Ear Barotrauma Over A Month

[Keda]

Hi, I'm new to diving and recently joined this forum due to a problem I encountered. On my last dive a month ago, I had problems equalizing, but I felt I eventually equalized well enough (obviously not). When I returned to the surface, my left ear felt full; my right ear for the most part did not as far as I can recall. I also noticed popping sounds whenever I swallowed. I called DAN and was told to give it a week, so I did. The next day the fullness seemed to be mostly gone, it no longer felt as though a cushion was being held by my ear, and after another week I felt as though the popping was less frequent. After some noise exposure however, I noticed I had tinnitus, no idea if it was there after the barotrauma and I just didn't notice it, or if it was a result of the noise exposure. Due to this new symptom I went to an ENT.

I had both a pure tone audiometry and tympanometry, both of which were fine....no hearing loss and responses to pressure fine. The ENT diagnosed me with middle ear barotrauma as he said the tinnitus was more likely from the noise exposure and as I suffered no hearing loss and my hearing was "perfect", it suggested my inner ear was fine. For both the barotrauma and tinnitus I was just told to wait it out.

It has been been 5 weeks now and while my right ear feels pretty normal, I still hear some popping/clicking when I swallow though much softer than in the beginning, but my left ear feels full compared to my right ear. In fact the feeling of fullness seems to run from my left nostril back. I am very concerned and the waiting game is just allowing my anxiety to swell. I keep worrying I've ended my diving career before it even started.

 

[DogDiver]

Go see an ent specialist

 

[wgw04024]

First, I'm not a Dr. I'm sure your ENT would of check, however, I'll tell you my experience when I started diving, not sure if it's in anyway related to yours.

When I started, I noticed during OW pool dives that my right ear would not drain properly for a few days. That seemed odd. Went to the ENT, who diagnosed me with 'wax in my ear'. He wanted to remove it in the office, and I flatly told him there was no way I could let someone put a dentist tool that far in my head without flinching. Long story short, i went back, under anesthesia, and they removed it. He said he had no way of knowing that it was 'so large', and I never would of survived having it done awake. After that, I have had zero ear issues while diving. Just throwing that out there.

Bill

 

[rsingler]

What you describe is on the end of the bell shaped curve, but not worrisome. With your tympanometry being normal, what you are likely noticing is the continued slow "working out" of serum that accumulated in your middle ear due to your clearing problems.
Your middle ear tried to compensate for the low pressure inside (from inadequate clearing) by filling up with the only thing it had available: extracellular fluid, or serum.

The fact that it's taking so long is a little concerning, but not "dive career ending". You've just discovered why "equalize early and often" is a mantra.

Yes, it's possible that you have a marginally performing Eustachian tube on the left, but it's good news that your tympanometry was normal. If the problem recurs after you improve your clearing technique, then there is a new outpatient procedure to widen a Eustachian tube that repeatedly blocks up.
But for now, I'd just be patient. It WILL stop clicking. Give it a month more, and work on very slow descents when you start diving again.

This is a frequent problem, to one degree or another. The vast majority of cases like yours stop happening with experience. It's more likely a technique thing, than an anatomy thing.

Diving Doc

 

[DandyDon]

Ask a pharmacist if you can legally get/have allergy medicines with pseudoephedrine. It's very helpful to many with equalizing, but prohibited in some countries as it's commonly used in illicit drug production. If you can have it, try it to see if it bothers you as some people don't handle it well. Many of us find it not a problem but essential for diving. If it doesn't bother you, then try it an hour before diving.

 

[Keda]

What you describe is on the end of the bell shaped curve, but not worrisome. With your tympanometry being normal, what you are likely noticing is the continued slow "working out" of serum that accumulated in your middle ear due to your clearing problems.
Your middle ear tried to compensate for the low pressure inside (from inadequate clearing) by filling up with the only thing it had available: extracellular fluid, or serum.

The fact that it's taking so long is a little concerning, but not "dive career ending". You've just discovered why "equalize early and often" is a mantra.

Yes, it's possible that you have a marginally performing Eustachian tube on the left, but it's good news that your tympanometry was normal. If the problem recurs after you improve your clearing technique, then there is a new outpatient procedure to widen a Eustachian tube that repeatedly blocks up.
But for now, I'd just be patient. It WILL stop clicking. Give it a month more, and work on very slow descents when you start diving again.

This is a frequent problem, to one degree or another. The vast majority of cases like yours stop happening with experience. It's more likely a technique thing, than an anatomy thing.

Diving Doc

What exactly do you mean by "ön the end of the bell shaped curve?". I never had problems equalizing before, I do it very often and employ three different techniques, i pinch and blow, swallow and also wiggle my jaw. I didn't use the line going down and believe maybe my descent was too fast. My anxiety about this honestly only increased after I noticed the tinnitus (which as I said I only noticed 2 weeks later after a concert). But this and the fact that a month later I still have symptoms suggest to me the barotrauma I suffered was severe and has me concerned about it possibly being inner ear barotrauma and I am beating myself up about potentially causing myself irreversible ear damage, and thoroughly freaked about diving in the future as I keep envisioning making it worse, and doing more damage. Though the audiologist and ENT said my results suggest I am fine to dive, the persisting clicking and tinnitus have me thoroughly freaked about diving, which for me as an aspiring marine researcher, has me contemplating if I need to consider a career change, as I don't want to make things worse. I don't know if my level of worry is above and beyond the level of my situation or not. I just feel very stupid and worried at the moment.

 

[rsingler]

I didn't mean to alarm you. What I meant was that having the clicking a full month out is just a little uncommon. Hence my "bell-shaped curve" comment regarding statistics. It sounds as though you have a good range of techniques to equalize, and the results of your tympanography probably indicate that you don't have residual structural damage to the eardrum. If your acuity is still good then it's unlikely you caused yourself any damage at all. The tinnitus you have ascribed to the concert, which seems reasonable. I presume that has finally disappeared. The clicking will too.

My only suggestion is for you to equalize earlier and more often, with a comment that that doesn't mean more forcefully, just more often. I'm willing to bet that you'll do just fine in the future. Some temporary clicking is common for all of us, from a little accumulated Eustachian sea water after a series of dives. It usually resolves in a week. If yours recurs and lasts longer, I'd go back to your ENT and ask for him to evaluate your anatomy. But that will probably turn out to be unnecessary as you gain experience.

Notwithstanding others comments, I am NOT a fan of pseudoephedrine, because while it is very effective, it has a short half life. As a rescue drug it is effective, but it is not advisable for regular use, and can be associated with rebound stuffiness. Oxymetazoline (Afrin) is much longer acting, but again should only be a rescue to help clear up after a problematic series of dives, and not to keep your ears open to keep diving. My 2¢.

 

[Duke Dive Medicine]

Hi, I'm new to diving and recently joined this forum due to a problem I encountered. On my last dive a month ago, I had problems equalizing, but I felt I eventually equalized well enough (obviously not). When I returned to the surface, my left ear felt full; my right ear for the most part did not as far as I can recall. I also noticed popping sounds whenever I swallowed. I called DAN and was told to give it a week, so I did. The next day the fullness seemed to be mostly gone, it no longer felt as though a cushion was being held by my ear, and after another week I felt as though the popping was less frequent. After some noise exposure however, I noticed I had tinnitus, no idea if it was there after the barotrauma and I just didn't notice it, or if it was a result of the noise exposure. Due to this new symptom I went to an ENT.

I had both a pure tone audiometry and tympanometry, both of which were fine....no hearing loss and responses to pressure fine. The ENT diagnosed me with middle ear barotrauma as he said the tinnitus was more likely from the noise exposure and as I suffered no hearing loss and my hearing was "perfect", it suggested my inner ear was fine. For both the barotrauma and tinnitus I was just told to wait it out.

It has been been 5 weeks now and while my right ear feels pretty normal, I still hear some popping/clicking when I swallow though much softer than in the beginning, but my left ear feels full compared to my right ear. In fact the feeling of fullness seems to run from my left nostril back. I am very concerned and the waiting game is just allowing my anxiety to swell. I keep worrying I've ended my diving career before it even started.

Keda,

I don't have much to add to what @rsingler said, but from your description, it doesn't sound like you did any permanent damage. The inflammation after barotrauma can take a while to subside - I wonder if it wasn't inflammation that made your inner ear more sensitive and resulted in the tinnitus you experienced after the noise exposure. Just for clarification, noise exposure can result in transient tinnitus anyway... was this an unusually loud exposure for you, or did noise that you're used to being around produce the tinnitus unexpectedly?

Best regards,
DDM

 

[Keda]

Keda,

I don't have much to add to what @rsingler said, but from your description, it doesn't sound like you did any permanent damage. The inflammation after barotrauma can take a while to subside - I wonder if it wasn't inflammation that made your inner ear more sensitive and resulted in the tinnitus you experienced after the noise exposure. Just for clarification, noise exposure can result in transient tinnitus anyway... was this an unusually loud exposure for you, or did noise that you're used to being around produce the tinnitus unexpectedly?

Best regards,
DDM

Yes, you could consider this an unusually loud exposure for me as I was quite close to the speakers. Though I have been close to speakers before at such events it has been very seldom and many moons ago, so I didn't think too much of it.

 

[icechip]

Keda,
I think I may be going through the same thing. About three weeks or so ago, I was just swimming and had some wax blockage, especially in the left ear. Had the ears flushed at my primary doc but still had a muffled left ear. Also felt like my cheek was sore (like when I have a sinus cold during the winter or something). Did some diving after that and had no issues clearing for depth but lots of crackles and pops in the left when I ascended. Left ear still muffled. Went to an ENT and they had me do a hearing test and put me on a steroid and augmentin. I was worried that I might have frigged my ear for diving. The test showed the left ear hearing was indeed less (because it is still somewhat muffled). Since then I've been hearing crackling and popping in the left as it is trying to breakup and release. And at times it does pop clear, but then gums up again. Slow process, but it is getting better.