Aural health awareness and incident prevention in UK scuba divers.

INTRODUCTION: Otological disorders, including Eustachian tube dysfunction (ETD), are commonly observed in divers. Data were gathered to observe the prevalence of ear disorders, and awareness of ear health recommendations for recreational divers in the United Kingdom. METHODS: An anonymous online survey included: diver/diving demographics, the validated Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) (a mean score of ≥ 2.1 indicating the presence of dysfunction), pre-existing ear health conditions, medications, decongestants and knowledge of diving and ear health guidance. RESULTS: A total of 790 divers (64% males) responded (age range 16-80, median 47 years). An ETDQ-7 mean score of ≥ 2.1 was calculated in 315 of 790 respondents (40%), indicating varying degrees of ETD; 56/315 (18%) recorded a pre-existing ear condition. Ear disorders, (external, middle, and inner ear issues) since learning to dive were recorded by 628/790 (79%) of respondents; 291/628 (46%) did not seek medical advice. ETDQ-7 scores of ≥ 2.1 to 6.6 were reported by 293/628 (47%). Six reported inner ear decompression sickness. Decongestants were used by 183/790 (23%). Two hundred and seventy-seven of 790 divers (35%) had aborted a dive with ear problems. Only 214/790 (27%) of respondents were aware of the United Kingdom Diving Medical Committee guidance regarding ear health and diving. CONCLUSIONS: Ear problems and ETD since diving were widely reported in this cohort of divers, with not all divers in this study aware of ear health recommendations and advice.

Flying after diving: a questionnaire-based evaluation of pre-flight diving behaviour in a recreational diving cohort.

INTRODUCTION: Divers are recommended to observe a pre-flight surface interval (PFSI) ≥ 24 hours before boarding a plane following a diving vacation. Decompression sickness (DCS) symptoms may occur during or post-flight. This study aimed to examine the adherence of PFSI ≥ 24 in vacationing divers, and if any perceived signs and symptoms of DCS during or after flight were experienced. METHODS: An anonymous online survey was publicised through diving exhibitions and social media. Data included diver/diving demographics, PFSI before flight, flight details, and perceived signs and symptoms of DCS during or after flight. RESULTS: Data from 316 divers were examined (31% female) with the age range 17-75 years (median 49). Divers recorded 4,356 dives in the week preceding the flight, range 1-36 (median 14). Overall, 251/316 (79%) respondents reported a PFSI of ≥ 24 hours. PFSIs of < 12 hours were reported by 6 respondents. Diagnosed and treated DCS developing during, and post flight was reported by 4 divers with PFSIs ≥ 24 hours and by 2 divers with PFSIs < 24 hours. Fifteen divers boarded a plane with perceived symptoms of DCS. CONCLUSIONS: These data suggest that most divers in this study observed the recommendations of a ≥ 24 hour PFSI with safe outcomes.

Diving and mental health: the potential benefits and risks from a survey of recreational scuba divers.

INTRODUCTION: Scuba diving is physically and cognitively demanding. Medical guidance regarding physical and mental health (MH) issues and related prescribed medication is often based on limited evidence. There is a paucity of data concerning diving with MH issues. This survey aimed to investigate the prevalence of MH issues and use of prescription medications among United Kingdom (UK) sport divers, and the rate of non-compliance with current guidance among divers suffering depression and anxiety. The positive effects of scuba diving on MH were also considered. METHODS: An anonymous online survey was publicised through diving exhibitions and social media. Measures included diver and diving demographics; GAD-7 Anxiety and PHQ-9 depression questionnaires; diagnosed current and/or past MH conditions; medication usage; comorbid medical conditions/treatments; disclosure of past/current MH issues; and perceived MH benefits of diving. RESULTS: Data from 729 respondents revealed MH issues at rates comparable with the general population. Current and/or past MH issues were reported by 111/729, with 60 having active diagnoses, and 45/60 taking prescribed psychotropic medications; 21/45 did not declare their medication on diver self-certification medical forms. The activity of diving was thought to be beneficial to MH by 119/729 respondents. CONCLUSIONS: Divers experienced expected levels of MH issues, but did not comply with current medical guidelines on modifying or abstaining from diving activity or reporting their MH condition. Changes may be needed to diver training to encourage more accurate reporting and aid development of evidence-based protocols. Guidelines could be reconsidered in light of current diver behaviour, risks and potential MH benefits.

Does self-certification reflect the cardiac health of UK sport divers?

BACKGROUND: Since 2009, the United Kingdom diving incident data show an increasing number of fatalities in the over-50s age group. Previous studies also suggest some divers take cardiac medications. Since 2001, diving medicals have not been mandatory for UK sport divers. Instead, an annual medical self-certification form, submitted to their club/school or training establishment, is required. We documented in a survey of UK sport divers the prevalence of cardiac events and medications and the frequency of medical certifications. METHODS: An anonymous on-line questionnaire was publicised. Measures included diver and diving demographics, prescribed medications, diagnosed hypertension, cardiac issues, events and procedures, other health issues, year of last diving medical, diagnosed persistent foramen ovale (PFO), smoking and alcohol habits, exercise and body mass index. RESULTS: Of 672 completed surveys, hypertension was reported by 119 (18%) with 25 of these (21%) having not had a diving medical. Myocardial infarction 6 (1%), coronary artery bypass grafting 3 (< 1%), atrial fibrillation 19 (3%) and angina 12 (2%) were also reported. PFOs were reported by 28 (4%), with 20 of these opting for a closure procedure. From 83 treated incidences of decompression illness (DCI), 19 divers reported that a PFO was diagnosed. CONCLUSIONS: Divers inevitably develop health problems. Some continue to dive with cardiac issues, failing to seek specialised diving advice or fully understand the role of the diving medical. Physicians without appropriate training in diving medicine may inform a diver they are safe to continue diving with their condition without appreciating the potential risks. The current procedure for medical screening for fitness to dive may not be adequate for all divers.

Decompression sickness in women: a possible relationship with the menstrual cycle.

BACKGROUND: Women are increasingly participating in recreational scuba diving and the professional roles of women are expanding in the fields of aviation, space, and diving. Evidence exists that there may be a relationship between altitude decompression sickness (DCS) and the menstrual cycle, although diving studies to support such findings are limited. The aim of the present study was to investigate the presence of any relationship between the development of DCS in female sports divers, the phase of the menstrual cycle, and the use of the oral contraceptive pill (OCP). METHOD: Personal, dive, symptom, and menstrual history details were collected by questionnaire from women treated with hyperbaric therapy for DCS in 23 treatment centers worldwide. RESULTS: There were 150 records suitable for analysis. The phase in the menstrual cycle of the DCS incident was estimated. The DCS incidents were unevenly distributed throughout the cycle (p = 0.001) with the greatest percentage of incidents occurring in the first week of the menstrual cycle. The variation in incidence across the cycle appeared to be greatest for the non-OCP users (p = 0.01), and when age was taken into account there was a significant difference between the OCP and non-OCP users with respect to risk of DCS across the menstrual cycle (p = 0.03). CONCLUSION: These data suggest that the risk of DCS may be dependent on the phase of the menstrual cycle and that the distribution of risk differs between OCP and non-OCP users.

Alcohol and UK recreational divers: consumption and attitudes.

INTRODUCTION: Scuba diving demands information processing, recall, reasoning, decision making and the ability to take control of situations under different scenarios. Anecdotal evidence suggests that some divers consume alcohol to excess around the time of a dive. This study investigates alcohol consumption and attitudes to alcohol in United Kingdom (UK) recreational divers. METHODS: A questionnaire addressing diving demographics, general health, type and frequency of alcohol consumption, and attitudes to drinking alcohol around the time of diving was available for anonymous completion online between September 2010 and January 2011. RESULTS: Records from 818 divers were analysed. Older divers were more likely to exceed the weekly alcohol units recommended by the UK government compared to younger divers (P < 0.001), but binge drinking was associated with younger divers (P = 0.014). Diving when considering themselves unfit to drive a car was reported by 151 (18.5%) respondents and 187 (22.9%) had witnessed a diving incident which they felt was attributable to alcohol. Only 313 (38.3%) respondents reported a responsible attitude to alcohol by their dive clubs both under normal circumstances and whilst on a dive trip. CONCLUSION: Some divers undertook diving activities when potentially over the legal limit to drive a car and demonstrated a possible lack of understanding of the effects of alcohol beyond dehydration. Divers considered club attitudes to drinking and diving to be less responsible when on a diving trip. Some divers took a more responsible attitude to alcohol consumption having witnessed a diving incident which was potentially related to alcohol.