ear advice please

[munkispank]

Ok- here's the score. I would like opinions from those who have been through this to help me make a decision.

went diving thanksgiving- somehow my sinus' got blocked- second day of diving was hard to clear, so I aborted the latter dives. Had no ear pain, but was blocked. came home and visited walk in clinic (currently have no insurance and dive/travel insurance would only cover if I had visited whilst on vacation!!) Doctor said it all looks fine - no infection, no ear damage, just take sinus meds and it should be ok in a week. Now I have never seen this guy before, so I am assuming he is right.

It is now a week on, I think it is a bit better (or maybe I am just used to it now), but it still feels a little muffled. I called the clinic and the doc said that I would need to go for second opinion if I am not happy.

So, I have had ear infections before after diving- doesn't feel like that (no itchiness, goo etc) and I think hearing is a little better now. Is it worth me seeking out an ENT for more $$$ and being told the usual 'wait and it will heal'? isn't that what usually happens if one has damaged ear tissue diving?- what else could be causing the muflled hearing if it is not and infection or ear damage?

As always, I know that the best course of action is a doctor, I am just getting some opinions before making my own decsion- of course DAN told me to see an ENT.

 

[Dr. Doug Ebersole]

Ok- here's the score. I would like opinions from those who have been through this to help me make a decision.

went diving thanksgiving- somehow my sinus' got blocked- second day of diving was hard to clear, so I aborted the latter dives. Had no ear pain, but was blocked. came home and visited walk in clinic (currently have no insurance and dive/travel insurance would only cover if I had visited whilst on vacation!!) Doctor said it all looks fine - no infection, no ear damage, just take sinus meds and it should be ok in a week. Now I have never seen this guy before, so I am assuming he is right.

It is now a week on, I think it is a bit better (or maybe I am just used to it now), but it still feels a little muffled. I called the clinic and the doc said that I would need to go for second opinion if I am not happy.

So, I have had ear infections before after diving- doesn't feel like that (no itchiness, goo etc) and I think hearing is a little better now. Is it worth me seeking out an ENT for more $$$ and being told the usual 'wait and it will heal'? isn't that what usually happens if one has damaged ear tissue diving?- what else could be causing the muflled hearing if it is not and infection or ear damage?

As always, I know that the best course of action is a doctor, I am just getting some opinions before making my own decsion- of course DAN told me to see an ENT.

As a physician myself, I would STRONGLY advise you to go see an ENT. You may just have some fluid behind your tympanic membrane (ear drum) and need a longer course of decongestants, but don't take any chances!

 

[sharkdiver00]

What Debersole said....plus I know seveal people that will have an ear infection without any of the symptoms, not even the muffled hearing. Go to the ENT soon.

 

[simbrooks]

In the case around here, the ENT is a cheaper visit than a GP/family doc, i found out the annoying way last time around and think i might have to go back again as i might be infected once more - even using alcohol in my ears after the dives, what gives???

Go see the ENT, i am going to wait on mine a little while longer to see if it goes away before hitting the doc again.

 

[pipedope]

Seeing the ENT sooner is less expensive than seeing him (her) later.

There is an excellent streaming video at;
http://faculty.washington.edu/ekay/index.html

It will help a lot with your understanding of your ears and diving.

 

[munkispank]

thanks for the advise- I have done all the reading and had ear issues in the past, but I guess I don't know what to do about finding an ENT. I have called around my local area and no-one is accepting patients- and the walk in clinic was where I saw the other doctor who said it is all fine, do I just go to the emergency room?

Maybe I am just being impatient- the doctor who checked me out said he didn;t see anything wrong- what does an ENT do that is different?
Every other ear issue I have had has always been infection, so I don't know what to expect.

 

[simbrooks]

Just made my appointment for tomorrow, another $80 for the visit and i should be done. I hate paying this way, but i am back on PPO with co-pay next year (and watch me have no problems). It feels just like the ear infection i had a couple of months ago and stopped me diving back then, not pleased if i cant dive again for weeks.

 

[pipedope]

The trick is getting an ENT that is a diver and understands diving ears.

As a specialist the ENT sees a lot more ears than a GP and is more likely to catch something that is subtle.

Are you a DAN member?
Have you called DAN for a list of local diving ENTs?

 

[LubaScuba]

Sometimes, especially with slower descent, barotrauma of the middle ear can happen without much pain. If non-equilized ear is given a chance to very slowly compensate itself for increased ambient pressure (slow descent) it could eventually leak the fluid into the middle ear to reach the pressure equilibrium and no severe soft tissue injury (and hence no pain) or bleeding would then happen. Otoscopic finding might not reveal any bleeding but serous exudate might be found behind the eardrum. (Can be missed if ear drum is not fairly transparent or the examining physician has suboptimal light in the otoscope. Pneumatic otoscope is an advantage.) That would give conductive hearing impairment and feeling of fullness in the affected ear. Believe it or not but there are few divers who barotraumatise their ears this way on every single dive wandering why they feel fullness after every dive as they don't have any major equalizing difficulities (ie no pain). Those divers do not really open their Eustachian tubes, instead they somehow learned to descent slow enough (pain is a good buoyancy teacher) to prevent pain and bleeding while exudating the serous fluid into the middle ear cavity on the way down. That is certainly not recommended way to reach the pressure equilibrium as middle ear infection or even more severe complications such as cholesteatoma (destructive epithelial growth) for example might follow on a long run.
The exudate and mild soft tissue injury can be just one of the causes of painless hearing impairment. The malfunctioning (not venting) Eustachian tube is another one. After even mild barotrauma Eustachian tube might become 'lazier'. If it does not open frequently (happens normally even during the sleep) gas gets absorbed from the middle ear and 'vacuum' remains causing hearing impairment, exudation and even infection. Exudate and infection might further irritate the tube and make it even 'lazier ' which closes the vicious circle. Your physician might try to breake that circle with some venting method (so called Politzer method) and medications.
The bad option is inner ear barotrauma (oval/round window rupture) as it commonly leaves some hearing impairment (usually in upper frequenzy range). It is usually acompanied with tinnitus and vertigo but isolated hearing impairment and fullness might be the only symptoms. Surgery is sometimes benefitial. The possible inner ear barotrauma is the reason you need to see ENT specialist.


I am wandering...when you speak do you hear yourself louder in the affected ear or opposite is true?
Are there any crackling sounds coming occasionally from the affected ear? Try with yawning.
Is there any tinnitus (high pitch sound) when you are in your bed before sleeping?
Do you feel any dizzines with head movements?

 

[munkispank]

wow lubascuba- thats some good comments. I am going to call DAN for a name locally and have a check.
to anser your questions:
when you speak do you hear yourself louder in the affected ear or opposite is true?
Neihter actually- it seems the same for both
Are there any crackling sounds coming occasionally from the affected ear? Try with yawning.
Not anymore- had a bit of crackling on the first couple of days after diving, but nothing now.
Is there any tinnitus (high pitch sound) when you are in your bed before sleeping?
no- none of this
Do you feel any dizzines with head movements?
Again- I did a little the first two days or so (before I saw the doctor) but now I have nothing. I was also taking some sinutab so this made me a little dizzy.

so - I will check up local options and hopefully get an appointment for mon/tues. I will post my info as a when I have any updates.

simbrooks- thanks for posting your costing- I paid $128 for a regular doctors walk in and was told a specialist referral was going to cost around $350, hence my reticence. I am in the same boat insurance wise as since I moved I am 'between jobs" and have not yet signed onto a new plan.

I'll keep the board posted- thanks for al the advice