Ear drops to help equalize?

[doctormike]

Wow, a flame war about ear drops..! OK, I'm an ENT doc, so I HAVE to get in on this...




ENT points:

1) People often are inexact when they use the term "equalization". To a non-medical diving audience, this may refer to anything they do to relieve a feeling of fullness in the ear. They may be re-ventilating the middle ear (the space behind the eardrum), or they may be draining the outer ear (the space outside the eardrum), and having similar subjective sensations.

2) Obstruction in the outer ear - from earwax, osteomas ("surfer's ear"), foreign bodies (e.g. earplugs) - can impact on the ability of a diver to clear the middle ear space. True equalization generally relies on the eardrum moving outwards, since the other walls of the middle ear are unyielding bone. This is usually associated with the opening of the Eustachian tube (the natural drainage pathway of the ear). SO, if there is something that is blocking the eardrum from moving, theoretically this could make equalization more difficult. One could imagine a situation where a partially blocked outer ear combines with water to cause this problem - to be relieved when the water drains out (maybe with eardrops). Not a very common scenario, but I think that BKP's statement that the eardrops help him equalize could have scientific basis in this way. Of course, point 1 still applies, and it doesn't take much movement of the drum to allow for ventilation...

3) Nasal steroids (e.g. Flonase) are good for for nasal obstruction due to allergies or other types of congestion, but have not been shown to affect the function of the Eustachian tube. In fact, in children, even decongestants like Afrin and Sudafed have not been shown to be helpful for middle ear fluid (OME): Practice Guidelines - June 15, 2004 - American Family Physician

4) Since there isn't a lot of literature on this in adults, and since I don't get to dive very often, if my ear locks up on a dive trip, I take decongestants and steroids (no WAY I'm missing a precious dive unless it's absolutely necessary!). Steroids are controversial and have side effects, so I'm reluctant to prescribe them for others.

5) Doctors make TERRIBLE patients.



Now a Web forum point:

Despite the fact that I think that BKP may be right on one level, he has written a few troubling phrases which seem to have caused some bad feelings:

"Look Bill. Frankly, I don't know what your problem is"
"Now I *do* see what your problem is, Bill... You need need to get a life."
"Happy? If not, feel free to write another novelette. "

And while Bill has also responded at one point in a somewhat confrontational manner, I think that BKP has him beat here... even given Bill's "novellette"...



SO, I hope that you all won't turn on me for getting in the middle of this. I really like ScubaBoard, and you both clearly care a lot about diving and helping other people (that's why we post here, right?)...



Bonaire... here I come!

Mike

 

[BKP]

Bill,

Credentials posted in a bio do not necessarily impress me, either. As you correctly stated they can be exhaggerated, or just completely fictionalized. I'm not the one that asked: "...How do you verfiy those credentials?..."

Further, I agree with both you and DocV that content and common sense often take precedence over credentials, anyway (and excuse me for paraphrasing, however, I believe that was the gist of your contention).

Even *more* importantly, I agree with you (and DocV) that there are a number of sub-forums where fact and opinion have to be distinguished, Dive Medicine being one of them. This is where credentials *do* apply. If you lead readers to believe that you have the credentials/training/background to offer conclusive summation on a topic, then you had better be trained on that topic. Anything else, along with my post, as I am *not* medically trained (and have repeated that multiple times), by default become simply a personal observation, as in my own case, and obviously not forwarded as medical advice or fact.

A simple: "...that's interesting that you seemed to experience a drops/equalization correspondence, even though it's not medically viable..." would have sufficed, and I would have nodded my head, and yielded to a more knowledgeable authority, without another word typed.
If everyone on this board were to restrict comments or observations or opinions to only those topics on which they had years of training, this would be one dull place. However, along with that comes a responsibility to make it clear either via the profile (which is why it's there, and which is why I *do* list my background), or admonition in the post that their comments (and mine in this case), are personal observation, whether clinically valid or not.
Don, not you, actually had the good sense to question it by asking if I had been checked by an ENT... that perhaps there was another principle at work outside of the drops. All you did was besmirch.

I'm a computer consultant. I make that clear in my bio. If I offered observations on best practices for systems and storage virtualization management in a bladed ESX 3.5 environment with a fiber SAN back end, I would expect that to be taken as an authoratative observation based on *fact*.
When you leave your bio empty, and then make authoratative commentary, no one can make the above determination about you. This is all Don meant, by suggesting you fill out your profile. Instead you chose to express your 'concern...' and again condescend.

I appreciate DocVikingo's comments above, and completely agree with them on many levels.
I don't take his comments personally, since I think they're universal, and simply good practice.

As for your comments, I did "get it." However, when you begin making assertions that I 'contradicted' an authority, or when you become as blatantly condescending as you did in post #18, then expect pushback.

Bottom line, yes, I've read what I'll take as fact from those that are certainly better informed than me, on this topic. In fact, I've learned something, and if the drops no longer work, than my placebo is now shot all to hell...

EDIT: doctormike: You're absolutely right. I'm capable of getting my dander up when I feel patronized, or condescended...
Along those lines, let me be the first to retract the confrontational statements... Consider my wrist slapped, and duly accepted...

 

[doctormike]

EDIT: doctormike: You're absolutely right. I'm capable of getting my dander up when I feel patronized, or condescended...
Along those lines, let me be the first to retract the confrontational statements... Consider my wrist slapped, and duly accepted...

heheheh... Thanks! I hope that I didn't overstep any bounds of behavior there myself...



It was obvious that you meant well, and were posting to help. AND, as is frequently the case in medicine, the observation that something works often comes long before someone figures out why it works!

Take care,

Mike

 

[TravelDave]

As a followup to my original post, did 16 dives on this trip, didn't use Sudafed, and had no problems clearing. It's good to have figured out that I didn't need the stuff.

Sorry to stir up so much drama.

Dave

 

[DandyDon]

Drama happens Glad it worked out.
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