen if decompression illness is suspected. First aid providers should conduct a complete neurological exam and note any deficits.
Inner-Ear Barotrauma or Inner-Ear Decompression Sickness?
It is important to distinguish between these two conditons, because their treatments differ. The standard treatment for DCS of any kind is hyperbaric oxygen treatment in a recompression chamber; recompression or any pressure change is contraindicated when inner-ear barotrauma is likely. While the symptoms are similar in both conditions, barotrauma is preceded by failed equalization of middle-ear pressure and usually occurs at the beginning of dive, while DCS occurs due to failed decompression at the end of the dive.
Definitive Treatment
Urgently seek an evaluation by a physician to rule out DCS. If your physician determines it is not DCS, consult an ENT specialist with experience treating divers. For a referral in your area, email , atau hubungi Saluran Informasi Medis DAN di +1 (919) 684-2948.
Avoid any exertion, middle-ear equalization, altitude or diving exposure, sneezing or nose blowing. Do not take aspirin, nicotinic acid (vitamins), other vasodilators or anticoagulants. Conservative treatment includes bed rest in a sitting position and avoiding any strains that can increase intracranial or middle-ear pressure. If symptoms do not improve, surgery may be necessary. Healing of the tear (fistula) usually occurs within a week or two. Hearing loss may become permanent.
Kebugaran Untuk Menyelam
Evaluation of fitness to dive requires an expert diving physician and depends on the degree of permanent damage as well as the probability of repeated injury.
Prognosis
In many cases, complete healing occurs spontaneously. If fistula presents and does not heal soon spontaneously, surgery may be recommended. In some cases, the inner ear may be damaged permanently; the body may adapt to one side not working properly. If injury occurs to the other ear, the situation can be serious and may involve incapacitating balance problems.
Pencegahan
Learn gentle but effective equalization techniques, and avoid aggressive employment of the Valsalva maneuver. Do not dive when congested.
Perilymph Fistula
A perilymph fistula is a tear in the round- and/or oval-window membranes through which inner-ear fluid (perilymph) is leaking.
Mechanism
Leakage of perilymph from the labyrinth may occur when the round or oval window is disrupted due to severe middle-ear barotrauma or forceful Valsalva maneuver.
Manifestasi
The symptoms of perilymph fistula may include dizziness, vertigo, imbalance, nausea and vomiting. Some people experience ringing (tinnitus) and fullness in the ears, and many notice some hearing loss. Symptoms worsen with changes in altitude (elevators, airplanes or travel over mountains), weather changes and with physical exertion.
Penanganan
This condition can usually be managed conservatively with absolute bed rest in the sitting position. Straining, sneezing, nose blowing, sexual activity, loud noises and middle-ear equalizing should be avoided to prevent pressure waves in the inner ear.
The round-window fistula often heals spontaneously within a week or two with this regimen, but if hearing loss progresses or the other features persist, it may be necessary to resort to surgery to repair the round-window leak.
Kebugaran Untuk Menyelam
Even after the acute symptoms of an oval- or round-window fistula have resolved, the diver’s future in diving is questionable. Flying should be completely avoided for several months to allow complete healing of the injury or the surgical repair.
For a referral in your area, email , atau hubungi Saluran Informasi Medis DAN di +1 (919) 684-2948.
Pencegahan
Ensure the Eustachian tubes are functioning properly before diving by gently equalizing on the surface.
Vertigo Alternobarik
Vertigo alternobarik terjadi selama turun atau naik, atau segera setelah muncul ke permukaan setelah menyelam dan disebabkan oleh stimulasi tekanan yang tidak sama di setiap telinga.
Statistik
According to various sources, up to 25 percent of divers experience alternobaric vertigo at some time.
Mekanisme
During ascent, air in the middle-ear space expands, relative pressure increases, the Eustachian tubes open passively, and gas escapes through the Eustachian tubes into the nasopharynx. Occasionally the Eustachian tube may obstruct this flow of air, with subsequent air distension and increased pressure sensation in the middle-ear cavity during ascent. If the obstruction is one-sided and the pressure difference is greater than 60 centimeters of water, vertigo may occur as the pressure increase stimulates the vestibular apparatus. Usually it is relieved by further ascent, because the increasing differential pressure in the middle-ear space forces open the Eustachian tube and vents the excess air. Contributing factors include middle-ear barotrauma during descent, allergies, upper respiratory infections (congestion) and smoking.
Manifestasi
The symptoms of alternobaric vertigo may include disorientation, nausea and vomiting.
Note: The disorienting effects of vertigo while diving are extremely dangerous. The inability to discern up from down, follow safe ascent procedures, and the risks associated with vomiting pose a significant hazard to the diver as well as other divers in the water.
Penanganan
Advice provided by Dr. Carl Edmonds about how to manage alternobaric vertigo during a dive:
“If a diver encounters ear pain or vertigo during ascent, he should descend a little to minimize the pressure imbalance and attempt to open the Eustachian tube by holding the nose and swallowing (Toynbee or other equalization maneuver). If successful, this equalizes the middle ear by opening it up to the throat and relieves the distension in the affected middle ear.
“Occluding the external ear by pressing in the tragus (the small fold of cartilage in front of the ear canal) and suddenly pressing the enclosed water inward may occasionally force open the Eustachian tube. If this fails, then try any of the other techniques of equalization described previously, and attempt a slow ascent.”
Uncomplicated cases resolve quickly within minutes upon surfacing. If symptoms persist, see your primary care physician or an ENT specialist. Do not dive if you have equalization problems.
Associated injuries include middle-ear barotrauma and inner-ear barotrauma; alternobaric vertigo may occur during descent or ascent, but is commonly associated with a middle-ear barotrauma of ascent (reverse squeeze). Other conditions such as inner-ear DCS or caloric vertigo (when cold water suddenly enters one ear) should be ruled out.
Kebugaran Untuk Menyelam
As soon as all symptoms and contributing factors have been resolved, a diver may return to diving.
Pencegahan
Take measures for the prevention of ear barotraumas. Avoid the unequal pressurization of the ear by avoiding tight-fitting wetsuit hoods or earplugs. Maintain good aural hygiene. Do not dive when congested or unable to equalize.
Tekanan Terbalik (Reverse Squeeze)
A reverse squeeze is barotrauma due to an inability to release pressure from the middle ear on ascent.
Mekanisme
Pressure must be released from the middle ear as the diver ascends, or the expanding air will bulge and even rupture the eardrum. Expanding air normally escapes down the Eustachian tubes, but if the tubes are blocked with mucus at depth (usually the result of poor equalization on descent, diving while congested or relying on decongestants that wear off at depth), barotrauma can result.
Manifestasi
Pressure, fullness in ear
Ear pain
Vertigo
Penanganan
While diving: Sometimes one of the equalizing techniques used on descent will clear your ears on ascent. Pointing the affected ear toward the bottom may help, too. Ascend as slowly as your air supply allows. Increasing pressure usually opens the Eustachian tube and relieves overpressure. However, in rare cases it may persist all the way up. In that case, you will have to endure the pain to reach the surface. Notify your buddy, and stay in close proximity.
First aid: Nasal decongestant spray may help open the Eustachian tube. A physician evaluation is advised if you experience vertigo, protracted pain and fullness of the ears.
Kebugaran Untuk Menyelam
Repeated episodes require an ENT evaluation. For an ENT referral in your area, email , atau hubungi Saluran Informasi Medis DAN di +1 (919) 684-2948.
Pencegahan
Prior to diving, try equalizing on the surface to ensure Eustachian tube function is adequate.
Baroparesis Wajah
Facial baroparesis is reversible paralysis of the facial nerve due to increased pressure in the middle ear when ascending in an airplane or from scuba diving.
Mekanisme
Mans Bell’s Palsy
The facial nerve is a cranial nerve that controls the muscles of the face. On its way from the muscle to the brain it passes through the channel in the wall of the middle-ear space. Pressure changes in that space normally have little or no effect on the nerve.
In some people, the canal of facial nerve misses the bony wall and is separated from the middle-ear cavity by only a thin membrane. If such a person experiences an overpressure in the middle ear equal or greater to the capillary pressure, circulation to the facial nerve stops, the facial nerve loses its functionality and facial muscle is paralyzed (facial baroparesis). This can happen while flying or diving. Fortunately, the pressure in the middle ear returns to normal soon after the exposure, restoring the circulation to the nerve and enabling its functionality. Facial baroparesis tends to recur with flying or repeated diving.
Manifestasi
Symptoms include numbness, paresthesia, weakness or even paralysis of the face. Decreased sensation and a facial droop can be seen, generally on one side of the face.
Penanganan
Facial baroparesis usually is discovered postdive. Even when its duration is brief and it resolves spontaneously, the patient should be evaluated by a physician to exclude other possible causes such as stroke, infection, trauma or decompression sickness.
In rare instances of protracted facial baroparesis, treatment may be necessary. There is experimental evidence that overpressure lasting more than 3.5 hours may cause permanent damage. Divers who continue to experience facial numbness and drooping should see a physician within three hours.
Kebugaran Untuk Menyelam
This condition is self-limiting and resolves spontaneously within hours, but it can recur with diving or flying. Return to diving may be considered when symptoms have completely resolved and have been determined to be the result of facial barotrauma.
Pencegahan
Learn gentle but effective equalization techniques. Do not dive with congestion.
Temporomandibular Joint Syndrome (TMJ)
Temporamandibular joint syndrome is pain in and around the temporomandibular joint caused by prolonged gripping of a mouthpiece from a snorkel or scuba regulator.
Statistik
It has been reported that TMJ occurs in 15-20 percent of snorkelers and scuba divers.
Mechanism
TMJ is a chronic inflammation of the jaw joint just in front of the ear. The pain can be great enough to make holding the mouthpiece between the teeth difficult. The condition is exacerbated by local factors such as joint laxity, anatomical factors, capsular or muscular inflammation, or the type of mouthpiece used.
Diving-associated TMJ is thought to result from the forward posturing of the mandible by an ill-fitting mouthpiece and clenching of the mouthpiece, especially with heavy regulators. Diving may aggravate preexisting TMJ. The pain is sometimes severe enough to cause divers to abort the dive. It can occur in novice divers who clench their teeth, sometimes with such intensity that they occasionally bite through the mouthpiece.
Manifestasi
Pain in the TMJ and ears
TMJ clicking or crepitus (cracking or popping sound)
Trismus (inability to open mouth fully) and impaired TMJ mobility
Dizzy spells (could be hazardous should it occur underwater)
Masticatory muscle pain
Stuffy sensation in the ears
Eustachian tube dysfunction
Headache and facial pain
Penanganan
While diving: Work to relax your bite while retaining the mouthpiece in place. If unsuccessful, safely end the dive, surface and consider alternative mouthpiece options.
Definitive treatment: If pain persists, a consultation with a specialist is suggested as solutions are highly individualized. Treatment includes bite adjustment, management of dental problems and the use of orthodontic mouthpieces. Heat and anti-inflammatory drugs are helpful.
Kebugaran Untuk Menyelam
Return to diving is possible upon pain resolution. You must also be able to grip the mouthpiece without pain.
Pencegahan
Use only a mouthpiece that fits properly. Consider a customized mouthpiece. Correct contributing conditions such as dental problems, anxiety and teeth grinding (bruxism).
Surfer’s Ear
Surfer’s ear is the narrowing of the outer ear canal due to an abnormal growth of bone caused by exposure to cold and wet conditions.
Mechanism
The external ear canal is a tubular structure that conducts sounds and protects the middle ear. Exostosis is a chronic condition characterized by narrowing of the inner half of the ear canal as a result of bone growth. The bony wall grows outward slowly over a period of years in response to local irritation by cold water. These growths are called swimmer’s nodes and are common in swimmers, surfers and divers. This condition is not related to infection nor is it caused by infection; however, the narrowing of the ear canal may prevent water from draining out, which increases susceptibility to outer-ear infections. The bony swellings continue to grow while there is a continued exposure to cold water (such as that found in seawater and outdoor swimming pools in temperate climates). Exostosis often occurs in outdoor enthusiasts in their mid- to late-30s, but individuals who experience significant cold-water exposure — such as surfers, swimmers and divers — can develop the condition earlier.
The narrowed ear canal is more prone to blockage by earwax or debris and more susceptible to swimmer’s ear (otitis externa). An exostosis on the floor of the ear canal can form a sump that retains moisture and is susceptible to infection. Exostosis is seen as a narrowing of the ear canal. The average ear canal is about 0.25 inches wide (7 milimeters). The bone growth may cause it to narrow to 0.04 inches (1 millimeter). Early signs include water trapping in the ear canal after swimming. Debris trapping and infections may make surgery necessary.
Manifestasi
External ear infections and difficulty removing water from the external ear canal may be recurrent. Exostosis symptoms in advanced cases include a decreased hearing possibly combined with an increased prevalence of ear infections.
Diagnosis Diferensial
Other causes of external ear-canal obstruction could include infection or earwax (cerumen) impaction.
Perawatan
In case of decreased hearing or repeated infections, exostosis may be removed surgically.
Kebugaran Untuk Menyelam
Exostoses do not affect fitness to dive unless they are occluding the ear canal or causing recurrent infection.
Pencegahan
Wear a hood in cold water.
After diving, rinse both ears with freshwater to flush contaminated water and salt.
If prone to ear infections, blow warm air into external canal using a hair dryer (take care to make sure the air is not too hot).
If your ears have a natural tendency to build up a blockage of earwax, have them checked regularly, particularly before a prolonged diving trip.
Swimmer’s Ear
Acute inflammation or infection of the outer ear (pinna and ear canal) caused by prolonged exposure to wet and warm conditions is known as swimmer’s ear.
Statistik
Otitis externa affects one in 200 Americans every year and is present in chronic form in 3-5 percent of the population. Swimmers, surfers and other individuals who are exposed to wet and warm conditions are at an increased risk.
Mechanism
The external auditory canal is the tubular opening between the outside environment and the eardrum (tympanic membrane). It is covered by skin and secretes earwax (cerumen), which helps protect against infection.
Otitis externa, commonly referred to as swimmer’s ear, is the acute inflammation or infection of the external auditory canal, resulting in ear pain and pus discharge.
Breakdown of the external ear canal’s protective barrier leads to infection. Excessive moisture, mechanical trauma or underlying skin conditions are contributing factors. The bacteria normally found in the external ear canal often trigger the infection. With frequent immersion, water swells the cells lining the ear canal. Eventually, these cells separate far enough for the bacteria that are normally found on the surface of the ear canal to penetrate the skin, where they find a warm environment and start to multiply. Otitis externa is more likely to develop if the skin in the ear canal is already chafed and cracked by excessive moisture from showering or scratching. Bacteria or fungus from the water can easily invade damaged skin.
Seborrheic dermatitis, psoriasis and excessive cleaning of wax from the ears that injures the skin lining the external ear canal may increase susceptibility of the ear canal to infection. Excessive debris or cerumen may trap water in the canal.
Manifestation
The chief complaint is generally itching often accompanied by pain, tenderness and swelling of the ear canal. If left untreated, the swelling can increase to include nearby lymph nodes and produce enough pain that moving the jaw becomes uncomfortable.
Penanganan
Pertolongan Pertama
Avoid getting in the water until after the problem clears up.
Use a hair dryer to carefully dry the ear after you shower (take care to ensure the air is not too hot).
In case of pain, over-the-counter pain medications can be effective. Examples of such medications include acetaminophen (Tylenol), ibuprofen (Advil or Motrin) or naproxen (Aleve). Read and follow all instructions on the label.
Perawatan Stop swimming and diving; schedule an appointment with your physician. Do not put anything in your ear unless instructed to do so. If you have diabetes or take medicine that suppresses your immune system, swimmer’s ear can cause severe problems that require immediate medical attention.
It is important for your physician to rule out external ear squeeze, otitis media and mastoiditis (infection of the bone just behind the ear).
Kebugaran Untuk Menyelam
Return to diving is possible once your physician determines that the infection has resolved.
Pencegahan
Keep your ears clean and dry.
Dry ears with a towel after swimming or showering by tilting your head and pulling your earlobe in different directions while your ear is facing down.
Refrain from putting objects — such as cotton swabs or your finger — in the ear canal or removing ear wax yourself; both actions can damage the skin, potentially increasing the risk of infection.
You can dry your ears with a blow dryer if you put it on the lowest setting and hold it at least a foot (about 0.3 meters) away from the ear.
Talk to your doctor about whether you should use alcohol-based eardrops after swimming.
If you know you don’t have a punctured eardrum, you can use over-the-counter eardrops or homemade preventive eardrops before and after swimming. This mixture of one part white vinegar to one part rubbing alcohol may help promote drying and prevent the growth of bacteria and fungi that can cause swimmer’s ear. At the end of each day of diving, put five drops of the solution into each ear. Let it stay for five minutes before draining back out.
Nyeri adalah gejala yang paling umum dari cedera telinga, tetapi gejala yang paling mengkhawatirkan adalah vertigo, tinitus dan tuli akut. Ketiga gejala tersebut dapat disebabkan oleh berbagai kondisi medis akut dan kronis yang mempengaruhi kebugaran untuk menyelam. Onset akut dari gejala-gejala ini sehubungan dengan menyelam dapat mengindikasikan barotrauma telinga bagian dalam atau penyakit dekompresi dan harus segera dievaluasi secara medis.
Vertigo sering dikacaukan dengan pusing, yang memiliki penyebab dan implikasi yang berbeda. Penyelam harus terbiasa dengan gejala-gejala ini sehingga mereka dapat mengenali potensi masalah dan melakukan intervensi dengan tepat.
Seasickness is a condition individuals may experience when on a moving platform. It involves a general feeling of illness, dizziness, nausea and vomiting. It is also called motion sickness. Passive motions disturb fluid movement within the labyrinth and affects one’s sense of balance and equilibrium. It is exaggerated when the brain receives conflicting messages delivered from the eyes, muscles and joint sensors (proprioceptors). In a closed room, the view indicates that the surroundings are still, while the signals from the labyrinth indicate that the body is moving.
Mabuk perjalanan dapat terjadi saat bepergian dengan kapal, pesawat, kereta api, bus atau mobil. Beberapa orang lebih sensitif daripada yang lain, tetapi jika rangsangan geraknya kuat dan paparannya berlangsung cukup lama, hampir semua individu akan mengalaminya.
Gejala
The symptoms of motion sickness include dizziness, sweating, nausea, vomiting and a general feeling of discomfort or illness. Symptoms can strike suddenly and progress from simply not feeling well to cold sweats, dizziness and vomiting. Motion sickness is more common in women and in children 2-12 years old. Individuals who suffer from migraine headaches are also more prone to motion sickness. Motion sickness lasts as long as the motion lasts. Once the motion stops, symptoms quickly subside. Some people feel “sea legs” after a long sojourn at sea.
Pencegahan dan Pengelolaan
Jika Anda tahu Anda mengalami mabuk perjalanan atau mungkin rentan terhadapnya, pertimbangkan saran ini:
Di atas perahu: Tetap di dek dan fokus pada cakrawala. Hindari menghirup asap knalpot.
Di dalam mobil: Duduk di kursi depan. Jika Anda penumpangnya, lihatlah pemandangan di kejauhan.
Jangan membaca di kendaraan yang bergerak. Membaca membuat mabuk perjalanan semakin parah.
Hindari makanan berat sebelum menyelam.
Minum banyak air.
Hindari alkohol di malam hari sebelum Anda bepergian.
Jika memungkinkan, berdiri. Duduk atau berbaring dapat membuat kondisi Anda lebih buruk.
Makan kerupuk kering untuk membantu mengatasi perut mual.
Hindari orang lain yang menjadi mual karena mabuk perjalanan.
Perawatan
Mabuk perjalanan dapat diobati dengan produk obat bebas dan resep.
Produk yang dijual bebas: Antihistamin biasanya digunakan untuk mencegah dan mengobati mabuk perjalanan. Efek samping antihistamin adalah kantuk, yang akan menjadi berlebihan ketika alkohol juga dikonsumsi. Mengantuk dapat mempengaruhi keselamatan penyelam.
Produk resep:Patch kulit skopolamin (Transderm Scop) adalah pilihan yang populer. Patch diterapkan ke area kulit di belakang telinga setidaknya delapan jam sebelum paparan dan dapat membantu mencegah mabuk perjalanan hingga tiga hari per patch. Skopolamin dapat menyebabkan mulut kering, penglihatan kabur, mengantuk dan pusing. Pasien dengan glaukoma, pembesaran prostat dan beberapa masalah kesehatan lainnya tidak boleh menggunakan obat ini. Pastikan untuk memberi tahu dokter Anda tentang masalah kesehatan Anda yang ada untuk membantu menentukan obat mana yang paling cocok untuk Anda.
Pengobatan alternatif:Berbagai pengobatan alternatif telah dipromosikan untuk membantu dalam mengurangi atau mencegah mabuk perjalanan. Dalam kebanyakan kasus, bukti kemanjurannya menghilang. Namun, jika Anda memiliki gejala ringan, Anda dapat mencoba produk jahe atau peppermint untuk meredakan gejala tanpa risiko efek samping.
Vertigo
Vertigo adalah perasaan terus-menerus dari gerakan miring, bergoyang, berputar atau berputar dari diri sendiri atau dunia sekitarnya ketika tidak ada yang bergerak.
Vertigo selama atau setelah menyelam adalah gejala umum dari cedera telinga tengah atau telinga dalam. Hal ini sering dikaitkan dengan mual dan dalam kasus yang parah muntah. Jika vertigo terjadi di bawah air, penyelam mungkin tidak dapat membedakan mana yang naik; panik dan muntah dapat menyebabkan tersedak dan tenggelam. Di darat, pasien mungkin tidak bisa duduk atau berdiri
Ada berbagai penyebab vertigo. Dalam menyelam, paling sering disebabkan oleh barotrauma telinga bagian dalam. Hal ini juga dapat terjadi dari stimulasi satu sisi dan bukan yang lain, seperti ketika perbedaan tekanan hanya pada satu telinga yang menyamakan (vertigo alternobarik) atau ketika air dingin masuk ke satu telinga tetapi tidak pada telinga yang lain (vertigo kalori). Vertigo jenis ini menghilang saat kondisinya menjadi seimbang dan tidak meninggalkan efek yang bertahan lama kecuali disorientasi, mual dan muntah yang terkait saat berada di bawah air dapat menyebabkan kecelakaan menyelam.
Vertigo adalah gejala akut cedera vestibular yang mungkin terkait dengan gejala lain, beberapa di antaranya mungkin menjadi kronis. Gejala mungkin termasuk ketidakseimbangan dan disorientasi spasial, gangguan penglihatan, perubahan pendengaran, gerakan mata yang tidak disengaja (nystagmus), dan perubahan kognitif dan / atau psikologis diantaranya.
Diagnosis Diferensial
Vertigo is not the same as dizziness, lightheadedness or unsteadiness. When you’re dizzy, you may feel lightheaded or lose your balance. If you feel that the room is spinning, you have vertigo.
Untuk vertigo, bedakan antara penyakit dekompresi telinga bagian dalam (DCS) dan barotrauma telinga bagian dalam.
Pedoman Umum
Vertigo yang terjadi sebentar selama atau setelah menyelam dan sembuh secara spontan memerlukan evaluasi tuba Eustachius sebelum melanjutkan menyelam.
Vertigo yang terus-menerus adalah tanda kondisi serius dan memerlukan evaluasi segera oleh spesialis THT. Untuk rujukan THT di daerah Anda, email , atau hubungi Saluran Informasi Medis DAN di +1 (919) 684-2948.
Vertigo pasca menyelam persisten yang parah adalah keadaan darurat.
Kebugaran Untuk Menyelam
Kerusakan organ vestibular oleh DCS, barotrauma atau syok akustik mungkin permanen. Dalam kasus cedera telinga tunggal, vertigo dapat hilang dalam dua hingga enam minggu, karena otak belajar untuk mengkompensasi dan mengabaikan sisi yang rusak, tetapi salurannya tidak akan sembuh. Penyelam akan mengalami kesulitan menjaga keseimbangan dalam kegelapan ketika kehilangan petunjuk visual. Kerusakan pada kedua organ vestibular melemahkan dan dapat membuat aktivitas kehidupan tertentu (seperti mengendarai mobil) menantang atau tidak mungkin.
Vertigo yang terus-menerus atau berulang, bahkan jika dikendalikan oleh obat-obatan, mendiskualifikasi menyelam.
Kembali menyelam setelah barotrauma telinga bagian dalam atau DCS harus dievaluasi secara individual tergantung pada tingkat cedera permanen organ telinga bagian dalam.
Tinitus (Telinga Berdenging)
Tinnitus adalah suara atau dering di telinga.
Tinnitus adalah sensasi suara eksternal yang sebenarnya tidak ada. Tinnitus (telinga berdenging) mempengaruhi sekitar satu dari lima orang dan dapat disebabkan oleh banyak kondisi medis.
Tinnitus adalah sensasi suara eksternal yang sebenarnya tidak ada. Tinnitus (telinga berdenging) mempengaruhi sekitar satu dari lima orang dan dapat disebabkan oleh banyak kondisi medis.
Diagnosis Kemungkinan
Penting untuk menemukan penyebab yang mendasari tinnitus. Tinnitus akut yang terjadi selama atau setelah menyelam kemungkinan terkait dengan barotrauma telinga atau DCS telinga bagian dalam. Jika dikaitkan dengan menyelam, dokter Anda harus menentukan apakah itu barotrauma atau DCS telinga bagian dalam, karena perawatannya tidak sama, dan perawatan yang salah bisa berbahaya.
Kemungkinan penyebab tinnitus lainnya termasuk:
Gegar otak
Kebisingan atau ledakan intensitas tinggi
Infeksi
Infeksi telinga (otitis media)
Tumor
Temporomandibular joint (TMJ) dysfunction
Benda asing dalam telinga
Abnormalitas vaskular
Meniere’s disease
Hipertensi
Migraine
Beberapa obat (termasuk aspirin dan kina)
Berbagai keracunan (seperti karbon monoksida, nikotin dan logam berat)
Kebugaran Untuk Menyelam
Jika tinnitus tidak berhubungan dengan menyelam dan masalah yang mendasarinya bukan merupakan kontraindikasi untuk menyelam, tidak ada alasan untuk membatasi penyelaman karena tinnitus itu sendiri.
Gangguan Pendengaran/Ketulian
Kehilangan pendengaran atau tuli adalah kehilangan pendengaran sebagian atau seluruhnya dari garis dasar normal.
Kehilangan pendengaran total atau sebagian dapat terjadi karena berbagai alasan. Ada beberapa penyebab yang berhubungan dengan menyelam termasuk barotrauma, penyakit dekompresi (DCS) dan kerusakan pada telinga bagian dalam.
Gangguan pendengaran dapat diklasifikasikan sebagai konduktif atau sensorineural.
Gangguan pendengaran konduktif melibatkan saluran telinga, gendang telinga dan tulang-tulang kecil tulang-tulang pendengaran telinga tengah; komponen anatomi ini secara mekanis menghantarkan suara ke telinga bagian dalam, tempat sinyal listrik dihasilkan.
Gangguan pendengaran sensorineural melibatkan otak, saraf kranial kedelapan atau telinga bagian dalam.
Diagnosis Kemungkinan
There are many causes of hearing loss, including infection, blocked ear canal, barotrauma, drugs, trauma, round- or oval-window rupture, stroke, Meniere’s disease, noise and medications.
Kebugaran Untuk Menyelam
Meskipun jarang, gangguan pendengaran permanen terkait menyelam akibat barotrauma telinga atau DCS telinga bagian dalam mungkin terjadi. Jika cedera menyebabkan kehilangan atau gangguan pendengaran unilateral permanen (hanya satu telinga), sebagian besar dokter akan merekomendasikan untuk tidak kembali menyelam. Ini sering direkomendasikan karena jika penyelaman berikutnya mengakibatkan cedera pada sisa telinga yang berfungsi, individu tersebut dapat mengalami gangguan pendengaran bilateral permanen. Rekomendasi ini berlaku untuk semua individu monaural (pendengaran satu sisi), terlepas dari penyebab gangguan atau gangguan pendengaran unilateral.
Populasi tambahan yang sering tidak disarankan untuk menyelam atau sangat berhati-hati termasuk mereka yang telah menjalani operasi implan koklea, operasi tulang pendengaran atau perbaikan membran timpani (miringoplasti.) Menyelam menempatkan individu dengan riwayat medis ini pada risiko kerusakan perbaikan bedah, mengakibatkan gangguan pendengaran. Untuk penyelam yang telah menjalani prosedur tersebut atau menderita gangguan pendengaran permanen akibat barotrauma telinga, sangat disarankan untuk sangat berhati-hati, dan konsultasi dengan dokter THT sebelum menyelam sangat disarankan. Untuk referensi di daerah Anda, email , atau hubungi Saluran Informasi Medis DAN di +1 (919) 684-2948.
Penting untuk disebutkan bahwa gangguan pendengaran bilateral (baik bawaan atau didapat) tidak selalu secara medis menghalangi seseorang untuk menyelam. Namun, dalam kasus gangguan pendengaran bilateral, lingkungan menyelam dapat menimbulkan potensi kesulitan dengan komunikasi permukaan, baik dengan penyelam lain maupun dengan anggota kru. Komunikasi yang terhambat dalam kasus-kasus yang berkaitan dengan lalu lintas kapal, penarikan kembali penyelam dan keadaan tak terduga lainnya dapat mengakibatkan keterlambatan tanggap darurat, cedera atau kematian.
Orang-orang menyadari telinga mereka dalam banyak hal. Mereka mengambil tempat yang menonjol di kepala, dan dengan demikian masalah estetika terkadang bersaing dengan masalah kesehatan. Perlindungan alami kulit saluran telinga melibatkan lilin, yang dalam beberapa kasus dapat menjadi gangguan kesehatan dan menyebabkan masalah medis yang nyata. Beberapa orang menganggap lilin sebagai masalah kebersihan dan berusaha keras untuk menghilangkannya. Hal ini dapat menimbulkan masalah tersendiri.
Aktivitas di luar ruangan, terutama olahraga air, membuat telinga terkena kondisi dingin, basah, dan terlalu hangat, yang dapat merusak telinga. Ada banyak solusi komersial yang diusulkan yang konon akan mengurangi risiko cedera atau kerusakan telinga. Sayangnya, hanya sedikit dari produk-produk tersebut yang telah diuji oleh otoritas kesehatan. Di bagian ini, kita akan membahas kebersihan telinga dan obat-obatan serta penyumbat telinga (perangkat yang tidak kami rekomendasikan untuk penyelam) dan tabung ventilasi telinga.
Having a clean ear canal is important for divers. In extreme cases, earwax can form a plug and trap air between itself and the eardrum, which can cause an “explosive” tympanic membrane perforation that tears outward instead of the more common inward perforation.
Selain itu, sumbat kotoran telinga dapat mencegah air mendinginkan satu telinga, sementara telinga lainnya secara alami didinginkan oleh air yang mengisi saluran telinga. Perbedaan suhu antara kedua telinga ini menyebabkan vertigo kalori.
Akhirnya, sumbat lilin dapat mencegah drainase yang tepat dari saluran telinga. Kelembaban yang tertahan dapat menyebabkan pelunakan kulit dan membuka jalan menuju infeksi.
Lantas, bagaimana cara membersihkan telinga?
Cara yang Salah
Hindari pembersih berujung kapas. Aplikator ujung kapas dapat mendorong kotoran lebih dalam ke telinga, membuat pembuangan kotoran lebih sulit. Selain itu, ujung aplikator kapas dapat terlepas dan tertinggal di saluran telinga. Dalam beberapa hari ini biasanya menyebabkan infeksi saluran telinga yang parah. Jika ini terjadi, kapas harus diidentifikasi dan dikeluarkan oleh dokter yang berkualifikasi. Jangan pernah mencoba melakukan ini sendiri; Anda bisa merobek gendang telinga Anda.
Penanganan Infeksi Serangga
Occasionally, people who sleep outdoors or who live in warm areas can get insects in their ears. An insect in the ear can be an alarming experience. For removal, you’ll need a cool head, especially if the insect is still moving or stinging.
Di lapangan, Anda dapat menggunakan alkohol gosok, yang dengan cepat menenggelamkan serangga dan membersihkan saluran telinga. Juga diperbolehkan menggunakan spuit bola yang diisi dengan air sabun hangat (seperti sampo bayi) dan larutan hidrogen-peroksida. Jika ini tidak berhasil, dapatkan bantuan medis segera. Metode yang disukai adalah pengangkatan oleh dokter yang berkualifikasi dengan instrumen khusus dan mikroskop.
Cara yang Benar
So, how should you clean your ears? When you bathe, occasionally wash your ears with a bulb syringe filled with warm soapy water and hydrogen-peroxide solution. On a diving trip, use a mixture of half white vinegar and half rubbing alcohol after a day’s diving; this serves to cleanse and dry the ear canal as well as change the pH balance to make the area less prone to bacterial infection. This can also help prevent swimmer’s ear (otitis externa).
If you have a hard time getting water out of your ears, try using a hair dryer. It’s a good idea to lift the ear upward and back to straighten the ear canal and then to blow warm dry air into the ear canal for five minutes. Take special care to ensure the air is not too hot.
Ingatlah bahwa perawatan telinga memiliki dasar dan kepentingan yang sama dengan perawatan peralatan menyelam Anda yang lain.
Sumbat Telinga
Penyumbat telinga adalah perangkat yang menyumbat saluran telinga luar. Mereka terutama digunakan untuk memblokir tekanan air pada gendang telinga. Umumnya, penyumbat telinga tidak boleh digunakan oleh penyelam.
Prosedur dalam Praktek
Penyumbat telinga padat standar menciptakan ruang udara yang tidak dapat diseimbangkan saat menyelam, membuatnya umumnya tidak aman untuk menyelam; namun, beberapa penyelam menggunakan penyumbat telinga dalam situasi khusus.
Perhatian utama adalah bahwa tekanan air dapat mengganjal sumbat ke dalam saluran telinga. Jika ini terjadi, ada risiko barotrauma telinga luar. Untuk mengatasi masalah ini, beberapa produsen mempromosikan penyumbat telinga berventilasi, yang memiliki lubang kecil untuk ventilasi antara air dan saluran telinga. Lubang biasanya memiliki katup untuk tekanan tanpa membiarkan air masuk ke saluran telinga.
Sebagian besar produsen penyumbat berventilasi menekankan kemudahan ekualisasi produk mereka dan merekomendasikan agar penyelam sering membersihkan telinga mereka saat mengenakan penyumbat telinga untuk mempertahankan tekanan yang tepat. Namun, pernyataan ini belum diuji secara independen. Tidak ada cukup data atau bukti untuk merekomendasikan penggunaan penyumbat untuk penyelam. Risiko komplikasi di bawah air akibat malfungsi atau pelepasan penyumbat telinga adalah nyata dan berpotensi menempatkan penyelam pada peningkatan risiko cedera.
Tetes Telinga
Obat tetes telinga adalah larutan obat yang ditujukan untuk aplikasi di saluran telinga luar.
Penggunaan Tetes Telinga untuk Profilaksis
For most divers, eardrops are not necessary after diving. The purpose of most eardrops is to prevent external ear canal infections (known as otitis externa or swimmer’s ear). Infections of the ear canal are associated with persistent moisture as well as local skin trauma, which can result from inserting cotton swabs or other objects into the ears that can damage the thin skin lining the ear canal. As DAN medical information specialists are fond of saying, “Don’t put anything smaller than your elbow in your ear.” Persistent moisture and local skin trauma can enable bacterial overgrowth and infection.
Obat tetes telinga diformulasikan untuk membantu mengeringkan telinga setelah terpapar dan menurunkan keasaman (pH), membuat saluran telinga luar menjadi lingkungan yang tidak ramah untuk kolonisasi dan infeksi bakteri atau jamur. Bahan umum termasuk asam asetat (bahan aktif dalam cuka), asam borat, aluminium asetat, natrium asetat, alkohol isopropil dan gliserin. Asam mengubah pH, yang menghambat pertumbuhan bakteri; aluminium asetat dan natrium asetat adalah zat, yang mengecilkan jaringan. Isopropil alkohol membantu mengeringkan jaringan, dan gliserin dapat membantu melumasi kulit untuk mencegah pengeringan yang berlebihan.
For divers plagued by swimmer’s ear, gently rinsing the ears with freshwater after each dive may help. Drying the ears with a hair dryer may also be helpful, but take care to ensure the air is not too hot.
Penggunaan Obat Tetes Telinga
Obat tetes telinga dapat diresepkan oleh dokter Anda untuk mengobati infeksi atau peradangan pada saluran telinga luar. Tetes ini mungkin mengandung antibiotik dan/atau steroid.
Catatan: Penting untuk tidak memasukkan obat tetes ke dalam saluran telinga jika diduga gendang telinga pecah. Biasanya gendang telinga berfungsi sebagai penghalang ke ruang telinga tengah. Jika pecah, kontaminasi atau obat-obatan yang berbahaya bagi telinga bagian dalam dapat memperoleh akses.
Kebugaran Untuk Menyelam
Tetes telinga profilaksis digunakan untuk mencegah infeksi saluran eksternal selama penyelaman berulang selama berhari-hari. Jika Anda merasakan sakit telinga, Anda harus berhenti menyelam dan memeriksakan telinga Anda. Penyelam yang didiagnosis dengan infeksi telinga atau cedera telinga tidak boleh menyelam sebelum sepenuhnya sembuh dan diizinkan oleh dokter.
Tabung Ventilasi Telinga
Tabung ventilasi telinga adalah tabung kecil yang dimasukkan melalui pembedahan melalui gendang telinga untuk meningkatkan drainase dan pemerataan tekanan.
Prosedur
Tabung ventilasi kecil dapat dimasukkan melalui pembedahan melalui gendang telinga (membran timpani) untuk membantu menghentikan siklus infeksi telinga tengah yang berulang. Proses infeksi menyebabkan pembengkakan dan peradangan di saluran Eustachius, mencegah drainase yang tepat; tabung ventilasi memungkinkan drainase dari telinga tengah sampai saluran Eustachius menjadi normal. Memasukkan tabung ventilasi melalui sayatan kecil di membran timpani (miringotomi) biasanya memperbaiki situasi ini.
Tabung tidak dimaksudkan sebagai implan permanen dan biasanya lepas dengan sendirinya atau dikeluarkan oleh dokter. Sayatan kecil biasanya sembuh segera setelah tabung diangkat. Dalam kasus yang jarang terjadi, lubang kecil mungkin tetap ada jika tabung dibiarkan dalam waktu yang lama. Situasi ini dapat diuji dan paling baik ditangani oleh dokter Anda. Tidak mungkin bahwa tabung masih di tempatnya setelah lebih dari beberapa tahun.
Kebugaran Untuk Menyelam
Menyelam tidak dianjurkan saat tabung terpasang karena akan memungkinkan air masuk ke telinga tengah, berisiko vertigo dan infeksi. Setelah tabung ventilasi dilepas atau keluar, waktu yang cukup untuk penyembuhan harus diberikan (setidaknya enam minggu). Fungsi telinga tengah dan tuba Eustachius harus dipastikan normal sebelum menyelam dapat dipertimbangkan.
Masalah yang lebih besar mungkin jaringan parut pada saluran Eustachius sebagai akibat dari infeksi telinga kronis. Hal ini dapat mempersulit penyamaan telinga bagi penyelam. Saat ini, tidak ada prosedur pembedahan yang dapat memperbaiki tuba Eustachius yang tersumbat sebagian.
Anak-anak dan orang dewasa sama-sama membutuhkan perhatian segera untuk gejala infeksi telinga tengah dan barotrauma. Gejala mungkin termasuk tetapi tidak terbatas pada rasa sakit; telinga berdenging atau menderu (tinnitus); sensasi pendengaran parsial, menurun atau teredam; dan drainase dari saluran telinga.
Your ears and ability to equalize may be affected by various diseases. In this section, we have provided information about two conditions divers often ask about: Meniere’s disease and deviated nasal septum. If you have questions about specific conditions that are not highlighted in this book, do not hesitate to contact the DAN Medical Information Line at +1 (919) 684-2948.
Meniere’s disease is a disorder involving recurring episodes of vertigo, which may be associated with vomiting, fluctuating hearing loss, ringing in the ears (tinnitus) and a sensation of increased pressure in the ear.
This chronic condition affects the inner ear. It results in vertigo and hearing dysfunction. A disabling episode of vertigo may involve severe nausea and vomiting. In addition, Meniere’s disease can muffle or impair hearing. Individuals may also experience a sensation of increased pressure in the ear. Migraine headaches have also been linked to this condition.
Penanganan
Treatment focuses on symptom management. Medications are used to control the vertigo and associated nausea and vomiting. Diuretics are sometimes used to help regulate the excess volume of endolymph (fluid contained in the inner ear) that is associated with Meniere’s disease.
Konsultasi dengan dokter THT direkomendasikan karena prosedur bedah dapat membantu mencapai penyembuhan. Untuk referensi di daerah Anda, email , atau hubungi Saluran Informasi Medis DAN di +1 (919) 684-2948.
Kebugaran Untuk Menyelam
Kondisi ini bervariasi. Ini mungkin secara spontan menghilang atau berkembang untuk melibatkan telinga yang lain. Jika Anda berisiko mengalami gejala melumpuhkan seperti vertigo, disorientasi, mual atau muntah, sebaiknya jangan menyelam; jika gejala-gejala ini terjadi di bawah air, mereka dapat menyebabkan kepanikan, tersedak, dan bahkan tenggelam. Selain itu, gejala-gejala ini mungkin dikacaukan dengan cedera terkait penyelaman seperti barotrauma telinga bagian dalam atau penyakit dekompresi telinga bagian dalam.
Septum Menyimpang (Deviated Septum)
Penyimpangan dinding yang memisahkan kedua lubang hidung yang dapat menyebabkan penyumbatan saluran hidung dan sinus adalah septum yang menyimpang.
Septum hidung adalah dinding yang memisahkan kedua lubang hidung. Ketika septum dipindahkan atau melengkung, itu dikenal sebagai septum menyimpang. Umumnya kondisi ini tidak banyak atau tidak ada konsekuensinya dan mungkin tidak diperhatikan; individu yang terkena mungkin mengalami kesulitan menyamakan tekanan. Septum yang menyimpang mungkin ada saat lahir (gangguan bawaan) atau akibat trauma pada hidung. Hal ini sering ditemukan selama pemeriksaan fisik rutin. Kondisi ini telah dikaitkan dengan sinusitis serta barotrauma (sinus dan telinga tengah).
Perawatan
Dekongestan dapat memberikan sedikit kelegaan. Koreksi bedah (septoplasti) biasanya diperuntukkan bagi mereka yang memiliki gejala seperti mendengkur, sumbatan hidung, sinusitis berulang, atau sleep apnea.
Kebugaran Untuk Menyelam
Tidak ada kontraindikasi untuk menyelam dengan septum menyimpang tanpa gejala. Jika terjadi infeksi berulang atau kesulitan menyamakan tekanan, konsultasi THT disarankan. Untuk referensi di daerah Anda, email , atau hubungi Saluran Informasi Medis DAN di +1 (919) 684-2948.
Penyakit Dekompresi
Penyakit dekompresi (DCS) adalah hasil yang tidak diinginkan dari menyelam. Tindakan untuk mengurangi risiko DCS harus menjadi bagian dari setiap penyelaman. Buklet ini memberikan konsep terbaru tentang penyebab dan mekanisme, manifestasi khas, manajemen standar dan pencegahan DCS.
Chapter 5 – Factors Contributing to Decompression Sickness Beban kerja Stres Termal Praktik Optimal Perjalanan Udara Setelah Menyelam Kebugaran Medis dan Fisik Keadaan Hidrasi Campuran Gas Pernapasan Tingkat Karbon Dioksida Patent Foramen Ovale Faktor-Faktor Tambahan
Managing Editor: Petar Denoble, MD, DSc Author: Neal Pollock, PhD
Bab 1: Pengantar Penyakit Dekompresi
“One of the hazards associated with underwater diving is decompression sickness (DCS), caused by uncontrolled release of gas from tissues during or after surfacing.”
Diving is a popular recreational pastime as well as an activity with numerous practical applications in the scientific, commercial, military and exploration realms. While diving can be done safely, it is essential for all divers — no matter what their reason for diving — to appreciate that the underwater environment is unforgiving. Problems may arise during a dive due to insufficient medical or physical fitness, improper use of equipment or inadequate management of the high-pressure environment.
One of the hazards associated with the pressurized underwater setting is decompression sickness (DCS), a condition also known as “the bends.” This chapter explains the basics of DCS, while subsequent chapters provide details regarding its manifestation and management, risk factors that may predispose you to the condition and preventive steps that you can take to minimize your chance of developing it.
When a diver is exposed to an environment of elevated pressure, inert gases (nitrogen, for example) accumulate in tissues. The deeper a dive is, the faster the body’s absorption, or “uptake,” of such gases. When the diver ascends, the drive is reversed, and gas leaves tissues. A diver’s ascent must be controlled to allow for an orderly elimination, or “washout,” of the accumulated gas. A slow ascent, conducted either continuously or in stages, usually allows for safe decompression, whereas a too rapid ascent following gas accumulation can sometimes result in DCS.
Tekanan udara meningkat perlahan dari nol pada batas ruang menjadi satu atmosfer (14,7 psi) di permukaan laut; tekanan air meningkat jauh lebih dramatis, menambahkan satu atmosfer tekanan untuk setiap 33 kaki air laut.
The concentration, or “tension,” of dissolved inert gas within your body’s tissues is a function of ambient pressure — that is, the pressure of the environment surrounding you at any given time. The inert gases that are not used in your body’s metabolic reactions normally exist in equilibrium with your ambient environment — in the same concentration as in the air around you. Tissues under such conditions are described as “saturated.” Minor pressure changes, such as those created by shifting weather conditions, produce minor pressure variations in atmospheric gases that are then matched by pressure changes in the gases in the body’s tissues. When a pressure difference, or “gradient,” is created, molecules from the area of higher concentration flow toward the area of lower concentration until balance is re-established. Since all of us constantly experience minor changes and corrections of this nature, the gas tension in our bodies is in a state of dynamic, rather than static, equilibrium — even before diving is added to the equation.
Tekanan
The diving environment puts a significant additional burden on this adaptive mechanism. Here’s why: Pressure is measured using a unit known as an “atmosphere.” There is no actual physical boundary between the Earth’s atmosphere and space, but the atmosphere is often considered to extend 62 miles (100 kilometers) from sea level to the edge of outer space. The pressure produced by this entire column of gas acting at sea level is one atmosphere, equal to 14.7 pounds per square inch (psi) or 101.3 kilopascals (kPa). By comparison, the change in pressure underwater increases by one atmosphere for every 33 feet of saltwater and every 34 feet of freshwater. As a result, any variation you experience in surface atmospheric pressure is extremely modest compared with the variation in pressure you can undergo when you travel vertically underwater; this can create huge gradients in the uptake of gases during your descent and in their elimination during your ascent.
Pertukaran Gas
Paru-paru Anda berfungsi sebagai penghubung utama antara tubuh Anda dan lingkungan tempat Anda berada pada waktu tertentu. Ketika Anda mengekspos diri Anda pada peningkatan tekanan di bawah air, gas di paru-paru Anda dikompresi. Ini menciptakan gradien dari paru-paru Anda ke aliran darah Anda dan, selanjutnya, dari aliran darah Anda ke jaringan Anda saat mereka diperfusi, atau disuplai, dengan darah beroksigen. Jaringan Anda akan mengambil gas inert sampai gradien dihilangkan, keadaan keseimbangan yang efektif, atau saturasi, dengan tekanan lingkungan sekitarnya. Dibutuhkan eksposur yang lama untuk mencapai saturasi penuh, tetapi begitu tercapai, tinggal lebih lama tidak lebih meningkatkan penyerapan gas atau dekompresi yang diperlukan.
Memprediksi Penyerapan dan Eliminasi Gas
Kompartemen Jaringan
This natural physiological mechanism can be predicted by a series of mathematical algorithms based on “half-time compartments,” which approximate the exponential uptake and elimination patterns expected in various types of perfused tissues. The key to these algorithms is that different parts of the body take up and eliminate inert gases at differing rates — for example, blood is considered a “fast compartment” and bone a “slow compartment.” (The term “compartment” is not meant as an exact referent for these tissues but, rather, as a mathematical construct to estimate what happens in various parts of the body.)
Jaringan tercepat adalah paru-paru, yang mencapai keseimbangan hampir seketika. Darah mengikuti dengan kecepatan, lalu otak. Jaringan yang paling lambat adalah jaringan yang perfusinya relatif buruk, seperti ligamen dan tulang rawan, atau yang memiliki kapasitas tinggi untuk penyerapan gas inert, seperti lemak di daerah yang perfusinya buruk. Alasan penggunaan algoritme matematika untuk memperkirakan status jaringan adalah karena saat ini belum praktis untuk mengukur serapan atau eliminasi secara langsung dalam jaringan tertentu.
Untuk jaringan teoretis dengan waktu paruh 10 menit, 50 persen perbedaannya dihilangkan dalam 10 menit pertama, lalu 25 persen dalam 10 menit berikutnya (setengah dari sisa 50 persen), lalu 12,5 persen dalam 10 menit berikutnya. , dan seterusnya.
An example may demonstrate how the algorithms work. Let us imagine a diver who has been instantly displaced from the surface to a fixed depth — effectively, a fixed pressure — and let us say that in this particular dive scenario, a fast compartment has a half-time of five minutes. In such a case, the first five minutes of exposure to the higher pressure would result in sufficient inert gas uptake to eliminate half of the difference produced by the pressure gradient (50 percent, in other words); this is the steepest portion of the uptake curve. The second five-minute period would eliminate half of the remaining difference (another 25 percent). The third five-minute period would eliminate half of the remaining difference (12.5 percent); the fourth, 6.25 percent; the fifth, 3.125 percent; and so on. This exponential pattern means that the rate of change becomes progressively slower as the magnitude of the difference decreases. The example described a fast compartment; half-times for slow compartments have been computed in some algorithms out to almost 500 minutes. In decompression theory, the absolute difference in pressure is immaterial — the same half-time construct applies to any gradient. With no additional influences on the process, equilibration, or saturation, would be achieved in a period equal to about six half-times. As gas dissolves in the tissue, the difference between the external pressure and internal pressure decreases, reducing the driving force.
Most dives do not last long enough for the diver to reach saturation — these are known as “bounce dives.” During such exposures, the inflow gradient exists throughout the descent and bottom phase of the dive, which causes continued uptake of inert gases, certainly in the body’s slow compartments and probably in intermediate compartments. When the diver starts to ascend, and the ambient pressure starts to drop, the gradient begins to reverse — first in fast compartments and then in progressively slower compartments.
Derajat Kejenuhan
Effectively, during and after surfacing, most of a diver’s tissues will be supersaturated in comparison with the ambient pressure. If the degree of supersaturation is modest, inert gases can travel in an orderly manner from the body’s peripheral tissues into the blood and then to the lungs, from where they can be exhaled to the atmosphere. But if the degree of supersaturation is too great, the elimination of inert gases becomes disorderly. In this case, gas bubbles can form in the tissues of the diver’s body.
Pembentukan gelembung tidak selalu menimbulkan masalah, tetapi semakin tinggi gradien, atau derajat lewat jenuh, semakin besar kemungkinan tanda dan gejala DCS dapat terjadi.
It is a dangerous misconception that measurable bubbles form after all dives and are of no importance. But at the same time, it is a misconception that bubbles visualized in the blood stream in and of themselves signal DCS. The formation of gas bubbles during decompression represents a stress greater than is optimal and may lead to DCS. It is best to follow conservative dive profiles to minimize the likelihood of bubble formation. The greatest difficulty is in knowing what counts as “conservative,” since most divers have never been monitored for bubbles, and uptake and elimination is altered by a number of factors in addition to the pressure-time profile.
The half-time compartment calculations are used to generate exposure-limit predictions for a range of hypothetical compartments. In paper or plastic form these are known as “dive tables.” Modern dive computers allow for much more flexible guidance since they are able to continuously monitor the pressure-time profile and simultaneously compute the status of a variety of theoretical tissue compartments. But in reality, the picture is much more complex. Gas exchange is influenced by more than just the pressure-time profile. So while it is important for divers to understand the concepts behind calculating half-time compartments, divers must also keep in mind that a wide range of factors can influence gas uptake and elimination and effectively alter decompression risk. Thus the onus is on the diver not to rely too heavily on a table or device for safety.
Bab 2 – Menggunakan Komputer Selam Anda Secara Efektif
“Divers are surprised when symptoms of DCS develop after dives that appeared safe according to their dive computers. Remember, models reflect an average diver, not you.”
In recent years, dive computers have supplanted dive tables as the primary means of regulating dive profiles. Dive computers offer an advantage in that they enable the diver to dynamically establish different compartments as the controlling compartment, as conditions change during a dive. In reality, the compartments in a dive computer’s modeling software do not have to represent any particular tissue, as long as the guidance provided by the model results in an acceptable outcome — specifically, very little DCS.
While the guidance provided by decompression models can be very useful, it is important for divers to keep in mind that dive schedules — whether they are presented in printed tables or on the screen of a dive computer — are limited in what they measure and in the assumptions upon which the model was constructed. Tissue compartment parameters can be adjusted, or new compartments can be added to an algorithm, if experience shows deficiencies in a given model — but in real time, the calculations are limited by the variables that are being processed. Algorithms can estimate limits based on time and pressure (depth) profiles for a given breathing gas, but they are not able to compute the impact of myriad real-time factors, including thermal status, exercise intensity, joint forces and a host of individual predispositions that are currently not well understood, let alone quantifiable in their impact on decompression stress.
Divers are often surprised when symptoms of DCS develop after dives that were conducted within the limits of their dive computers. It is important to remember, though, that while mathematical models predict outcomes, they do not guarantee them. The fact that a dive was conducted within the limits suggested by a dive computer (or a dive table) does not make a DCS hit “undeserved.” The mathematical algorithms provide guidance that must be evaluated and tempered by a thoughtful diver.
Banyak penyelam juga tidak menyadari fakta bahwa komputer selam menggunakan banyak model matematika yang berbeda, atau versi model yang berbeda; tidak ada standar universal. Sebuah pabrikan tunggal bahkan dapat menggunakan lebih dari satu model, mungkin dalam satu jenis komputer. Ini membuatnya sangat sulit untuk menilai nuansa lengkap setiap sistem.
Pedoman Dasar
There are some basic guidelines that can help to ensure the safe and effective use of a dive computer. The following considerations are intended to offer a somewhat light-hearted insight into what your dive computer can — and cannot — do.
Akan sangat membantu untuk memikirkan komputer selam Anda dengan cara berikut:
Sebagai pesaing bisnis: Kuasai dengan mempelajari kekuatan dan kelemahannya.
Sebagai kencan: Harus dihidupkan agar hubungan dapat berjalan.
Sebagai buddy: Harus ikut turun dan naik kapan saja Anda melakukannya.
Sebagai asisten pribadi: Mengingatkan Anda tentang aturan dan jadwal yang mungkin Anda lupakan.
Sebagai seorang aktor: Melafalkan baris-baris kalimat tanpa harus memahami implikasinya.
Sebagai politisi: Jangan percaya semua yang dikatakannya.
As a hotel concierge: It will help you do what you want — but at a price.
Sebagai orang asing: Ia hampir tidak tahu apa-apa tentang realitas pribadi Anda.
Sebagai pasangan: Apakah cocok dengan teman-teman Anda?
Sebagai reporter berita: Ia akan menyiarkan tentang cucian kotor Anda.
Sebagai alat: Gunakan secara tepat.
Tip dan Trik Spesifik
Tekan Tombol yang Tepat
Anda harus tahu tidak hanya tombol mana yang harus ditekan agar komputer Anda bekerja, tetapi juga model matematika atau turunan model mana yang digunakannya dalam membuat perhitungan dekompresi. Ada rentang model yang mengejutkan, dari konservatif hingga liberal, dan perbedaan ini mungkin tidak terlihat pada pandangan pertama. Misalnya, komputer dapat menetapkan batas konservatif untuk penyelaman awal tetapi batas liberal untuk penyelaman berulang. Yang terbaik adalah mempelajari cukup banyak tentang berbagai model dan turunan yang tersedia sebelum Anda memilih komputer selam, jadi Anda pasti memilih salah satu yang kompatibel dengan tingkat toleransi risiko Anda sendiri. Memilih satu murni berdasarkan keakraban mungkin bukan strategi terbaik. Bahkan jika Anda memiliki hasil yang baik pada penyelaman sebelumnya dengan komputer, itu tidak menjamin bahwa itu akan menjadi yang terbaik untuk penyelaman masa depan Anda. Mengumpulkan pengetahuan membutuhkan komitmen, tetapi perencanaan yang matang untuk keselamatan dekompresi harus menjadi perhatian utama.
Setel dan Nyalakan
Failing to turn on your dive computer (or to take it with you on a dive) may sound like a joke, but it does happen and can create real problems. No computer can factor in the exposure profile of a previous dive if it was not there. And any decompression model is invalid unless you start using it when you are “clean” — fully off-gassed from any previous dives. If you forget to take your computer with you on a dive early in a repetitive series, you are then restricted to using tables for the duration of that series (assuming that you are able to manually compute the exposure of the unmonitored dive). And do not even think about hanging your computer on a downline during a surface interval in an effort to compensate for having forgotten it on an earlier dive; there may be stories about that happening, but it is not a responsible practice.
Gunakan Secara Tepat
The only person who does not have to worry about taking a dive computer on every dive is the one who uses it solely as a datalogger — that is, only to record time and depth information instead of to calculate decompression profiles. Remember, however, that using your computer simply to log your time and depth data means that you must still plan all your dives using dive tables and must recompute your repetitive group status afterward, as appropriate. You cannot move in and out of relying on your computer’s decompression computations unless it has recorded all of your exposure profiles.
Ingat Keterbatasannya
Dive computers are wonderful at carrying out programmed mathematical computations, but they are blind to the many insights you may have before, during and between your dives. For example, your dive computer knows nothing about your personal health status, your level of physical fitness or your individual susceptibility to decompression stress. It also knows nothing about your thermal stress or physical efforts during or between dives. The fact that many dive computers display water temperature might suggest that thermal stress is factored into the device’s algorithms. A water temperature reading, however, provides no useful information regarding thermal stress, since the diver carrying the device could be wearing anything from a bathing suit to a wetsuit without a hood to a cold-water drysuit with a hood, gloves and cold-water undergarments. More important, it is not yet possible to directly compute the impact of differences in thermal status during different parts of a dive, even if the computer was able to measure the diver’s core temperature and skin temperature in key spots.
We do know that being warm (rather than cool or cold) during the compression and bottom phase of a dive promotes inert gas uptake (not optimal), and that being warm during the decompression phase promotes elimination (optimal). While impractical for the comfort-loving diver, decompression safety is optimized by being neutral or cool during the inert gas uptake phase of descent and bottom time and warm during the inert gas elimination phase of ascent. While the concept of thermal changes on decompression stress is clear, we are still years away from being able to quantify the real-world effects of these factors for dive-planning purposes. Similarly, while some computers are able to track gas consumption, we have much to learn before this information can be meaningfully incorporated into decompression models. Variations in air consumption can reflect differences in the depth of a dive or in the diver’s experience, level of anxiety or degree of physical exertion. The bottom line is that interpreting the precise physiological impact of the interactions among these diverse factors is exceedingly difficult, requiring thoughtful practice by divers.
Heed Your Computer’s Readings
Divers need to pay attention to their dive computers if the information provided is to be of any use. Be aware that confirmation bias can promote risky behavior. “Getting away with” a risky exposure once, twice or even many times may eventually catch up with you. It may not truly be safe for you or for a partner who might have a higher degree of susceptibility to decompression stress. Those who wish to worry less about their exposure will have greater peace of mind if they choose a computer that employs an extremely conservative decompression model. It is also important to pay attention to your dive computer. If you are diving with a group, do not forget that there can be considerable variability in the guidance provided by different computers or computers with different user-selected settings. That means there is considerable benefit in diving with others who use a computer with a similar decompression model and settings, because if modest discrepancies arise, following the most conservative directive will likely not be terribly burdensome for the group. But if members of a group are using dive computers with substantially different models, and each diver wishes to follow his or her own device, it can lead to a breakdown in the buddy system.
Jangan Mengandalkan Komputer Anda Secara Buta
Although heeding your computer is important, do not take its advice unthinkingly. The same profile can sometimes be conducted without problem again and again, right up to the dive where it does not prove safe. Divers often try to blame a specific factor, such as dehydration, for the development of symptoms following one dive but not another. This approach is not productive. The range of variables in play during a dive are rarely identical, and there is a probabilistic element to decompression risk — that is, chance can play a role in the manifestation of DCS.
Pendekatan terbaik adalah menghindari ekstrem baik pengunduran diri fatalistik atau fokus sombong pada satu peluru ajaib yang diduga. Ada banyak, banyak langkah kecil yang dapat Anda ambil untuk membuat penyelaman apa pun lebih aman. Yang paling penting adalah untuk tetap berada dalam profil kedalaman waktu yang cukup konservatif dan menambahkan perhentian keselamatan untuk setiap penyelaman. Langkah penting lainnya adalah meminimalkan intensitas latihan Anda dan menghindari kepanasan selama fase penyerapan gas saat menyelam, memilih gas pernapasan yang tepat, berlatih cukup sehingga Anda dapat mengontrol daya apung dengan sempurna, tetap cukup istirahat dan terhidrasi, pilih pengaturan yang lebih konservatif yang dapat disesuaikan pengguna di komputer, dan menyelam dengan pasangan yang memiliki tujuan serupa dan mengikuti praktik serupa. Menambahkan margin keamanan kecil ke setiap langkah dapat membantu memberikan bantalan keamanan yang nyaman. Komputer selam adalah alat yang ampuh, tetapi pengetahuan yang baik tentang fisiologi menyelam, pengkondisian fisik yang baik, dan kepatuhan terhadap praktik yang bijaksana menawarkan perlindungan terbaik bagi penyelam.
Bawa Bersama Anda
Jika Anda mengembangkan gejala DCS, Anda harus membawa komputer Anda saat Anda pergi untuk evaluasi medis. Beberapa fasilitas mungkin memiliki kemampuan untuk mengunduh atau meninjau profil Anda untuk membantu dalam evaluasi kasus Anda. Staf medis pasti akan senang melihat konfirmasi deskripsi Anda tentang peristiwa yang memicu gejala Anda.
“While DCS is commonly thought of as a bubble disease, bubbles are probably only the gateway to a complex array of consequences and effects.”
DCS may develop when a diver’s degree of supersaturation is so high (or, stated another way, if the elimination gradient is so steep) that a controlled transfer of inert gases from the body’s tissues to the bloodstream — and then from the bloodstream to the lungs and the lungs to the environment — is not possible. If that removal process is inadequate, inert gases will come out of solution and form bubbles that can distort tissues, obstruct blood flow, cause mechanical damage (to the joints, for example) and/or trigger a cascade of biochemical responses.
Meskipun banyak yang diketahui tentang DCS, mekanisme pembentukannya masih diselidiki. Dan sementara DCS umumnya dianggap sebagai penyakit gelembung, gelembung itu sendiri mungkin hanya pintu gerbang ke serangkaian konsekuensi dan efek yang kompleks.
Bintik-bintik kulit seperti ini adalah karakteristik dari cutis marmorata, suatu kondisi yang dapat memperingatkan kemungkinan perkembangan gejala Tipe 2 yang lebih serius.
Tanda dan Gejala DCS
The collective insult to the body’s systems can produce symptomatic DCS. The condition’s primary effects may be evident in the tissues that are directly insulted. Its secondary effects can compromise the function of a broad range of tissues, further jeopardizing the diver’s health.
The ability to recognize the signs, or objective evidence, and the symptoms, or subjective perceptions, of DCS — and to differentiate them from signs and symptoms less likely to be associated with DCS — is important. A variety of classification systems have been established for DCS. One common approach is to describe cases as Type 1 or Type 2.
DCS Tipe 1
Type 1 DCS is usually characterized by musculoskeletal pain and mild cutaneous, or skin, symptoms. Common Type 1 skin manifestations include itching and mild rashes (as distinct from a clear mottled or marbled and sometimes raised discoloration of the skin — a condition that is known as cutis marmorata that may presage the development of the more serious symptoms of Type 2 DCS). Less common but still associated with Type 1 DCS is obstruction of the lymphatic system, which can result in swelling and localized pain in the tissues surrounding the lymph nodes — such as in the armpits, groin or behind the ears.
Kolase menunjukkan rasa sakit di beberapa bagian tubuh
Gejala DCS Tipe 1 dapat meningkat intensitasnya. Misalnya, rasa sakit mungkin berasal dari rasa sakit ringan di sekitar sendi atau otot dan kemudian bertambah besar. Namun, rasa sakit yang terkait dengan DCS biasanya tidak meningkat pada pergerakan sendi yang terkena, meskipun memegang anggota badan dalam satu posisi daripada yang lain dapat mengurangi ketidaknyamanan. Rasa sakit seperti itu pada akhirnya bisa sangat parah.
DCS Tipe 2
Tes Romberg mengevaluasi kontrol postural. Romberg yang diasah, yang mencakup menyilangkan lengan dan meletakkan satu kaki di depan yang lain, lebih sensitif terhadap perubahan keseimbangan statis.
Type 2 symptoms are considered more serious. They typically fall into three categories: neurological, inner ear and cardiopulmonary. Neurological symptoms may include numbness; paresthesia, or an altered sensation, such as tingling; muscle weakness; an impaired gait, or difficulty walking; problems with physical coordination or bladder control; paralysis; or a change in mental status, such as confusion or lack of alertness. Inner-ear symptoms may include ringing in the ears, known as “tinnitus”; hearing loss; vertigo or dizziness; nausea; vomiting; and impaired balance. Cardiopulmonary symptoms, known commonly as “the chokes,” include a dry cough; chest pain behind the sternum, or breastbone; and breathing difficulty, also known as “dyspnea.” The respiratory complaints, which are typically due to high bubble loads in the lungs, can compromise the lungs’ ability to function — threatening the affected diver’s health, and even life, if treatment is not sought promptly.
Type 2 symptoms can develop either quickly or slowly. A slow build can actually obscure the seriousness of the situation, by allowing denial to persist. For example, fatigue and weakness are common enough concerns, especially if their onset is protracted, that they can be very easy to ignore. Less common symptoms, such as difficulty walking, urinating, hearing or seeing — especially if their onset is quick — can sometimes prompt faster recognition of the existence of a problem. It is fair to say that divers can initially be reluctant to report symptoms, though they usually will do so if their symptoms do not go away. This is a shortcoming divers should be aware of, lest they fall prey to it.
Presentasi DCS
The presentation of DCS is frequently idiosyncratic — that is, its “typical” pattern can be atypicality. In some cases, an affected diver’s chief complaint may draw attention away from more subtle but potentially more important symptoms. The following list ranks the initial manifestations of DCS, from those most commonly to least commonly reported (Vann et al. 2011):
Nyeri, terutama di sekitar persendian
Mati rasa atau parestesia
Constitutional concerns — such as headache, lightheadedness, unexplained fatigue, malaise, nausea and/or vomiting, or anorexia
Pusing atau vertigo
Kelemahan motorik
Cutaneous, or skin, problems — such as an itch, rash, or mottling (“cutis marmorata”)
Ketidaknyamanan otot
Gangguan status mental
Pulmonary problems — such as breathing difficulties (“the chokes”)
Koordinasi terganggu
Penurunan tingkat kesadaran
Auditory symptoms — such as hearing sounds that are not there or having a hard time hearing
Lymphatic concerns — such as regional swelling
Bladder or bowel dysfunction — such as retention of urine
Fungsi kardiovaskular terganggu
Menurut tinjauan baru-baru ini, nyeri dan mati rasa, juga dikenal sebagai parestesia, dilaporkan awalnya pada hampir dua pertiga kasus DCS, gejala konstitusional pada sekitar 40 persen kasus, pusing/vertigo dan kelemahan motorik pada sekitar 20 persen, dan gejala gangguan kulit pada sekitar 10 persen (Vann et al. 2011).
Diagnosis Diferensial DCS
DCS adalah cedera menyelam profil tinggi karena potensi keparahannya. Tetapi penyelam perlu mengingat bahwa tidak semua masalah yang berhubungan dengan penyelaman berubah menjadi DCS. Ketika dua atau lebih kondisi memiliki gejala yang tumpang tindih, seperti halnya dengan banyak cedera terkait penyelaman, diagnosis banding adalah proses di mana tenaga medis mencari tahu kondisi potensial mana yang paling mungkin bertanggung jawab atas gejala tersebut.
The term decompression illness (DCI) was coined to encompass both DCS and the related condition known as arterial gas embolism (AGE), the latter arising from barotrauma of the lungs that introduces gas into the systemic bloodstream. Some of the other conditions and circumstances that involve similar symptoms include inner-ear barotrauma; middle-ear or maxillary sinus overinflation; contaminated breathing gas; oxygen toxicity; musculoskeletal strains or trauma sustained before, during or after a dive; marine life envenomation; immersion pulmonary edema; water aspiration; and coincidental neurological disorders, such as stroke (Vann et al. 2011). Thermal stress — sometimes due to excessive heat, but usually due to cold exposure — can also be responsible for similar symptoms. In some cases, a careful medical history can easily rule out one diagnosis or another. For example, symptoms of immersion pulmonary edema often develop at depth. In such a case, a good history would rule out DCS, which only develops after significant decompression stress during ascent.
Sangat penting bagi penyelam dengan gejala-gejala ini untuk mencari evaluasi dan dukungan medis. Sementara responden pertama mampu melakukan analisis awal dari individu yang terluka, seperti memberikan penilaian neurologis lapangan, kemampuan non-dokter tidak mendekati keterampilan klinis dan wawasan yang dimiliki oleh spesialis klinis berpengalaman.
“If signs or symptoms consistent with DCS develop, initiate appropriate first aid and contact the nearest emergency medical services. For additional emergency assistance contact DAN +1-919-684-9111.”
Ada beberapa elemen untuk manajemen DCS yang efektif, khususnya evaluasi di tempat dan pertolongan pertama, transportasi dan evaluasi dan pengobatan medis definitif. Siapa pun yang menderita DCS harus mencari evaluasi yang tepat, dan kemungkinan perawatan berkelanjutan, dari dokter yang mengetahui dengan baik tentang masalah medis terkait penyelaman.
Dasar dari pertolongan pertama adalah bantuan hidup dasar. Tindakan pertolongan pertama utama untuk DCS adalah pengiriman oksigen tambahan dalam konsentrasi tertinggi, atau fraksi, yang praktis (Longphre et al. 2007). Fraksi oksigen yang tinggi, jika diberikan dengan cepat dan dalam jangka waktu yang lama, dapat mengurangi atau bahkan menghilangkan gejala DCS, meskipun seringkali hanya sementara jika pengobatan definitif tidak dijamin. Sistem oksigen aliran kontinu, menggunakan masker non-rebreather atau masker saku, sering tersedia di lingkungan menyelam; namun, peralatan tersebut memberikan fraksi oksigen sedang. Fraksi yang jauh lebih tinggi dapat dicapai dengan demand mask, meskipun hanya sesuai untuk individu yang sadar yang dapat bernapas sendiri.
Berbagai masker yang berbeda dapat digunakan dengan sistem oksigen.
Para ahli DAN mengembangkan oksigen rebreather permukaan remote emergency oxygen (REMO2) ini untuk penggunaan pertolongan pertama (Pollock dan Natoli 2007).
Rebreather systems are another on-the-scene option; such systems permit the unused oxygen in the diver’s exhalations to be recycled, or rebreathed. A rebreather apparatus can thus provide high fractions with minimal gas use and may prove especially helpful in settings where the supply of oxygen is limited (Pollock 2004; Pollock and Natoli 2007).
Chemical oxygen generating systems — devices with a long shelf life that deliver oxygen via a chemical reaction — may in some situations be the only option available. However, if emergency medical services are not readily accessible, such devices are unlikely to provide a sufficient oxygen supply (Pollock and Natoli 2010).
Evaluasi Selanjutnya
First aid is just the first step in treating an affected diver. Anyone who has experienced symptoms associated with DCS is advised to seek subsequent medical evaluation. This should occur even if the diver’s symptoms improved or disappeared upon the administration of oxygen, since subtle issues can be missed or symptoms can return once oxygen delivery is stopped. For the same reason, it is advisable to seek input from an experienced dive-medicine specialist — someone aware of all the nuances in the presentation, course and treatment of DCS.
Terapi Oksigen Hiperbarik
Pengobatan definitif untuk DCS adalah terapi oksigen hiperbarik (HBO), atau pemberian oksigen murni pada tekanan yang jauh lebih tinggi daripada tekanan atmosfer. Terapi HBO mengurangi ukuran gelembung apa pun dan meningkatkan gradien yang meningkatkan pengiriman oksigen dan eliminasi gas inert. Terapi HBO biasanya diberikan di ruang rekompresi (chamber).
This is a monoplace hyperbaric chamber — able to hold a single patient, without any inside support personnel, or “tenders.”
A common HBO regimen is the U.S. Navy Treatment Table 6 (USN 2008). According to this regimen, the hyperbaric chamber is initially pressurized to 2.8 atmospheres absolute (ATA), equivalent to the pressure found at 60 feet (18 meters) of seawater. The patient breathes pure oxygen, interspersed with scheduled periods of breathing regular air to reduce the risk of oxygen toxicity. The usual duration of the USN TT6 treatment is just under five hours, but extensions can be added as required, based on the patient’s response.
Ini adalah chamber hiperbarik multiplace dan multilock kecil yang dapat menampung banyak pasien plus tender di dalam. Personil atau peralatan dapat dipindahkan ke dalam atau ke luar chamber saat perawatan sedang berlangsung.
HBO treatment can be conducted in a monoplace chamber, often an acrylic tube sized to hold just one patient, or in a multiplace chamber, sized to accommodate one or more patients plus one or more “tenders” — that is, technicians or other medical personnel. Multilock chambers are designed to allow patients, tenders or equipment to be transferred into and out of the chamber while treatment is ongoing.
The course of HBO therapy will vary according to the particulars of each case; both the presentation of DCS and its response to treatment can be idiosyncratic. A full resolution of DCS symptoms can often be achieved with one or sometimes multiple HBO treatments. In some cases, however, resolution will be incomplete, even after many treatments. The normal clinical approach is to continue the treatments until no further improvement is seen in the patient’s symptoms. Modest residual symptoms will then often resolve slowly, after the treatment series is ended. Full resolution of symptoms can sometimes take months to achieve and in some instances may never be realized.
Ini adalah chamber hiperbarik multiplace dan multilock yang besar, di mana beberapa eksposur tekanan dapat dilakukan secara bersamaan.
Rekompresi Dalam Air
Rekompresi dalam air dapat menjadi alternatif untuk chamber rekompresi di lokasi terpencil, jika tidak ada chamber terdekat atau sarana untuk mengangkut pasien dengan cepat ke chamber di tempat lain. Teknik ini melibatkan membawa penyelam ke bawah air lagi, untuk mendorong gelembung gas kembali ke dalam larutan untuk mengurangi gejala dan kemudian secara perlahan mendekompresi dengan cara yang mempertahankan pembuangan gas berlebih secara teratur.
While in-water recompression is simple in concept, it is practical only with a substantial amount of planning, support, equipment and personnel; appropriate water conditions; and suitable patient status. Critical challenges can arise due to changes in the patient’s consciousness, oxygen toxicity, gas supply, and even thermal stress. An unsuccessful in-water recompression may leave the patient in worse shape than had the attempt not been made. The medical and research communities are divided on the utility of in-water recompression. It is beyond the scope of this publication to consider all of the relevant factors, but it is fair to say that there are probably more situations when in-water recompression should not be undertaken than situations when it would be a reasonable choice.
Sebagai aturan umum, seorang penyelam yang memiliki gejala yang konsisten dengan DCS harus dikeluarkan dari air, dan pertolongan pertama harus diberikan di permukaan, bahkan jika terdapat kemungkinan terjadinya penundaan sebelum sebuah perawatan medis definitif dapat dicari.
Sumber Daya Darurat
The best course of action, if signs or symptoms consistent with DCS (or any other serious injury) develop, is to initiate appropriate first aid and then immediately contact the nearest emergency medical services (EMS). The next step should be to contact DAN to seek advice regarding the proper progression of care. The organization’s emergency hotline number is +1-919-684-9111.
Umumnya tidak tepat untuk datang tanpa pemberitahuan di chamber hiperbarik terdekat. Hal ini bisa berarti melewati fasilitas di mana korban mungkin dapat menerima evaluasi yang lebih menyeluruh dan tepat. Ingatlah bahwa tidak semua cedera yang terkait dengan penyelaman adalah DCS, meskipun tampaknya demikian di saat yang menegangkan. Selain itu, chamber di beberapa fasilitas tidak tersedia untuk merawat penyelam setiap saat. Salah satu tantangan di Amerika Utara adalah menyusutnya jumlah chamber hiperbarik yang menerima korban menyelam, terutama di luar jam kerja normal.
Hal utama yang harus diingat adalah bahwa menjalin kontak dengan layanan medis darurat dan DAN dapat memastikan manajemen kasus yang tepat waktu dan tepat. Jika ragu, telepon.
SAAT ANDA MENGHUBUNGI HOTLINE DARURAT DAN
Beri tahu operator bahwa Anda memiliki keadaan darurat penyelaman. Operator akan mengkonfirmasi nama, lokasi dan nomor telepon Anda, dan menghubungkan Anda secara langsung dengan staf medis DAN atau meminta seseorang menelepon Anda kembali secepat mungkin.
Anggota staf medis dapat membuat rekomendasi segera atau menghubungi Anda kembali setelah membuat perjanjian dengan dokter setempat
Anggota staf medis mungkin meminta Anda untuk menunggu melalui telepon saat pengaturan sedang dibuat. Rencana ini mungkin memakan waktu 30 menit atau lebih, karena koordinasi yang rumit sering kali diperlukan. Jika situasinya mengancam jiwa, atur transportasi yang aman bagi penyelam ke fasilitas medis terdekat untuk stabilisasi dan penilaian segera terlebih dahulu. Kemudian hubungi Hotline Darurat DAN untuk konsultasi dengan penyedia medis setempat.
Bahkan jika gejalanya tidak parah dan sembuh sepenuhnya, seorang penyelam yang telah mengalami beberapa kali serangan DCS harus mengambil pertimbangan khusus. Terutama jika DCS berulang mengikuti profil penyelaman yang aman, spesialis medis selam harus berkonsultasi untuk menentukan apakah penyelaman dapat dilanjutkan dengan aman.
DAN EMERGENCY HOTLINE +1 919-684-9111 (Internasional) - 021-5085-8719 (di Indonesia)
