Currently in Bonaire: ear issues / conflicting advice

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gryffin

Contributor
Messages
86
Reaction score
21
Location
Northern New England
# of dives
200 - 499
I’m in the middle of a two week dive trip in Bonaire. During the first week I pushed a bit on two dives (out of about 17 total dives) where my ear wasn’t clearing well. I often have difficulty clearing my right ear- usually if I wait it out and descend slowly, I can equalize successfully, though sometimes there is some squeaking initially. On the first dive of the two dives I pushed through, 1st dive Wednesday (4th day of diving, 10th dive of the trip) I was feeling pressure to descend quickly- I felt pressure in my ear during the beginning of the dive, which eventually resolved, over 15 min or so while I ascended a couple of feet to relieve the pressure before trying to descending again- repeating this process a few times until I got to about 25 feet and eventually had no discomfort at that depth. I didn’t have a feeling of fullness or echoey hearing post dive, nor did I have vertigo or dizziness, but I did have some cracking noises when I tried equalization techniques on the surface after surfacing. However, during the night, I had an itchy ear canal, and a bruised feeling when I pushed on the base of the earlobe. I had a similar experience on the 1st dive on Friday, the 16th dive of the trip and during the night following it. On the other 15 dives, I sometimes had some squeaking during equalization, but no real difficulty. The bruised feeling and itchiness continued though, I did do some scratching, so I called DAN on Saturday, and decided to go to a clinic for an evaluation. Both DAN and I were thinking swimmers ear.

The doctor observed: mild swelling redness external ear canal, bulging tympanic membrane. She diagnosed ear squeeze and beginning otitis externa. She prescribed Panotile and said no diving until complaints have resolved. She said it could be a few days or as long as 7-10 days.

I’ve been out of the water since Friday afternoon, and using the drops since Saturday afternoon. Today, Tuesday, I have no feeling of bruising no matter where I press on my ear, and I hear a normal click when I swallow or use Valsalva on land. I thought maybe I could try a dive today based on the doctors notes, but I followed up with DAN and they still advise against it.

Including today, we have 4 more days of diving. Should I really sit out if I am feeling this improved? Should I try to see if I can equalize in the water? Should I see if the doctor can look again? DAN seemed more worried about the possible infection than the barotrauma. The doctor seemed less concerned about that.

We have a big trip coming up in April that I am nervous about (Maldives), and I was really hoping to get some good continued confidence building here as a tune up before that trip- including some surface buoy/line training (I had an experience last December that I am rebuilding confidence from- I was fine, training kicked in when it needed to, story for another time).

I want to do the right thing, but I don’t want to waste the dive opportunities (nor the vacation time sitting around in a hotel room) if it’s truly an over abundance of caution. I’ve dove on past trips with ear crackling, itchiness, even a bruised feeling, figuring as long as I could clear, I was not going to do any long-term damage, but I’m no longer sure if that was a correct assumption.

Sorry for such a long post.
 
I’m in the middle of a two week dive trip in Bonaire. During the first week I pushed a bit on two dives (out of about 17 total dives) where my ear wasn’t clearing well. I often have difficulty clearing my right ear- usually if I wait it out and descend slowly, I can equalize successfully, though sometimes there is some squeaking initially. On the first dive of the two dives I pushed through, 1st dive Wednesday (4th day of diving, 10th dive of the trip) I was feeling pressure to descend quickly- I felt pressure in my ear during the beginning of the dive, which eventually resolved, over 15 min or so while I ascended a couple of feet to relieve the pressure before trying to descending again- repeating this process a few times until I got to about 25 feet and eventually had no discomfort at that depth. I didn’t have a feeling of fullness or echoey hearing post dive, nor did I have vertigo or dizziness, but I did have some cracking noises when I tried equalization techniques on the surface after surfacing. However, during the night, I had an itchy ear canal, and a bruised feeling when I pushed on the base of the earlobe. I had a similar experience on the 1st dive on Friday, the 16th dive of the trip and during the night following it. On the other 15 dives, I sometimes had some squeaking during equalization, but no real difficulty. The bruised feeling and itchiness continued though, I did do some scratching, so I called DAN on Saturday, and decided to go to a clinic for an evaluation. Both DAN and I were thinking swimmers ear.

The doctor observed: mild swelling redness external ear canal, bulging tympanic membrane. She diagnosed ear squeeze and beginning otitis externa. She prescribed Panotile and said no diving until complaints have resolved. She said it could be a few days or as long as 7-10 days.

I’ve been out of the water since Friday afternoon, and using the drops since Saturday afternoon. Today, Tuesday, I have no feeling of bruising no matter where I press on my ear, and I hear a normal click when I swallow or use Valsalva on land. I thought maybe I could try a dive today based on the doctors notes, but I followed up with DAN and they still advise against it.

Including today, we have 4 more days of diving. Should I really sit out if I am feeling this improved? Should I try to see if I can equalize in the water? Should I see if the doctor can look again? DAN seemed more worried about the possible infection than the barotrauma. The doctor seemed less concerned about that.

We have a big trip coming up in April that I am nervous about (Maldives), and I was really hoping to get some good continued confidence building here as a tune up before that trip- including some surface buoy/line training (I had an experience last December that I am rebuilding confidence from- I was fine, training kicked in when it needed to, story for another time).

I want to do the right thing, but I don’t want to waste the dive opportunities (nor the vacation time sitting around in a hotel room) if it’s truly an over abundance of caution. I’ve dove on past trips with ear crackling, itchiness, even a bruised feeling, figuring as long as I could clear, I was not going to do any long-term damage, but I’m no longer sure if that was a correct assumption.

Sorry for such a long post.
I'm sorry this happened. Inflammation of the mucous membranes in the middle ear, pharynx and sinuses can take a frustratingly long time to resolve. The drops may get rid of the otitis externa, but they're not going to affect the inflammation in the Eustachian tube and surrounding mucous membranes. The clicking you're hearing is probably the Eustachian tube opening and closing, but that doesn't mean that it's fully functional. If your right ear is hard to clear at baseline, you're going to have even more difficulty and risk further injury if you dive with it now, thus (probably) the physician's recommendation.

Best regards,
DDM
 
@Duke Dive Medicine Thanks for your response. Is it recommended that I get seen by a doctor at home for clearance to return to diving?
I certainly would. I would not like to jeopardize that big trip coming up in April.
 
@Duke Dive Medicine Thanks for your response. Is it recommended that I get seen by a doctor at home for clearance to return to diving?
You're most welcome! If you feel like you're back to normal after a few weeks, then it's up to you whether to follow up with a provider. If you're still having symptoms, then a follow-up would be a good idea. It would also be reasonable to see an ENT about your right ear. There may be a correctable anatomic issue that causes it not to clear as well as the left.

Best regards,
DDM
 
This is for your next trip, not this one.

If you have an ear that's slow to equalize, turn it to the surface as you attempt equalizing. You can also stretch out your neck and take pointer finger and middle finger, run them with a bit of pressure from behind your ear lobe down to your collar bone. This works best for me with my ear turned up to the surface and neck stretched as far as it will go. May I hope that this is a clear enough explanation.
 

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