Barotrauma and tinnitus

[Derbdiver]

Hoping Duke Dive Medicine sees this and responds.

I am very concerned and seeking answers to a dive-related injury.

Context: I am a 29 year old male, otherwise healthy, who just began to dive in April.

I was doing my first few open water dives for the certification process on April 20. My ears did not equalize properly on descent, mostly felt in the left ear but some pressure in the right too. Thought I was able to successfully Valsalva after numerous attempts. Upon surfacing, I spit drainage into the water which contained bright red colors that I assume to be blood. April 21, went to an urgent care, where they told me my left eardrum was bulging out and there was dried blood in the ear. Right ear irritated too, but no bulging. No apparent rupture or hole in the eardrum. I was diagnosed with "otitis media, unspecified, left ear" and "unspecified otitis externa, bilateral". Antibiotics (oral and eardrops) given.

Took those as prescribed until seeing an ENT on April 24. Dx was barotrauma due to diving. Plan: "Discontinue antibiotics. He should autoinsufflate the ear as necessary. He will follow up as needed for persisting symptoms. A decongestant is recommended with future dives."

Move forward to April 29, I start to develop high-pitched tinnitus. This goes on for 1.5 weeks and persists today, May 8. I went back to that ENT and did a hearing test, which shows hearing loss in both ears at frequencies beginning around 2000 Hz. Now the doctor says the tinnitus and hearing loss is likely genetically caused? I am not a doctor, but I find his explanation very unlikely given the scuba circumstances. I don't know how to read all the hearing test charts, but I have them and can share details.

After combing the internet (again, not a doctor) I believe I have Inner Ear Barotrauma of some sort. I am approaching 3 weeks from the original injury, and the late onset of tinnitus has me worried something is getting worse. I lift weights regularly, and am pausing immediately.

I am also worried that, if not treated soon enough, the tinnitus and hearing loss may be permanent. Hopefully not because the tinnitus is mentally debilitating. I could probably cope more with the hearing loss.

Please help if you can,
Rebullar

I posted a Barotrauma injury I incurred in 2013 in Phuket Thailand. I went through a similar incident with two good ENT's and one really bad ENT. I did not get really detailed information until I looked up a DAN certified ENT. It was then that I got good information. He tested my ears 1month after injury and then again after 6 months. It was after the Tinnitus had gone away. He showed the baseline after 1month and again after 6months. I was very lucky and only lost a little hearing in the injured ear vs the uninjured one. He told me testing right after injury and then again after ringing stopped was the best way to gauge hearing quality. I really feel your pain and would reccomend an ENT who is DAN referred or is a diver himself.

 

[Johnboy70_99]

I injured my left ear about a year ago. It was a normal dive, but I think I was not paying attention to equalizing properly. I felt like what was a rush of water, then heard ringing. Upon surfacing I felt a bit dizzy. I was in the Philippines at the time, I went to the ER a couple of hours later when the dizziness persisted and I had almost completely lost hearing in my left ear.

They said it looked a bit irritated, gave me antibiotics, decongestant, and anti dizziness medicine. A couple hours later the dizziness pretty much went away and hearing started to come back. Still had a little pain from time to time.

Saw an ent there in ph a couple of days later who said I had a slight rupture in my eardrum. Looking back I don’t think he had any idea what he was talking about. Went back to the er a few days later as the pain was still coming and going. Since the ER in the Philippines costs around $15 I figured why not. they said my eardrum was fine.

I saw another ent a month later when I got back to the states. By then my ears looked fine. They did a hearing test. My right ear was 100% fine as it always was, and has been since. My left ear showed slight drop full spectrum and a large drop off starting around 6.5k. The ent said there was basically nothing they could do and just wanted to recheck in 3 months, and recommended never diving again. The tinnitus started to get noticeable around then, and started to really bother me. It was a constant screeching at 10khz, started in the injured ear but spread to both.

Saw another ent a month later, they said basically the same thing as the previous one. The tinnitus was probably the brain making up for the lost hearing and was likely permanent, and when this is the case usually it tends to lessen and get less noticeable over time, and most people get used to it. If it still bothered me they recommended I see the tinnitus clinic at Massachusetts Eye and Ear. I live in Massachusetts btw. They asked if anyone had given me steroids initially as treatment, which they had not. This was my biggest regret, as from what I understand if they are given within a few days they may help completely recover hearing, but at this point 3 months out it was too late.

At this point the tinnitus was really the only issue, as my hearing was fine for everyday activities. As a side job I mix audio for television and even that was fine with my hearing. Most of my coworkers in that field are half deaf anyways from mixing in clubs and arenas.

I saw an audiologist at mass eye and ear and they were fantastic. They listened to my concerns. By this time between all the doctors and googling I knew quite a bit about barotrauma and tinnitus, and there was no need for a discussion about curing my hearing loss or tinnitus as it isn’t really possible today. The focus was on a possible hearing aid to help with the hearing loss, and cognitive behavioral therapy to deal with the anxiety from the tinnitus. They also recommended I see the ent there for another opinion. We talked about practical solutions as well. One example is that sitting in a room with a tv on makes my ears start to really scream. So I usually listen now with earbuds or headphones, which calms them down quite a bit. They also suggested acupuncture, which I had never tried, and meditation, which I do already.

I made an appointment for cbt, there was lack of therapists and there was a 3 month wait. In the meantime I saw the next ent. He recommended an mri to see if it showed anything. It came back normal. He said that since my balance loss seemed to reverse within hours, and the hearing in my “bad” ear was still pretty much sufficient for everyday life, and I had over 70 dives where I didn’t have issues, he saw no reason why I couldn’t resume diving. The main reason for recommending no diving in this situation was if I had completely lost my ability to hear and balance in one ear, then it would be catastrophic if I was to lose balance and/or hearing in my good ear.

I did a pool dive 2 months later, I was very mindful to equalize very frequently. What I realized was that previously what I thought was frequent enough equalization may not have been enough. I focused on equalizing “too frequently”, but every time I equalized I still got a pop. I completed the dive with no issues.

I tried acupuncture. I really liked it and found it relaxing, but it didn’t seem to have much benefit to the ringing. I got covid and had to cancel a session and didn’t bother to go back, but I may start going again. My heath plan covered it.

Around 6 months after the accident , I noticed that the ringing seemed to be more intermittent and quieter a lot of the time. I could go days at a time without even noticing the ringing. This isn’t a gradual improvement, more like a random 2 steps forward one step back kind of thing.

By the time I had my first cbt appointment, 9 months after the accident, the ringing was still there but had pretty much stopped bothering me. After a while the brain just sort of tunes it out, the same way you don’t notice the traffic noise if you live by a busy road. The therapist wasn’t really much help so I stopped going.

I am going back into the ocean for the first time next week, around 11 months after the accident. I could have gone sooner but I have been busy and I usually don’t dive here in my home state, it’s cold and there’s no coral reefs. I have practiced several different methods of equalization, and I plan to equalize early, often, and gently. One of the theories is that too forceful of a valseuva may have caused the issue. Wish me luck.

I have a follow up hearing test in October, and I may get fitted for a hearing aid. I have always had trouble hearing people in a large crowded bar or restaurant and it may help with that. It also may calm down my tinnitus to the point where I don’t need headphones at all anymore (I wear them rarely now)

Sorry for the long read, to sum up everyone pay close attention to equalizing your ears. I realize all situations are unique and mine is different from op but there may be some similarities. It seems like it’s easier than you think to do permanent damage. But if you do end up with “permanent” tinnitus, from what I have read most people habituate like I have.

 

[Derbdiver]

I injured my left ear about a year ago. It was a normal dive, but I think I was not paying attention to equalizing properly. I felt like what was a rush of water, then heard ringing. Upon surfacing I felt a bit dizzy. I was in the Philippines at the time, I went to the ER a couple of hours later when the dizziness persisted and I had almost completely lost hearing in my left ear.

They said it looked a bit irritated, gave me antibiotics, decongestant, and anti dizziness medicine. A couple hours later the dizziness pretty much went away and hearing started to come back. Still had a little pain from time to time.

Saw an ent there in ph a couple of days later who said I had a slight rupture in my eardrum. Looking back I don’t think he had any idea what he was talking about. Went back to the er a few days later as the pain was still coming and going. Since the ER in the Philippines costs around $15 I figured why not. they said my eardrum was fine.

I saw another ent a month later when I got back to the states. By then my ears looked fine. They did a hearing test. My right ear was 100% fine as it always was, and has been since. My left ear showed slight drop full spectrum and a large drop off starting around 6.5k. The ent said there was basically nothing they could do and just wanted to recheck in 3 months, and recommended never diving again. The tinnitus started to get noticeable around then, and started to really bother me. It was a constant screeching at 10khz, started in the injured ear but spread to both.

Saw another ent a month later, they said basically the same thing as the previous one. The tinnitus was probably the brain making up for the lost hearing and was likely permanent, and when this is the case usually it tends to lessen and get less noticeable over time, and most people get used to it. If it still bothered me they recommended I see the tinnitus clinic at Massachusetts Eye and Ear. I live in Massachusetts btw. They asked if anyone had given me steroids initially as treatment, which they had not. This was my biggest regret, as from what I understand if they are given within a few days they may help completely recover hearing, but at this point 3 months out it was too late.

At this point the tinnitus was really the only issue, as my hearing was fine for everyday activities. As a side job I mix audio for television and even that was fine with my hearing. Most of my coworkers in that field are half deaf anyways from mixing in clubs and arenas.

I saw an audiologist at mass eye and ear and they were fantastic. They listened to my concerns. By this time between all the doctors and googling I knew quite a bit about barotrauma and tinnitus, and there was no need for a discussion about curing my hearing loss or tinnitus as it isn’t really possible today. The focus was on a possible hearing aid to help with the hearing loss, and cognitive behavioral therapy to deal with the anxiety from the tinnitus. They also recommended I see the ent there for another opinion. We talked about practical solutions as well. One example is that sitting in a room with a tv on makes my ears start to really scream. So I usually listen now with earbuds or headphones, which calms them down quite a bit. They also suggested acupuncture, which I had never tried, and meditation, which I do already.

I made an appointment for cbt, there was lack of therapists and there was a 3 month wait. In the meantime I saw the next ent. He recommended an mri to see if it showed anything. It came back normal. He said that since my balance loss seemed to reverse within hours, and the hearing in my “bad” ear was still pretty much sufficient for everyday life, and I had over 70 dives where I didn’t have issues, he saw no reason why I couldn’t resume diving. The main reason for recommending no diving in this situation was if I had completely lost my ability to hear and balance in one ear, then it would be catastrophic if I was to lose balance and/or hearing in my good ear.

I did a pool dive 2 months later, I was very mindful to equalize very frequently. What I realized was that previously what I thought was frequent enough equalization may not have been enough. I focused on equalizing “too frequently”, but every time I equalized I still got a pop. I completed the dive with no issues.

I tried acupuncture. I really liked it and found it relaxing, but it didn’t seem to have much benefit to the ringing. I got covid and had to cancel a session and didn’t bother to go back, but I may start going again. My heath plan covered it.

Around 6 months after the accident , I noticed that the ringing seemed to be more intermittent and quieter a lot of the time. I could go days at a time without even noticing the ringing. This isn’t a gradual improvement, more like a random 2 steps forward one step back kind of thing.

By the time I had my first cbt appointment, 9 months after the accident, the ringing was still there but had pretty much stopped bothering me. After a while the brain just sort of tunes it out, the same way you don’t notice the traffic noise if you live by a busy road. The therapist wasn’t really much help so I stopped going.

I am going back into the ocean for the first time next week, around 11 months after the accident. I could have gone sooner but I have been busy and I usually don’t dive here in my home state, it’s cold and there’s no coral reefs. I have practiced several different methods of equalization, and I plan to equalize early, often, and gently. One of the theories is that too forceful of a valseuva may have caused the issue. Wish me luck.

I have a follow up hearing test in October, and I may get fitted for a hearing aid. I have always had trouble hearing people in a large crowded bar or restaurant and it may help with that. It also may calm down my tinnitus to the point where I don’t need headphones at all anymore (I wear them rarely now)

Sorry for the long read, to sum up everyone pay close attention to equalizing your ears. I realize all situations are unique and mine is different from op but there may be some similarities. It seems like it’s easier than you think to do permanent damage. But if you do end up with “permanent” tinnitus, from what I have read most people habituate like I have.

I totally agree, one thing I have added to my diving routine is to equalize on the surface to open up my tubes before going down. I will never dive again if I feel symptoms of a head cold or sinus blockage as I believe this was the primary cause of my ear trauma and the hard blow to equalize.