Odd ear fullness again

[Duke Dive Medicine]

To the Community --

Just returned from AWESOME diving in Maui and on my last dive my ears got congested and now, four days later, they're still congested and "full" and popping and not clearing all the way.

I never had any pain while or after diving although I typically have some difficulty equalizing, but I always immediately ascend, equalize via Toynbee and then am eventually able to get all the way down. I always ascend slowly and don't have pain on surfacing so I don't think I ever had any middle or inner ear barotrauma. Interestingly, when I equalize, I usually hear little hissing/crackling sounds as the pressure releases and when I surface, it takes a couple of minutes for the crackling to stop.

During the week my ears were fine but just on the last dive to Cathedral #1 did they seem to "fill up" and stay congested. (During the week of diving, my ears would get slightly congested but then the congestion would resolve overnight so I'd be fine diving the next day.)

I saw a nurse practitioner yesterday who said my ears are clear and everything looks ok with the ear drum, not infected, etc. but it definitely seems I have some fluid or mucus buildup somewhere in there as both my ears seem "full." She suggested I try Flonase but after 1 day it hasn't helped yet.

My hearing is affected but improves if I tilt my head to one side so it doesn't seem permanent and, this happens every dive trip so I'm used to it now.

My ears cleared up last night -- with full hearing restoration -- but then they were full again this morning so I'd really like to know what's going on. It usually takes 1+ week for everything to resolve, but my ears pop with every swallow and it's kind of annoying, not to mention the hearing loss/stuffiness/head congestion feel.

Please help!

Thanks in advance,

John

You could either have some mild middle ear barotrauma with a small amount of residual fluid that rests over the opening of the Eustachian tube in the middle ear, or you have some water trapped behind a piece of ear wax and you're hearing it against your eardrum. These are tiny structures, so it doesn't take much fluid at all. Do you have environmental allergies? If so, that could be keeping your mucous membranes (including those in your middle ear) in a constant state of mild inflammation. That would make them more likely to seep fluid in the presence of a relatively mild pressure differential.

Best regards,
DDM

 

[jfksabal]

You could either have some mild middle ear barotrauma with a small amount of residual fluid that rests over the opening of the Eustachian tube in the middle ear, or you have some water trapped behind a piece of ear wax and you're hearing it against your eardrum. These are tiny structures, so it doesn't take much fluid at all. Do you have environmental allergies? If so, that could be keeping your mucous membranes (including those in your middle ear) in a constant state of mild inflammation. That would make them more likely to seep fluid in the presence of a relatively mild pressure differential.

Best regards,
DDM

Thank you very much! It's something I've always experienced when diving -- fluid seep after even the first dive of a dive trip.

I took loratadine those first several days and everything was ok. I felt fluid seep but my ears were clear. I'll see what the ENT says tomorrow and reply.

Again, thank you for the information!

 

[jfksabal]

Doc’s Proplugs are against otitis externa -> swimmers ear. Will not help for your condition. You need to nail it down to root cause. Is it wrong technique you use for equalisation or late equalisation or your eustachian tubes gets swollen due some allergy or another medical condition etc. You mentioned during the week your ears were congested mildy, this should have already ringing the alarm bells. If I had blocked ear overnight, I would skip next few dives (I know it is a tough call especially on a liveboard), use nasal decongestants, and this will actually give you better chances to dive for rest of your holiday.

Thanks again @Ucarkus.

I don't think it's wrong or late equalization, as I'm on top of it as soon as I release the air from my BCD.

I never went diving with a blocked ear -- always by a few hours after a dive, and then definitely by the next morning, any congestion would resolve and my ears were clear. Descending would be slightly uncomfortable, but not painful, as if I had a sore muscle from overuse. The instant I had a problem equalizing, I'd ascend a little, clear, and then getting down to 20-25m was no problem.

The fullness and congestion that is now lingering and resolving very slowly occurred on my last dive fortunately.

I'll report back after my ENT visit tomorrow.

Thanks again!

 

[jfksabal]

You could either have some mild middle ear barotrauma with a small amount of residual fluid that rests over the opening of the Eustachian tube in the middle ear, or you have some water trapped behind a piece of ear wax and you're hearing it against your eardrum. These are tiny structures, so it doesn't take much fluid at all. Do you have environmental allergies? If so, that could be keeping your mucous membranes (including those in your middle ear) in a constant state of mild inflammation. That would make them more likely to seep fluid in the presence of a relatively mild pressure differential.

Best regards,
DDM

Question: wouldn't the nurse practitioner who looked at my ears on Monday have seen ear wax? She said my ears looked clear...

 

[Duke Dive Medicine]

Question: wouldn't the nurse practitioner who looked at my ears on Monday have seen ear wax? She said my ears looked clear...

That depends on what she meant by clear. Ear wax is a normal finding on exam so it may not have been remarkable to her. She may have meant that the tympanic membrane looked normal and she didn't see any fluid behind it. In my experience, practitioners only mention ear wax when there's so much that they can't completely visualize the TM. But, if she didn't mention seeing any wax by the TM then maybe there wasn't any of clinical significance.

Best regards,
DDM

 

[Jade Blue]

H

Thank you very much! It's something I've always experienced when diving -- fluid seep after even the first dive of a dive trip.

I took loratadine those first several days and everything was ok. I felt fluid seep but my ears were clear. I'll see what the ENT says tomorrow and reply.

Again, thank you for the information!

Hi seems like we are same, my ears wont stop popping. At night its all clear and then in the morning i feel like its full again and needed to equalize . My ent said i have mild hearing lost even tho i can hear well! What about u! Whats the update ?

 

[jfksabal]

H


Hi seems like we are same, my ears wont stop popping. At night its all clear and then in the morning i feel like its full again and needed to equalize . My ent said i have mild hearing lost even tho i can hear well! What about u! Whats the update ?

Hello!

my ENT said my tympanic membrane is the source of the issue. He didn't think I had otitis media with effusion and he thinks that the stretching of the TM that is involved with diving, will, in some individuals, create odd "memory" movements when swallowing or changes in pressure that last awhile after diving. This includes the "fullness" in the ear although I SWEAR there's fluid in there! (He says no.) I have an audiogram scheduled for this week and he said he might be able to discern more of what's going on from those results.

I have those other, same symptoms, too: at night, swallowing does not create sounds from the TM but when I get going during the day, the odd sounds return. The "fullness" is slowly going away -- it's been three weeks since my last dive -- and now my only symptoms are the sounds with swallowing from both tympanic membranes.

The audiogram is scheduled for Thursday and I'll post the results afterward.

Cheers.

 

[Esprise Me]

During the week my ears were fine but just on the last dive to Cathedral #1 did they seem to "fill up" and stay congested.

Coincidentally, I had a similar experience diving that same spot about two weeks after you. I'd been diving in Maui all week with no issues, then had some pain and difficulty equalizing during that dive, followed by a feeling of fullness in my left ear. Did you go through the "shotgun" exit? I wonder if that triggered something for either of us.

My symptoms resolved in time to dive again the next day. I went at it with everything I could think of--Sudafed, Afrin nasal spray, and some homemade ear beer. I'm thinking the Sudafed was probably the most effective of these. However, when I felt a twinge of congestion returning before a planned night dive, I was able to ward it off with one of those cold pills that uses phenylephrine instead of pseudoephedrine, along with some other ingredients like antihistamines and NSAIDs. I don't think anyone would argue it works as well as pseudoephedrine, and some say it doesn't work at all, but I've had limited success with it when I needed to sleep or was traveling where pseudo is illegal. If I had noticed some congestion before I did that dive, I probably would've started the Sudafed then, and skipped diving until and unless I felt clear. I always use the 12-hour extended release Sudafed to reduce the chances of it wearing off during a dive and causing a reverse block.

 

[jfksabal]

Coincidentally, I had a similar experience diving that same spot about two weeks after you. I'd been diving in Maui all week with no issues, then had some pain and difficulty equalizing during that dive, followed by a feeling of fullness in my left ear. Did you go through the "shotgun" exit? I wonder if that triggered something for either of us.

My symptoms resolved in time to dive again the next day. I went at it with everything I could think of--Sudafed, Afrin nasal spray, and some homemade ear beer. I'm thinking the Sudafed was probably the most effective of these. However, when I felt a twinge of congestion returning before a planned night dive, I was able to ward it off with one of those cold pills that uses phenylephrine instead of pseudoephedrine, along with some other ingredients like antihistamines and NSAIDs. I don't think anyone would argue it works as well as pseudoephedrine, and some say it doesn't work at all, but I've had limited success with it when I needed to sleep or was traveling where pseudo is illegal. If I had noticed some congestion before I did that dive, I probably would've started the Sudafed then, and skipped diving until and unless I felt clear. I always use the 12-hour extended release Sudafed to reduce the chances of it wearing off during a dive and causing a reverse block.

Interesting coincidence! Isn't Cathedral I frikkin' fantastic?!?!?!

I don't think it was the Shotgun, though...didn't feel any pressure changes going through that marvelous place. Neither did my wife.

I'll post what my ENT says after the audiogram on Thursday...

FYI -- do you recognize my avatar photo???

 

[diver-jud]

Curious about your opinions here, I used to have all kinds of similar problems with my ears, eventually lost 70% hearing in my right ear and 30% in my left due to repeated trapped water, infections etc. I have been using a product called Ear Pro which is a combination of Pharmaceutical Grade Mineral Oil and Oregano Oil for the past year or so, done maybe 150 dives and have not had a problem at all since. The Mineral oil coats the ear canal for a few hours with a water repellent layer and the oregano oil acts as an anti-microbial which seems to work no matter what pool, lake or ocean site I have dived, warm or cold. I have tried all kinds of after dive remedies, jungle juice, alcohol, weird florescent green drops in Thailand etc but this Ear Pro stuff seems to make more sense from the preventative side.
Does anyone else have any experience with this stuff and can you see any long term issues with using it?