Addison’s disease
Q: I was recently diagnosed with Addison’s disease. Can I still dive?
A: Each case of Addison’s disease, or primary adrenal insufficiency, is vastly different and requires individual evaluation for medical clearance to dive. It has a variety of causes — including auto-immune diseases, infections, and cancer — and often the cause of Addison’s can be a bar to diving.
Most concerns related to adrenal insufficiency and diving pertain to resulting physical and physiological challenges, such as reduced exercise tolerance or the potential to lose consciousness due to postural hypotension. Symptoms such as low blood pressure and low blood sugar while in the water are problematic — even more so if unexpected dive conditions such as surge or choppy water were to occur.
Other possible symptoms, such as extreme fatigue or muscle and joint pain, can mimic DCS symptoms, making a correct diagnosis challenging. Medications used to treat Addison’s disease may carry additional considerations as well.
DAN recommends that individuals with Addison’s disease refrain from diving until they have been evaluated and cleared to dive by a physician trained in dive medicine or at a minimum your treating physician in consultation with a dive medicine physician. DAN’s medical department can consult with the treating physician about the issues and risks so they can make an appropriate decision regarding your health and diving. If cleared to dive, you should have an emergency action plan and a well-equipped medical kit that includes the required medications to avoid and treat an adrenal crisis.
Valsalva manoeuvre
About six weeks ago, I did the Valsalva manoeuvre to clear my ears after getting off a plane and noticed air coming out the inner corner of my right eye, seemingly from the tear duct. Since then, I can feel a puff of air coming out of that spot whenever I blow my nose. I have no other symptoms, but is this anything to be concerned about when I go diving?
What you describe seems to be air passing through your nasolacrimal duct when blowing your nose or trying to equalise by using the Valsalva manoeuvre. This phenomenon is not uncommon, and some people experience it when they try to equalise too forcefully. You may be executing the Valsalva manoeuvre with too much force. Equalisation should be a gentle and easy process with minimal effort. While it may feel odd or tickle slightly, you should not have any issues from diving. There is a possibility of infection from forcing mucus from the nasal passage into the nasolacrimal duct.
We recommend consulting a local ear, nose, and throat (ENT) specialist about your concerns. Knowledge of dive medicine is unnecessary as this is a common problem that happens to many people, including non-divers.
Join DAN to get a number of benefits, including answers to all your diving-related medical questions. Before you head back into the water, ensure you are fully protected by reviewing these considerations on diving insurance.”
FAQs
Is it safe to dive with Addison’s disease?
It depends on the individual. Diving with primary adrenal insufficiency requires medical clearance from a dive specialist to ensure your blood pressure, sugar levels, and exercise tolerance are stable enough for underwater conditions.
Why does the Valsalva maneuver cause air to come out of my eye?
This happens when air is forced through the nasolacrimal (tear) duct. It is usually a sign of equalizing too forcefully. Switching to a gentler technique can often stop the sensation.
Can Addison’s disease symptoms be mistaken for the “bends”?
Yes. Fatigue, joint pain, and muscle aches—common in Addison’s—closely mimic the symptoms of Decompression Sickness (DCS), which can complicate a medical diagnosis after diving.
What should a diver with Addison’s include in their medical kit?
If cleared to dive, you should carry a well-equipped kit containing the specific medications required to treat or prevent an adrenal crisis, alongside a clear emergency action plan.
Should I see a doctor if air escapes my eye while diving?
While rarely a serious medical emergency, it is recommended to see an ENT specialist to rule out potential infections caused by forcing nasal mucus into the tear duct.
