Underwater application of nasal decongestants: method for special operations

A simple method of emergency underwater application of a nasal decongestant in divers to prevent diving-related accidents or even fatalities attributable to sequelae of middle-ear and sinus barotrauma of ascent was evaluated. Eleven military divers had to inject 1 mL of 0.02% methylene blue into a central venous catheter after having inserted the tip between their upper lip and the mask at 1 m depth in a pool. After injection, the head had to be reclined. Blue liquid flowing from a diver's nostril and a "bitter" taste sensation reported immediately after surfacing indicated successful application. All divers were observed to have had blue liquid flowing from the nostril of application, and one diver could not describe the taste. This method of underwater application of nasal decongestants may be useful for emergency prevention in divers, especially during covert operations. Underwater availability of the system in a special kit carried by divers would be required.