DAN medics and researchers answer your dive medicine questions
I am a 57-year-old male who is planning to undergo a laparoscopic Nissen fundoplication for refractory gastroesophageal reflux disease (GERD) and a hiatal hernia. Is the procedure considered an absolute or relative contraindication to recreational diving? How crucial is the ability to belch after a Nissen fundoplication?
The decision to resume scuba diving following a Nissen fundoplication is intricate and personalized. Hiatal hernias can present a dive risk due to potential air trapping and gastric rupture. Even after surgical repair, there’s a possibility of gas bloat syndrome featuring gastric distention and the inability to belch, which could complicate dive situations.
The surgical team should assess the risks of air trapping and reflux. Discussing your specific case with your surgeon, accounting for the surgical technique, your medical history, and the physical gas laws associated with diving is imperative. Even when cleared by your surgeon, DAN advises caution until you have established your ability to dive safely, particularly in the initial postsurgery phase.
While some individuals successfully return to diving after Nissen fundoplication, some have complications. A safe return to diving should involve consulting your treating physician and considering physical therapy, rehabilitation, and medication requirements. Waiting an additional half of the recovery time your physician recommends before resuming diving allows a sufficient duration for tissue and vasculature recovery.
— Shannon Sunset AEMT, NCPT
I came up from a dive, and now my ears feel full, my hearing is muffled, and I have ear pain. What should I do?
The symptoms you mention typically indicate a middle-ear barotrauma, which usually results from inadequate pressure equilibration between the middle ear and the external ambient pressure. The typical symptoms are a sensation of ear blockage or fullness, some hearing loss, effusion (fluid buildup) in the middle ear, and pain. Other symptoms may include mild tinnitus, vertigo, or dizziness.
Severe vertigo, tinnitus, and pain suggest possible involvement of the inner ear, which can be very serious. Multiple consecutive days of diving may result in mild congestion, leading to impaired Eustachian tube function, which can present a greater risk of middle-ear barotrauma.
If you experience symptoms following a dive, DAN recommends immediately discontinuing diving and seeking an immediate medical evaluation. Attempting to equalize again will likely exacerbate the injury, extend your healing time, or lead to a more serious inner-ear injury. Your physician may prescribe antibiotics or steroids, and they may direct you to use a decongestant and anti-inflammatory medication to help reduce symptoms.
Unfortunately, nothing can get you back in the water right away. Only time can resolve this injury, which can take up to four to six weeks, depending on the injury’s severity. Returning to diving too soon could put you at risk for more severe barotrauma, which can result in permanent hearing loss, vestibular and balance issues, infection, or other complications.
If middle-ear barotrauma was the extent of your injury, returning to diving should not present a problem once a physician has verified that the condition has completely healed. A physician should verify that you have no vestibular dysfunction, fluid in the ears, pain, muffled hearing, and clicks or Rice Krispies sounds in your ear.
— Ryan Gan, NREMT
© Alert Diver – Q1 2025