Middle Ear Infection. Could it be bad Air?

[Allan C Smith]

Me and a fellow Divemaster have been suffering from ear infections for the past 3 weeks. Keeping us both out of work. I was wondering if it could be the air. We has an oily taste as well as steal tanks that are full of rust. We both have been though anti bio-tics both internal and topical. And both still have symptoms 3 weeks later. So I'm starting to think there is oil and a bit of rust that got pushed up there while equalizing.

Thanks for the help.

 

[zugbug99]

Hi Allan,
Sorry for your ear problems. Of course please inspect your air source (compressor and tanks). Compressed air with contamination of petrol oils can cause a whole host of respiratory hypersensitivity problems.
Have you had a chance to see a medical practitioner to check your nasal passages, throat, ear canals and hopefully to visualize the eardrum?
Do you remember what type of antibiotics you were using?
It may be more of an inflammation problem, hence the lack of response to antibiotics.
Would you consider a nasal irrigation program (in the states the Netti-Pot system by NielMed is popular). A old standby is a cup of warm clean water with a pinch (1/8th teaspoon) of table salt and sodium bicarb to help buffer and reduce nasal irritation.
A simple teaspoon system to help drain the solution from upstream nostril to the downstream nostril may help to reduce irritation and help to clear the middle ear space with gentle valsalva. Do this outside, or in the shower as it will likely loosen a significant amount of retianed mucus.
I would not recommend oral or nasal decongestants (sudafed, phenylpropralalnine, oxymetazoline) until you talk with a medical provider with diving experiance. Nasal steroids could be of help, but also should be evaluated first by a skilled medical professional. Antihistamines like loratadine, certrizine, or fexofenadine are very safe and can help if allergies are a component of the problem.
Good luck in your consideration of these measures
But please inspect your air source right away.
Of course nothing beats the skills of a trained medical diving professional to get you both back to working in paradise quickly.
Best Wishes!

 

[DocVikingo]

...Would you consider a nasal irrigation program (in the states the Netti-Pot system by NielMed is popular) [?] (sic)....

Hi Allan,

If so, you might want to see post #4 in the following thread --> http://www.scubaboard.com/forums/diving-medicine/404171-sinus-barotrauma.html

Regards,

DocVikingo

 

[doctormike]

Hi, Allan...

I have a few thoughts.

1) If you suspect that you have been breathing from tanks with contaminated gas, the least of your concerns should be ear problems. Get your gas source tested ASAP, and don't dive with them until you are sure that you are safe. Breathing contaminated gas mixes can cause serious, even fatal problems.

2) The term "ear infection" is always troublesome here. Most people mean that they have ear pain and/or a muffled sensation in their ear associated with diving. However, while this symptom can be caused by both middle and outer ear infections, they are completely different dive related conditions that have nothing to do with each other, and which are treated completely differently. To sort them out, someone needs to look in your ear. It's sort of like how migraine headaches and dandruff are both "head" problems, but they don't have much in common other than that. Here is my sticky on this issue.

3) Yes, the air that you push into your ears when you equalize is the same air that you breathe from your tank (nowhere else it can come from, right?). But middle ear infections are caused by bacteria growing in the ear (predisposed by barotrauma and fluid sitting behind the eardrum). As a practical matter, middle ear infections are very rare in divers - as opposed to middle ear fluid without infection, which is common. Contaminated tanks involve rust and hydrocarbons, or possibly carbon monoxide. These don't cause ear infections as far as I know.

Bottom line is that there is no substitute for someone with training and experience taking a look in your ear to figure out what is going on!

Good luck...

Mike

 

[DandyDon]

Wow! Those tanks sound deadly.

 

[flots am]

We has an oily taste as well as steal tanks that are full of rust.

I'll leave the medicine to the doctors, but I absolutely would not dive with rusty tanks. Rust, by definition means that the tank is contaminated, since it requires water, which requires a poorly maintained compressor. One rusty tank can mean that someone sucked it dry, left the valve open and some water got it. If they're all rusty, it's a compressor problem.

The oily taste is almost certainly from oil from a poorly maintained compressor, which means that it's ending up in your lungs.

If you want to remain alive and walking around, I would suggest not using any more tanks from that fill station until the compressor, storage banks, the rest of the fill station and your tanks have all been cleaned and serviced.

flots.

 

[Allan C Smith]

Thanks for all the answers guys. To answer the questions above. Yes I have had some on look in my ear. They Said there was fungal as well as bacteria on the drum. However this seems to have cleared up. yet I still have a fullness feeling in my ear. The antibiotics were first amoxicilin and then cipro(apologies for the spelling) as well as a course of anti fungal that I cannot remember the name of. I use a Nettie Pot but have quit during the infection. Maybe should give that a shot? I have a friend who dives and is an MD as well and he recommended sudifed. Started trying that today and it provided a bit of Releaf but symptoms return as it wares off. As far as barotramma is concerned while I did have problems clearing the week before the infection hit I had been out of the water for 2 days when I woke up with pain in my ear so I think I can rule that out. As far as the Air goes I know that's an issue and I guess heath has to come before the job so If I cannot get clean air to breath I will no longer teach out of that shop. Hopefully can find an ENT down here but might require leaving the island which is not in the fiscal cards at the moment.

Once again thank you and I will keep the thread updated as I hopefully progress. But at this point it Feels like I'm gonna be dealing with this for ever.


Again thanks for the help

 

[uncfnp]

Allen, it sounds like you had 2 separate ear issues. It's not clear from the posts but I think I understand that the infection was in the canal of the ear, commonly called swimmers ear. The infection causes ear pain (including pain with manipulation of the ear), swelling of the canal which can muffle sound and sometimes drainage. It is most often treated with ear drops and if severe, oral antibiotics. Most often it is bacterial but occasionally can be fungal or both. The air in your tank does not reach this part of the ear so would not have caused this. Prolonged immersion in water does and there are some preventative things you can do. If this sounds like part of your ear problem, let me know and I'll post some preventive options.

Then it sounds like you also have some middle ear issues. That is what the Nettie pot and the sudefed is for, to open up the sinuses and hopefully, ultimately, the eustachion tube that functions to equalize the pressure in your middle ear. This problem may well be related to your problems clearing the week before and, possibly, to the air in your tank if it could be irritating your throat/sinuses compounding the clearing problem and preventing the eustachion tube from functioning properly. Note I said possibly. I dive but am not trained in dive medicine. The possibility sounds reasonable. If you notice increased nasal symptoms and stuffiness after using that air (which hopefully you are not) and not with air from another source, there could be a relationship.

Hope this helps.

 

[DandyDon]

The oily taste & rust in the tanks are the biggest risks, but even the course material you teach your students cautions against diving such, doesn't it? And if breathing oily air doesn't kill you, then you have to wonder how much Carbon Monoxide is getting in your tanks too? I doubt that personal CO tank analyzers are common there, but I won't dive any tank without testing for that - along with the old smell & taste testing.

Additionally agreeing with previously stated opinions here, your ear problems sound like a combination of injury & infection. Since you are an Instructor, I suppose you know the various ways to equalize - but it's got to be done well. You can prevent ear canal infections with a very cheap mix of white vinegar & alcohol, soaking in each ear for 3 minutes at the end of a dive day. Or after problems set in, with your symptoms - I hope you continue the oral antibiotics for systemic treatment of the infection plus antibiotic ear drops containing hydrocortisone for the pain. I did not get ear infections from swimming for decades, but after I started Scuba - I incurred some bad ones, so I don't go in water now without having the prevention drops and treatment drops both available. I hate sitting in a doc's office on the verge of tears waiting my turn for help.

And if you are going to take Sudafed to help open your sinuses, make sure it has pseudoephedrine in contents - the chemical that originally gave the med its name. It's more difficult to obtain that the OTC meds that do not contain it, but may have the same Sudafed brand label - but it's still the best.

A word of caution about decongestant nose sprays too: Read the warning labels closely if you use one. I was chatting yesterday with my home dive bud about his current head cold & treatment and his employee who sprays every day for allergies and they gave me the names of their sprays - which I looked up on the net. Both brands had serious dependency warnings, which neither of them knew about.

good luck...!!

 

[Allan C Smith]

Dandy Don I am working of getting a CO analyzer and the oil issue as been fixed at the moment by emphasizing proper purging of the compressor as well as a new CO filter. For the time being all my students are off this air until I can get it analyzed and my own set of cylinders.