Blood in ear

[spcoun]

My wife recently had a problem that has me perplexed. After a dive of 77' nice easy multilevel dive, max bottom time 45 min, water temp 82 degrees, nice slow accent, normal safety stop 3min plus.

Get on boat obvious mask squeeze with blood in her mask, from nose and my niece noticed blood in her left ear.

(This ear has given her problems years before diving, she had to have tube inserted in ear to relieve pressure and drainage)

She used swimmers ear solution afterward, she had water in ear, no burning from the solution.

I asked if she felt there was a problem and she said no it was fine.

Ok here is where I feel you guys will let me have it.

2nd dive no problem.

asked if she wanted to go see the doc at the hotel. she said no. they will just say don't dive.

She did 14 more dives after that (16total) with no pain or other bleeding.

What could that have been from?

 

[RikRaeder]

A punctured eardrum? If the doc says "no diving" there's probably a good reason for that. I missed out on half of a vacation in Puerto Gallera because the doc said "absolutely no diving." It was disappointing, but I rather like to hear.

 

[DocVikingo]

Hi spcoun,

The eardrum is quite rich in small blood vessels and these can bleed as a result of barotrauma, which your wife appears to have experienced as evidenced by blood in the mask and from the nose. Although mask squeze cannot be entirely ruled out, this bleeding more likely was caused by overly vigorous equalization with injury to the nose/sinuses, with the ear affected down the line. The primary feature of mask squeeze typically is hemorrhaging of the eye (reddish spots of blood in the white of the eyes) and immediately surrounding area.

That she went on to complete 14 additional dives without incident suggests it was an isolated event. Divers do from time to time experience minor and very infrequent bleeding such as described.

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[doctormike]

Get on boat obvious mask squeeze with blood in her mask, from nose and my niece noticed blood in her left ear.

...

What could that have been from?

Hi, spcoun, thanks for writing!

I hope that you do not think that my answer is deliberately evasive, vague, unhelpful or arrogant, but I would like to take a moment to comment on this type of question. Of course, I encourage any and all discussions here, and there is no question that should not be asked! Those of you who know me will vouch for my good intentions..

However, as an ENT doc who has been running an online "ask the doc" service since 1998, I hear this sort of thing a lot, and I worry that good faith attempts to make the diagnosis can be potentially dangerous.

The ear is unusual, in that different processes can present in similar fashions, and the initial presentation of something serious that can result in lifelong hearing loss (or worse!) may be mistaken for a more benign condition. Also, direct examination of the ear and an audiogram are so central to diagnosing ear problems, that no amount of clinical history or medical background can really make up for the lack of them. Finally, examining the ear is hard, and many general medical doctors (like the doctor at your hotel) might not have had a lot of experience with this. Pediatricians are much better at it, given the prevalence of ear disease in children, but even they may be at a loss with an unusual condition (such as a diving injury). An ENT doctor will have had a lot of experience seeing a wide range of ear pathology, and will have the tools (such as an ear microscope) do to a thorough exam.

Of course, one of the problems with becoming more and more specialized, is that we know more and more about less and less, until eventually we know everything about nothing!

Yes, it is true that statistically, things like a spontaneously healing tympanic membrane perforation from barotrauma are likely, but this is not the sort of condition for which reassurance should be given over the Internet.

Of course, we have the helpful information that your wife did 14 dives following the bloody otorrhea without apparent complication, and I will assume that if she is now deaf in that ear, she either isn't telling you or hasn't noticed it yet!

Bottom line is that there are some conditions for which this forum is not as helpful, and I worry that well intentioned attempts to guess the diagnosis may prevent someone, someday, from scrubbing the rest of their dives until they can get a good examination by someone with experience and an audiology booth. We all push the envelope on vacations with minor equalization issues, but blood from the ear after diving could involve more serious problems...

Sorry if this sounds snarky... I'm very glad that your wife is apparently OK! Probably a good idea for her to get a good evaluation when you get back home... let me know if you want a local referral in your area...

Happy Holidays!

Mike

 

[DocVikingo]

Hi Mike,

Any chance you can reduce all that prolixity into a couple of clear and straight-forward sentences?

Thanks,

Doc

 

[doctormike]

Hi Mike,

Any chance you can reduce all that prolixity into a couple of clear and straight-forward sentences?

Thanks,

Doc

Hehehe... wow, got me! Sorry, I love the sound of my own typing...

1) If you have blood coming out of your ear after a dive, don't dive again until someone with ear experience can examine you thoroughly.

2) If you dive with bloody otorrhea (ear drainage) and get away with it, you were lucky - don't press your luck.

3) While bloody drainage from the nose and bloody drainage from the ear usually come from similar types of injuries, you are less likely to have permanent problems if you beat up your sinuses than if you beat up your middle ear (leaving aside eye injuries).

4) While medical forums are generally a good thing, there are some problems may be made worse by online reassurances.

and finally...

5) When posting in an Internet forum, try to be concise and to the point!




Mike

 

[spcoun]

Hi spcoun,

The eardrum is quite rich in small blood vessels and these can bleed as a result of barotrauma, which your wife appears to have experienced as evidenced by blood in the mask and from the nose. Although mask squeze cannot be entirely ruled out, this bleeding more likely was caused by overly vigorous equalization with injury to the nose/sinuses, with the ear affected down the line. The primary feature of mask squeeze typically is hemorrhaging of the eye (reddish spots of blood in the white of the eyes) and immediately surrounding area.

That she went on to complete 14 additional dives without incident suggests it was an isolated event. Divers do from time to time experience minor and very infrequent bleeding such as described.

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Hi DocVikingo,

Thank you for your reply, and yes it helps. I just assumed mask squeeze due to her redness that looks like a mask, that lasted a few more hours. I was more concerned than she was about a potential problem. She did agree to abort the next dive if any discomfort, and there was none.

Best wishes

 

[spcoun]

Hi, spcoun, thanks for writing!

An ENT doctor will have had a lot of experience seeing a wide range of ear pathology, and will have the tools (such as an ear microscope) do to a thorough exam.

Of course, we have the helpful information that your wife did 14 dives following the bloody otorrhea without apparent complication, and I will assume that if she is now deaf in that ear, she either isn't telling you or hasn't noticed it yet!

I'm very glad that your wife is apparently OK! Probably a good idea for her to get a good evaluation when you get back home... let me know if you want a local referral in your area...

Happy Holidays!

Mike

Hi Doc Mike,

Thanks for the help, she can hear fine, let me rephrase that, she hears as well as she wants to. This took place Nov 1-10. We live in Napa CA. and have Kaiser Permanente as our health care provider. And yes I realize that she was lucky not to suffer permanent damage.

I will try to tone her down a little (she sets up her gear at the back of the boat, to be first off, more dive time) would it be too late to have a ent examine her?

Thank you,

 

[doctormike]

Hi Doc Mike,

Thanks for the help, she can hear fine, let me rephrase that, she hears as well as she wants to. This took place Nov 1-10. We live in Napa CA. and have Kaiser Permanente as our health care provider. And yes I realize that she was lucky not to suffer permanent damage.

I will try to tone her down a little (she sets up her gear at the back of the boat, to be first off, more dive time) would it be too late to have a ent examine her?

Thank you,

You are lucky that your wife is such an avid diver! You obviously do your best to give her good advice, and to be there for her when she has these problems...

It is pretty unlikely that she had a perforation or inner ear injury at this point, given the lack of symptoms, and the fact that you didn't notice bubbles coming out of her ear when she equalized on the later dives of your trip! However, it certainly wouldn't hurt to have someone from Kaiser take a look before the next dive...

Best,

Mike

 

[DocVikingo]

Hi spcoun,

My pleasure.

If your wife does decide to have her ear examined at Kaiser Permanente, or elsewhere, please do let us know what the ENT has to say.

Regards,

DocVikingo

PS: Better safe than sorry, although I'll make a side wager with doctormike that the examination will be without remarkable findings.