Diving With a Cleft Palate

Cleft palate is a congenital condition where there is incomplete closure of some of the branchial clefts before birth. This involves the mouth and soft palate and can be related to changes in the region around the openings to the Eustachian tubes. Problems diving are related to basically two things:

Difficulties associated with clearing the middle ears and difficulties with air management using the regulator.

Here is a query that has been received about the difficulties of diving with a cleft palate.

“I was born with a cleft palate (repaired) and am wondering if this is related to some problems that I am having in SCUBA lessons. With a regulator in my mouth, and my SCUBA mask off, I am having a difficult time breathing through the regulator without sucking water into my nose. I have experimented in the water with a snorkel, and outside the water; trying to breathe through my mouth, while not inhaling through my nose. This has been difficult for me to do, and when I am successful, my abilities still seem iffy at best. Could a short palate contribute such a problem, or is it more likely that I am doing something wrong? “

Difficulties with Eustachian tube function:

To quote from the ENT section of the text “Medical Examination of Sport SCUBA Divers”, A.A. Bove, Editor:”All patients with cleft palates have eustachian tube abnormalities. even though the defect has been repaired. Otologic evaluation prior to diving is advised to ensure patency of the eustachian tube”. In other words: can you clear your ears? (Bruce Miller, MD) It would be very important for you to have an ENT survey to ascertain the degree of abnormality of the nasopharynx and if there is any choanal atresia. (ESC)

Difficulties with closure of the nasopharynx

“When one inhales one reduces the intrathoracic pressure and air flows to the lungs. The reduced pressure is conveyed equally to the nose and mouth and if we wish to take air in through the mouth only we must establish an obsruction between the nasopharynx and the larynx. We do this by elevating the base of the tongue compressing it against the posterior aspect of the hard palate. If one has a short hard palate (by cleft or whatever) this maneuver is very difficult if not impossible. Thus water will enter the nose as well as the mouth.” (Dean Heimbach, MD)

“If this is not an anatomical problem, this could also be a consequence of a land critter adapting to the sea. We all have what I call the “primitive brain” … it tells us every time we submerge, that we are in an environment we cannot breathe. It also tells us that it is “not comfortable” breathing through the mouth, with nose exposed to water.This discomfort (different levels for everyone, but present in all) is merely a consequence of being a human with a set of reflexes conditioned for survival on the land in a breathable environment. In my opinion, the purpose of scuba class training to convince the primitive brain that its OK to be underwater. This takes time and many, many repeated exercises.

The ENT physician can tell you if it is NOT anatomy. If it is NOT anatomy, then the “primitive brain” needs a bit of behavioral conditioning to be convinced its OK to submerge. The following exercise has been used by several of my students over the last two decades to master the skill of breathing underwater without mask. I know of no faster way to develop comfort underwater without the mask.

Fill a bathtub with cold water. Kneel over the edge, and breathe through a snorkel (without mask)

Eventually, perhaps a couple of hours over several attempts, the “primitive brain” becomes convinced that the exercise is do-able. This exercise should be repeated until there is NO DISCOMFORT. Once there, then you should find that breathing without mask will be less stressful.” (L.T. ‘Harris’ Taylor, PhD)

Barring any problems with his Eustachian tubes and nasopharynx, he may get some benefit from a cleft palate prosthesis (see http://cpmcnet.columbia.edu/dept/dental/mpc/cleft.html ) to occlude the opening from the short soft palate. This itself is dangerous if unfixed to dentures, and can lead to several disastrous sequelae, such as aspiration.

The diving functions that are causing this diver difficulty are basic to a safe dive and inability to clear his mask, clear his ears or perform the regulator skills required would definitely preclude his participation in diving activities.


Ernest S. Campbell, M.D., FACS

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