Ear problems - equalising after past ear infection

[eshroom]

Hi!

I grew up on an island in Greece and spend most of my summers there, in 29 years of spending half the year in the sea or (sometimes questionable) pools I never got an ear infection.

I went diving in the Maldives 2 years ago and got a terrible infection in both ears, took 2 courses of different antibiotics to clear. I couldn't hear and the pain was intense, real downer to what was an amazing diving trip.

Since then I haven't been diving, but I have been free diving and cliff diving. I have found that it is much harder to equalise one of my ears and it hurts to equalise. As a result I have done a hardly any free diving and spearfishing since I had the ear infection. The last time I got really bad vertigo equalising at about 5-6m. The ear canal suddenly felt cold as if water had entered. It took about 30 minutes for the vertigo to completely go and I was shaken by how powerful the vertigo was.

The infection has not re-occured despite plenty of time in the sea and I equalise using the Frenzel Maneuver (always have).

Does any one have any idea what might be wrong and how I can fix it? I have 0 symptoms on dry land and in the air (I fly a lot).

Heading to Thailand next month and would like to book a liveaboard, but nervous of making the investment knowing my ear might ruin it.

Thanks for any input!

 

[iamrushman]

this need to be posted in the medical section...when was the last time you saw a ENT physician?

 

[eshroom]

Thanks. Could a mod move this discussion to the medical forum please?

I’ve never seen an ENT doctor about this problem. Don’t think I’ve seen an ENT doctor since I was a child...

 

[fmerkel]

This kind of post is difficult for a number of reasons. It this case the first major question is: inner ear infection, or outer ear infection?
Do you know the difference?
If makes a huge difference in how this is approached as they are 2 entirely different problems, with completely different approaches to deal with.

It....sounds....like you had middle ear barotrauma, that became a middle ear infection, possibly with complications.

 

[rsingler]

The sudden sensation of "water entering" was likely just that. It sounds like you sustained an eardrum perforation due to the pressure difference occuring from not being able to equalize normally. Your vertigo was caused by the temperature difference suddenly imposed upon the middle and inner ear, which includes structures that govern your sense of balance as well as your hearing.

It may be that after your bad infection of the middle ear, there is scarring involving the eustachian tube which transmits equalizing pressure from your nasopharynx when you use your equalizing maneuver. Because that scar tissue impeded or completely blocked the flow of higher pressure air into the middle ear, your eardrum may have ruptured.

The good news is that ruptures like that usually heal uneventfully.
The bigger challenge is in restoring your ability to equalize.
An ENT doc can look in your ear while you attempt to equalize and visually confirm that your eardrum "puffs out" a little. Your difficult ear may show no response. If that is the case, there is a new procedure that may help.

Our hospital's ENT's have just started using a new device that involves threading a thin balloon catheter up through the nose into the eustachian tube. The balloon is then inflated for two minutes and released. This sustained dilation of the eustachian tube stretches the tissue and can often create a permanent fix, at least according to the balloon manufacturers. This is a new procedure for my local hospital. Other docs may be able to comment if they've been doing it longer. This procedure can be done under sedation (no general anesthesia usually required). However it also may require an MRI or CT scan ahead of time to confirm that there is no aberrant carotid artery coursing nearby, which may get occluded by the inflated balloon.

Doubt that all this can get evaluated/treated in a week.
However, at least go see your regular doc. We all were trained to inspect the eardrum in medical school. Have him/her watch while you attempt to equalize. If your eardrum puffs, you should be okay for your trip, as long as you descend slowly and equalize often. Once the equalization problems start on descent, it becomes increasingly difficult to correct without ascending.

Cheers!
Diving Doc

 

[eshroom]

Thanks for the replies.

It’s crazy since equalising on planes is as easy as it ever was for both ears. I’ll make a doctors appointment.

From memory I thought it was an outer ear infection, but the doctor was Italian and we couldn’t communicate very well. I was cleared for flying with the infection.

 

[fmerkel]

An outer ear infection would be highly unlikely to cause equalizing problems. It's probable you got an inner ear infection, which is likely from inadequate equalization.
The problem with diving vs. flying is the huge magnitude of change in water vs. air. Remember 1 atmosphere/bar (the entire atmosphere above us) is 33 feet of sea water depth. A few feet of water is a lot of pressure.

To be blunt I suspect that your equalization technique is not as good as you think. It's a very common problem. You probably got barotrauma on that dive trip and got a secondary infection from it. I think you may be using too much force, possibly much too late. You need to be equalizing every 2 feet or so down to 20 feet. It should be easy and painless. If you go 6-10 feet from the surface without equalizing it either becomes impossible, or you can blow out your own eardrum trying. You certainly can cause damage. Slow and easy is the key.

As rsingler indicated you may have residual damage, that may be fixable. IMO, you have to deal with your equalization technique and improve that anyway. I also suggest seeing an ENT, preferably a diving oriented one to evaluate biological issues and your technique. Then you can decide if you just need to be a lot more careful about how you dive and clear, or if you need some intervention to deal with biological problems, or both.

 

[sealark]

Lots of good suggestions see a ENT doc that is a diver. Also here is a something I use after having many external ear infections. Been using it for 50 years over 10,000 dives. Good luck,,


When I hit 40 I would get ear infections every time I spent more than a couple hours a day in the water. Then I started using the recipe below after EVERY dive. I haven’t had an ear infection in 30 years. I always have a bottle on board and in my truck. I just take the cap off hold my finger over the opening and let a small amount go down into each ear.

All the materials are available at any drug store for less than $10.00. The Alcohol dries the water, The boric acid is what your grandmother used for infections and the white vinegar keeps the wax from drying up because of the alcohol.


Ear wash recipe
1 Pint 70% or less % Isopropyl Rubbing Alcohol

Boric acid powder 6 oz. is more than enough

White Vinegar



Pour out about 2" of the alcohol out.


Pour or put about 2 Table spoons Boric acid into Alcohol and shake up. If acid remains in powder on bottom you have enough if not add until a small amount remains on bottom. Only a certain % will go into solution so you can't overdue the Boric Acid. Fill the remaining area in the bottle with white vinegar and shake up. The solution is now ready to use.


I usually buy 3 or 4 bottles of alcohol and mix them up in a big bowl then pour them back mixed up into the alcohol bottles. This way the powder on the bottom remains in the bowl and won’t make your ears white when the solution dries out after pouring it into your ears.