Ear issues

[tridacna]

I did a one person test of Earshield on a recent trip. I warmed it up, shook it and sprayed my left ear only with Earshield before each dive. 17 dives later, it was apparent to me that there was no difference to me in terms of water drainage or comfort. Maybe it helps others. For my n=1 biased test, I found no benefit.

 

[doctormike]

Here you go!

 

[LI-er]

Well written article, but again it's stated that cotton tipped applicators should never be used because of possible problems- yet you've got all these divers using them all the time, including myself, with no problems.

I just picked up one of those ear cleaning devices that have a soft mini scoop at the tip along with a camera so you can see inside your ear and remove what doesn't belong. According to thousands of reviews, many people have benefited.

I haven't seen any reports of injury or damage from sticking things in the ear. I'm sure it happens just not all that much, certainly not enough to say "NEVER DO IT!".

It's like saying don't drive a car or use a power tool because you could have an accident.

The tools are there, they just need to be used properly.

I will ask @doctormike how often he treats patients who have damaged their ears with a Q-tip, versus how many patients say they use Q-tips regularly and are advised not to. My bet is more people are killed or seriously injured by falling vending machines than Q-tips causing ear damage.

 

[flymolo]

i put a couple drops of 50/50 mix of white vinegar and rubbing alcohol in my ears after each time i dive in freshwater. for saltwater i don't do much, however if i am staying somewhere warm and my room has a fan i opt to use that over the air conditioner as i find sleeping with the air conditioner on all night seems to cause a lot of congestion.

i used to use q-tips pretty religiously until i got an ear infection that caused me to miss a couple dives so i stopped using them

 

[rsingler]

I haven't seen any reports of injury or damage from sticking things in the ear. I'm sure it happens just not all that much, certainly not enough to say "NEVER DO IT!".
...My bet is more people are killed or seriously injured by falling vending machines than Q-tips causing ear damage.

Your professional opinion, @doctormike ?

During my own training, it was hard enough to use a thin wire ear curette without pushing things deeper into the outer ear canal while I was watching through the otoscope.
A Q-tip is simply huge, by comparison.

 

[doctormike]

I haven't seen any reports of injury or damage from sticking things in the ear. I'm sure it happens just not all that much, certainly not enough to say "NEVER DO IT!".

Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments - PubMed

Otologic complications of cotton swab use: one institution's experience - PubMed

There you go. Now you have.

It's like saying don't drive a car or use a power tool because you could have an accident.

No, it's like saying don't use a power tool to clean out your earwax, because that's not what it's designed for.

The tools are there, they just need to be used properly.

I will ask @doctormike how often he treats patients who have damaged their ears with a Q-tip, versus how many patients say they use Q-tips regularly and are advised not to. My bet is more people are killed or seriously injured by falling vending machines than Q-tips causing ear damage.

I will take that bet.

 

[doctormike]

And just to clarify one more thing, for people who may be reading this thread.

People focus on tympanic membrane perforations. While that's possible with any instrumentation of the ear, it's actually less likely with a cotton tipped applicator given the dimensions of the tip and the size of the tympanic membranes. This is actually more of a concern with the little curette tips that come with those $35 video otoscopes that you can buy on Amazon. Here's my take on those...

But remember, tympanic membrane perforations generally heal on their own, are usually associated with a minor hearing loss, and in the worst case scenario, they can be surgically repaired.

What CAN happen with instrumenting the ear, and which I have personally seen, is an inner ear pressure injury. It just takes a little pressure on the malleus to transmit energy to the stapes footplate. And that can cause a permanent, complete and unrepairable hearing loss.

There is no ear police. Do what you want to do. I'm just giving advice. But the idea that something is safe because a lot of people have done it with no issues is the very definition of normalization of deviance. Lots of people used to dive deep air, with no problems....

 

[tridacna]

 

[Rj516]

And just to clarify one more thing, for people who may be reading this thread.

People focus on tympanic membrane perforations. While that's possible with any instrumentation of the ear, it's actually less likely with a cotton tipped applicator given the dimensions of the tip and the size of the tympanic membranes. This is actually more of a concern with the little curette tips that come with those $35 video otoscopes that you can buy on Amazon. Here's my take on those...

But remember, tympanic membrane perforations generally heal on their own, are usually associated with a minor hearing loss, and in the worst case scenario, they can be surgically repaired.

What CAN happen with instrumenting the ear, and which I have personally seen, is an inner ear pressure injury. It just takes a little pressure on the malleus to transmit energy to the stapes footplate. And that can cause a permanent, complete and unrepairable hearing loss.

There is no ear police. Do what you want to do. I'm just giving advice. But the idea that something is safe because a lot of people have done it with no issues is the very definition of normalization of deviance. Lots of people used to dive deep air, with no problems....

Hi doctor mike, Can this inner ear pressure injury happen without an eardrum perforation too? Because if malleus transmits energy to the stapes footplate and causing inner ear related hearing loss, then ear irrigations are also very risky as doctors,nurses etc. cant really control the pressure (especially when they do it with a 60-100ml giant syringe). The weird thing is i have never seen many research on ear irrigation safety. Many researches dont even add ear irrigation to possible barotrauma reasons even though i see a lot of people on forums who experience similar symptoms to barotrauma after ear irrigations.

 

[doctormike]

Hi doctor mike, Can this inner ear pressure injury happen without an eardrum perforation too? Because if malleus transmits energy to the stapes footplate and causing inner ear related hearing loss, then ear irrigations are also very risky as doctors,nurses etc. cant really control the pressure (especially when they do it with a 60-100ml giant syringe). The weird thing is i have never seen many research on ear irrigation safety. Many researches dont even add ear irrigation to possible barotrauma reasons even though i see a lot of people on forums who experience similar symptoms to barotrauma after ear irrigations.

Good question.

I personally don't do ear irrigation for similar reasons - concerns about injury, but not specifically inner ear injury. In my case, I'm usually trying to remove the earwax from a struggling 3 year old, so the considerations are a little different. I just feel more comfortable removing the wax under direct vision with a microscope and surgical tools. This is NOT an easy thing to do, and it's one of the harder things to teach to residents. But it can almost always be done safely if you have the right equipment and experience.

To be fair, ear irrigation is incredibly common, and I had never heard of an inner ear injury related to this. But because you asked I looked at PubMed, and I was actually able to find a single case report of something like that!

Permanent Facial Paralysis and Hearing Loss After Aural Irrigation

Unfortunately, the article itself is behind a paywall, and I would have to wait until I am back on campus to read it. But there was a link to a response to that article (also behind a paywall), which implies that both the original case and a case handled by the authors of the response article may have had an infectious component:

The Risks of Aural Irrigation

So the bottom line is that while I don't like ear irrigation in my own practice, it's probably fairly low risk (especially in terms of inner ear injury) if done correctly and without excessive pressures.