The Lester-Jones tube and scuba diving

Insertion of a Lester-Jones tube remains the standard treatment for epiphora secondary to canalicular obstruction. We report on a patient requiring removal of his correctly working Lester-Jones tube to allow him to continue his hobby of scuba diving. This particular complication of the Lester-Jones tube has never previously been reported in the literature. Patients with Lester-Jones tubes are unable to perform the valsalva manoeuvre. The valsalva manoeuvre involves blowing the nose against occluded nostrils resulting in a raised pressure in the nose and post-nasal space which is transmitted via the eustachian tubes to the middle ear. The ability to perform a successful valsalva manoeuvre is a prerequisite of scuba diving to equalise middle ear pressure. Inability to equalise middle ear pressure can lead to barotrauma, including pain, rupture of the tympanic membrane and labyrinthine fistula. We recommend that when planning the insertion of a Lester-Jones tube it is wise to enquire whether the patient undertakes scuba diving. If the patient prefers to scuba dive raher than have control of their epiphora, the surgery should be deferred until the patient gives up diving.