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Passive flooding of paranasal sinuses and middle ears as a method of equalisation in extreme breath-hold diving
  1. Peter Germonpré1,2,
  2. Costantino Balestra2,3,
  3. Patrick Musimu2,3
  1. 1Centre for Hyperbaric Oxygen Therapy, Brussels, Belgium
  2. 2Divers Alert Network (DAN) Europe Research Division, Belgium
  3. 3Free University of Brussels Physiology Lab, Brussels, Belgium
  1. Correspondence to Dr Peter Germonpré, Military Hospital Brussels, Bruynstraat 1, Brussels 1120, Belgium; peter.germonpre{at}


Breath-hold diving is both a recreational activity, performed by thousands of enthusiasts in Europe, and a high-performance competitive sport. Several ‘disciplines’ exist, of which the ‘no-limits’ category is the most spectacular: using a specially designed heavy ‘sled,’ divers descend to extreme depths on a cable, and then reascend using an inflatable balloon, on a single breath. The current world record for un-assisted descent stands at more than 200 m of depth. Equalising air pressure in the paranasal sinuses and middle-ear cavities is a necessity during descent to avoid barotraumas. However, this requires active insufflations of precious air, which is thus unavailable in the pulmonary system. The authors describe a diver who, by training, is capable of allowing passive flooding of the sinuses and middle ear with (sea) water during descent, by suppressing protective (parasympathetic) reflexes during this process. Using this technique, he performed a series of extreme-depth breath-hold dives in June 2005, descending to 209 m of sea water on one breath of air.

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  • Competing interests PM is the subject of our case report. He occasionally receives financial compensation for conferences on extreme apnoea and on individual and group excellence and achievement. He received and receives sponsorship for the organisation of his apnoeic activities, from companies searching to highlight human achievement.

  • Provenance and peer review Not commissioned; externally peer reviewed.