Ear Barotrauma

[BobbyV]

Hi all,

I took my first two cold water dives this weekend. I forgot to clear my hood, and I got a pretty good squeeze when I was ascending. I descended for a bit, equalized, then got out of the water immediately.

I went to my ENT today and she said that I have noticeable blood build up behind my ears consistent with barotrauma. She said there were no acute perforations, but that the build up was significant enough for a possible perforation on the left ear to occur. I don't have any real pain or significant hearing loss, just some popping now and then.

She mentioned that I should not dive for at least two weeks, but if it perforates that could put me out for months. This would be a big problem, considering my summer was going to be based around diving. Anyways, I am just wondering if there are any active measures I can take to reduce the chances of it perforating, or am I simply out of luck?

Thank you for your suggestions. I feel like a total idiot for not thinking of clearing my hood, I just hope it wasn't as costly a mistake as I think it is.

 

[doctormike]

Hi all,

I took my first two cold water dives this weekend. I forgot to clear my hood, and I got a pretty good squeeze when I was ascending. I descended for a bit, equalized, then got out of the water immediately.

I went to my ENT today and she said that I have noticeable blood build up behind my ears consistent with barotrauma. She said there were no acute perforations, but that the build up was significant enough for a possible perforation on the left ear to occur. I don't have any real pain or significant hearing loss, just some popping now and then.

She mentioned that I should not dive for at least two weeks, but if it perforates that could put me out for months. This would be a big problem, considering my summer was going to be based around diving. Anyways, I am just wondering if there are any active measures I can take to reduce the chances of it perforating, or am I simply out of luck?

Thank you for your suggestions. I feel like a total idiot for not thinking of clearing my hood, I just hope it wasn't as costly a mistake as I think it is.

Well, I'm not sure that I am quite understanding what your ENT doctor was saying - it's not like the eardrum is a brick wall that gets weaker with cumulative barotrauma until it eventually crumbles...

I assume that she meant is that your Eustachian tube may not be functioning well (based on the presence of bloody fluid behind the eardrum). Therefore, you may be at risk for perforation if you dive before you can equalize well again... I don't know if she suggested any sort of medication, decongestants, etc...?

No special tricks, just the usual advice about early and frequent equalization, and checking things out with a shallow pool dive to see if you can equalize before you try it for real...

I assume that you have seen this

Mike

 

[BobbyV]

Hi Dr. Mike,

Thanks for replying to my thread. I read through a lot of related posts including many you have commented on trying to get down to the bottom of my problem without kicking up too much old dust.

The bottom line was that they noticed some fluid and swelling (mostly in the left ear), claimed I had barotrauma, and that I was "at risk for perforation." I'd like to clarify a typo and say the doctor that saw me was not a ENT, rather a acute care general practitioner; sorry about the confusion with that.

I was not prescribed any medication, other than pain pills. I called DAN after the visit and the specialist their suggested I take sudafed or some other decongestant to try to clear out the fluid. They suggested to wait another 24 hours or so to see if there is any resolve, if not at that point schedule an appt. with a specialist.

As far as the meds go is sudafed the extent of it at this point or do you think I should seek out something else, e.g. steroids or antibiotics? (I don't feel any real pain, yet, just crackling and the left ear feels a little full).

 

[doctormike]

The bottom line was that they noticed some fluid and swelling (mostly in the left ear), claimed I had barotrauma, and that I was "at risk for perforation." I'd like to clarify a typo and say the doctor that saw me was not a ENT, rather a acute care general practitioner; sorry about the confusion with that.

That's what I figured, but I didn't want to say..! The ear is sort of a "black box" for most other doctors, even very well trained and smart ones. But she is correct, you can get a perforated eardrum if you dive without the ability to equalize.

I was not prescribed any medication, other than pain pills. I called DAN after the visit and the specialist their suggested I take sudafed or some other decongestant to try to clear out the fluid. They suggested to wait another 24 hours or so to see if there is any resolve, if not at that point schedule an appt. with a specialist.

As far as the meds go is sudafed the extent of it at this point or do you think I should seek out something else, e.g. steroids or antibiotics? (I don't feel any real pain, yet, just crackling and the left ear feels a little full).

Well, this is controversial... there isn't much evidence that sudafed, nasal sprays, or antihistamines have much of an effect. Steroids probably do, but you might not want to take those because of the side effects. Gentle valsalva (ET maneuvers) should help the fluid clear with time... But you might want to see an ENT doctor.

Keep us posted!

Mike

 

[NTSilver]

Doesn't hearing loss usually accompany ear barotrauma? I have ear issues and am always popping etc. after a lot of diving. However, I have only had ear barotrauma once - I had severe hearing loss in one ear that cleared up with steroids. I did NOT have a perforation. However, it would have been uncomfortable to dive at that point, and two weeks seems like a good timeframe. Since I started wearing a hood to try to keep cold water away from my ears I have never had another issue. As Mike said, and ENT visit would probably be best.
BTW, what prompted you to go to the doctor? Was your ear hurting?

 

[doctormike]

Doesn't hearing loss usually accompany ear barotrauma? I have ear issues and am always popping etc. after a lot of diving.

Barotrauma is a general term referring to any sort of injury to the ear related to a pressure change which is not accompanied by appropriate equalization.

This can result in a number of problems, ranging from fluid/blood in the ear causing a conductive (temporary) hearing loss up to a leak of inner ear fluid leading to a potentially permanent nerve hearing loss. Patients with lesser degrees of barotrauma may only have a clogged sensation, but hearing can occasionally be normal...

 

[BobbyV]

I have noticed very subtle, if any hearing loss in the left ear. More of what I hear referred to as a very slight "autophone" affect (like a very, very light version of what it sounds like to close of your ear with a finger) The ear is still popping a little louder than usual when I swallow. All in all, though, it doesn't really feel that bad. No vertigo, dizziness, nausea, or real pain.

On a side note, I think that I have pretty tight Eustachian tubes. The reason I say this is that it is nearly impossible for me to fully equalize underwater by jaw movement or swallowing. I have to give a pretty substantial valsalva before I get the reassuring "squeak." For this reason I am a bit nervous about trying to do it until the ear clears up. Notwithstanding, I can feel the Eustachian tubes pop when I move my jaw or yawn, so it doesn't feel like they are closed up.

I really want to continue diving (very soon) but I am a little perplexed by the preliminary diagnosis, and neither do I want to do something potentially more damaging to myself. I think you all are right in that an ENT is in short order.

 

[BobbyV]

Hi again,

I figured I would post a follow-up since a lot has progressed since the initial problems. I got clearance by my doctor late last week, and I am happy to say that today I was certified and did two dives to ~60 feet pain free today.

I just wanted to post a few suggestions to anyone having trouble clearing who may be like me and have tight eustachian tubes...

1. If you have no physiological issues prescribed by your doctor, you might just not be trying to equalize with enough pressure (Otherwise known as ear fear, as it is described by Edmond Kay, M.D. Doc's Diving Medicine Home Page)

2. You may have to listen for the characteristic "squeek" or "rushing air" sound in your ear that accompanies middle ear pressurization. For some people including myself, feeling the pressure from blowing may not be enough. You may need to listen for the squeek! However, obviously don't overdo it. Experiment with the minimum pressure needed to get good, safe equalization.

I made the mistake of thinking the "crackling" sound achieved just by moving my jaw out of water was enough (similar to what you might do if you are going up in an elevator.) It's not, for me at least. I have to hear the "squeek" or "rushing air" before my ears will feel okay while descending underwater.

Either way, don't force it...ascend a few feet if its not working with the first try.

3. Definitely practice equalizing on land, several times before the dive

4. I found some benefit of doing some neck stretches (tilting head to the left or right) before the dive.

4. Keep your head up underwater when you are trying to equalize. This elongates the eustachian tubes and allows for easier clearing.

5. Equalize before submerging or a foot or two underwater

6. If you have a problem ear, ascend a few feet, then tilt the problem ear upward, and try equalizing again.

7. Equalize often and BEFORE you feel strong pressure

8. Ascend slowwwly and maybe wiggle the jaw if you have to to ensure air can escape. Don't pressurize on ascent. This is reverse logic as the air expands when you surface.

9. If you are diving with a hood, check it for tightness and if needed clear it of air pockets by letting some water in.


Maybe all of the experts out there can verify these tips.

 

[denniscloutier]

I haven't done much cold water diving, so I'm probably missing something here. What do you mean by "clearing my hood"?

Thanks,
Dennis

 

[BobbyV]

Opening the hood so water can get in... sometimes pockets of air can get trapped in a tight hood, and exacerbate equalization issues.