Barotrauma and tinnitus

[Rebullar]

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

 

[DiveLikeAMuppet]

@Duke Dive Medicine
It might be helpful if you describe how bad the hearing loss was and if it's at a similar level in both ears.

If you suddenly started suffering from tinnitus, your ENT might send you for an MRI to exclude other possible sources - if I remember correctly, there is a nerve that can get pinched by a tumour.

I had a similar problem after equalising too late (a mix of task loading, getting entangled and ... skill issues): middle ear barotrauma, hearing loss in higher frequencies in one ear, high-pitched tinnitus. No blood or ear drum damage, no balance issues. It took about 6 weeks for the fluid in my middle ear to drain and for my hearing to get almost back to normal and the tinnitus is now barely noticeable even in very quiet environments.

One dive doctor told me that he cannot exclude inner ear barotrauma and therefore I would never be able to dive again. Another well-regarded dive doctor happily signed me off after seeing the hearing improvement and a short in-person exam.

So you might feel horrible now but there is hope.

 

[Duke Dive Medicine]

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

Hi @Rebullar , I'm sorry this happened to you. A couple of questions: first, what oral antibiotic were you taking? Second, were you trying to Valsalva (the ENT provider wrote it as autoninsufflate) while you were being treated for this? If so, how vigorously did you do it? If the tinnitus was a symptom of inner ear barotrauma related to your dives it would most likely have begun immediately or very soon after the dives, not nine days later.

Best regards,
DDM

 

[Rebullar]

History:
Rebullar, a 29 y.o. male, was seen at [Hospital] for an audiologic evaluation. Patient has a history of left-sided barotrauma from diving approximately 3 weeks ago. He reports sudden onset of tinnitus bilaterally (L>R) about 1 week ago. He notes intermittent dizziness starting today. Patient denies aural fullness, true vertigo and subjective hearing loss.

Otoscopy:
General: alert, appears stated age, and cooperative
Right Ear: Normal appearance; clear visualization of tympanic membrane
Left Ear: Normal appearance; clear visualization of tympanic membrane

Test Language:
-English

Audiogram Results: Today's results were obtained using insert earphones with good reliability.
Right Ear: Hearing within normal limits sloping to mild conductive hearing loss from 4-8 kHz
Speech Reception Threshold: 15 dB HL
Word Recognition Score: 92% @ 60 dB HL (using recorded NU-6 words with masking in the contralateral ear)
Left Ear: Hearing within normal limits sloping to mild high frequency hearing loss from 6-8 kHz
Speech Reception Threshold: 10 dB HL
Word Recognition Score: 100% @ 60 dB HL (using recorded NU-6 words with masking in the contralateral ear)

Tympanometry:
Tympanometry was administered today to assess middle ear status:
Right ear: Tympanometry reveals a Type A tympanogram (normal compliance, pressure, and ear canal volume)
Left ear: Tympanometry reveals a Type As tympanogram (hypo compliant TM, normal pressure, normal ear canal volume)

Acoustic Reflexes:
Ipsilateral acoustic reflexes were measured:
Right ear: Responses were present at 500-4000 Hz
Left ear: Responses were present at 1000 Hz, 2000 Hz, and 4000 Hz and absent at 500 Hz

Impression:
-H93.13 Subjective tinnitus, bilateral
-R42 Dizziness
-H90.A11 Conductive hearing loss of the right ear, with restricted hearing on the contralateral side

 

[Rebullar]

Hi @Rebullar , I'm sorry this happened to you. A couple of questions: first, what oral antibiotic were you taking? Second, were you trying to Valsalva (the ENT provider wrote it as autoninsufflate) while you were being treated for this? If so, how vigorously did you do it? If the tinnitus was a symptom of inner ear barotrauma related to your dives it would most likely have begun immediately or very soon after the dives, not nine days later.

Best regards,
DDM

Thank you.

Oral antibiotic was amoxicillin-pot clavulanate 875-125mg tablet.

Yes, I was asked and able to Valsalva to autoinsufflate (felt my ears pop) on April 24 and subsequent visits. I didn't think it was vigorously, just enough to get the pops. Tinnitus began on April 29, some 5 days after the first ENT visit.

 

[Rebullar]

Oh also @Duke Dive Medicine, I see the ISS in your logo. I'm located by Johnson Space Center and looking for an ENT that understands diving injury. If you have any recommendations, please share! I'm trying to get timely treatment if possible.

 

[Duke Dive Medicine]

Thank you.

Oral antibiotic was amoxicillin-pot clavulanate 875-125mg tablet.

Yes, I was asked and able to Valsalva to autoinsufflate (felt my ears pop) on April 24 and subsequent visits. I didn't think it was vigorously, just enough to get the pops. Tinnitus began on April 29, some 5 days after the first ENT visit.

Thanks for that info. I would recommend you contact your ENT today and let him/her know about your new-onset tinnitus. It's probably connected (at least indirectly) to the barotrauma you experienced while diving. If there was a lot of blood in the middle ear, the by-products of the blood breaking down could be making the nerve cells act a little wonky, but it could also be related to attempts to equalize the ear.

Best regards,
DDM

 

[Duke Dive Medicine]

Oh also @Duke Dive Medicine, I see the ISS in your logo. I'm located by Johnson Space Center and looking for an ENT that understands diving injury. If you have any recommendations, please share! I'm trying to get timely treatment if possible.

DM sent.

 

[llamadiver]

Have you tried contacting DAN Medicine? They have information and a physician referral database that may assist you. 919-684-2948 Option 4 or go to their website and click "Ask A Medic".
Best of luck!