Barotrauma that just won't go away!

[rossinger]

Last January I was teaching an MSDT (in other words, was on the last dive of 2 intense weeks of IDC and MSDT) and was at 30ft. for my 4th dive of the day. My right ear was not wanting to clear very well at depth, so I placed my finger in my ear and pulled out to try and relieve some pressure...Bang! is what I heard. No real pain and no blood, though I certainly expected to find some with the sound. I surfaced slowly and exited the water. I felt congested and had immediate onset of tinitus as well as being a little dazed, more from the shock I think than anything.

Since then I have flown and been to 130ft with no problems equalizing at all. However, I do still have: tinitus, a feeling of pressure or fullness in my right ear (almost like a reverse block) and I have partial loss of touch sensation on my cheek where my sideburn ends as well as the sensation that the corner of my right eyelid and right side of my mouth are drooping down.

I am not dizzy or nauseous, but these symptoms have not gone away at all.

I have had 2 CT scans, the second I am waiting on results to ascertain whether we are dealing with a fistula or not.

Has anyone had anything like this?

If it was a fistula, did you have it fixed? Can you still dive?

I would do anything for this ringing to go away!

ross

 

[doctormike]

Wow, that certainly sounds like significant barotrauma, so sorry that you have to go through this. A CT scan will rarely demonstrate a fistula, this is usually a diagnosis made at surgical exploration. We have had a number of threads about this topic, such as this one, but I will try to help as best as I can.

Important information that we don't have from your post is the actual status of your hearing, on a formal audiogram. Do you have a conductive hearing loss (from fluid in the middle ear), a sensorineural hearing loss (from inner ear barotrauma or leakage of inner ear fluid), or both? If there is no dizziness or nausea, a fistula is less likely but not ruled out.

Also of significance is the numbness on the cheek, especially in the context of ear disease. Most of the sensation in the face is supplied by the fifth cranial nerve (the trigeminal nerve), which isn't really near the ear from an anatomical point of view. The seventh cranial nerve (the facial nerve) mainly is a motor nerve - that is, it moves the muscles of the face. However, there is a very small area of facial skin that is supplied by the facial nerve in the outer ear canal and around this area (not sure if this is what you are referring to). This is significant because the facial nerve runs right through the ear, and anything that affects this area (barotrauma, external trauma, infection, inflammation or otherwise) could give symptoms like this. An example of this sort of problem is Ramsey Hunt syndrome, which is like shingles in the facial nerve, leading to blisters in the distribution of the sensory portion of the facial nerve (just like shingles leads to blisters in the sensory area of the nerves of the chest wall). Patients with this problem also can have hearing loss and facial paralysis.

While I'm not saying that this could be an infectious or inflammatory problems (the acute onset with diving suggests otherwise), the lack of sensation may be related to the tinnitus and the full feeling in the ear. The maneuver that you did with your finger could have caused a rapid pressure shift, causing middle ear and/or inner ear problems. Indeed, one complication of ear surgery happens when the surgeon manipulates the little bones of hearing rapidly or roughly, which can transmit a pressure wave into the inner ear. The finger maneuver could do the same thing, by quickly pulling on the eardrum (and therefore, the attached middle ear bones).

Feel free to PM me if you want a local referral for an otologist (ENT doc specializing in ear problems), if you don't have one already.

Good luck!

Mike

 

[rossinger]

Hi there Mike and thank you for your post. I have indeed had two hearing tests since and have very minor loss in the right ear in the upper partials -- it is suspected more from the tinnitus than anything -- and I apparently have better than normal hearing even with the loss.

Hopefully the CT scan at mm slices will come up with something, but I am not holding my breath. If there is some kind of pressure on the 7th facial nerve is there any way of relieving that pressure? Side effects?

Thanks again for this info...I have the names from DAN of 3 dive-medicine ENT's in Miami...I will be in Key Largo teaching again, so will look them up if all else fails.

thanks,

ross

---------- Post added ----------

Hi there Mike and thank you for your post. I have indeed had two hearing tests since and have very minor loss in the right ear in the upper partials -- it is suspected more from the tinnitus than anything -- and I apparently have better than normal hearing even with the loss.

Hopefully the CT scan at mm slices will come up with something, but I am not holding my breath. If there is some kind of pressure on the 7th facial nerve is there any way of relieving that pressure? Side effects?

Thanks again for this info...I have the names from DAN of 3 dive-medicine ENT's in Miami...I will be in Key Largo teaching again, so will look them up if all else fails.

thanks,

ross

---------- Post added ----------

Hi there Mike and thank you for your post. I have indeed had two hearing tests since and have very minor loss in the right ear in the upper partials -- it is suspected more from the tinnitus than anything -- and I apparently have better than normal hearing even with the loss.

Hopefully the CT scan at mm slices will come up with something, but I am not holding my breath. If there is some kind of pressure on the 7th facial nerve is there any way of relieving that pressure? Side effects?

Thanks again for this info...I have the names from DAN of 3 dive-medicine ENT's in Miami...I will be in Key Largo teaching again, so will look them up if all else fails.

thanks,

ross