Eardrum 'flutter' exacerbated by cold water

[Jax]

I am raising this question in this forum because the middle of south Arizona doesn't have diving doctors, and none that I've seen (two military GP / NP and 1 ENT) have a clue. I'm hoping someone has heard of it.

Symtom
I have an intermittent 'fluttering' (eardrum spasm?) in my ears, predominantly the left ear. It's as if the eardrum was 'popping' 6 or 7 times in rapid succession. It is definitely intermittent, but happens more often upon exposure to water. You can duplicate the sensation by putting your palm over you ear and rapidly pressing and releasing without letting air escape.

I swim 4-5 times a week on dr's order for my back. (not related, but water exposure.)

Background
First instance was in '98. At first, doc thought it was just some kind of cold and gave me some strong decongestants. A follow-up showed fluid behind the drum in one of my ears; he gave me anti-biotics, and it went away.

I had maybe 3 or 4 episodes since then that cleared up after a couple of weeks by itself.

Sep 09, I was swimming in Mexico and tried to snort the Sea of Cortez, thoroughly rinsing my sinuses. (wave caught me by surprise). Shortly thereafter, I had significant tinnitus in the left ear and increased tinnitus in the right. (had some already, but faint) Then the fluttering started. I thought I might have picked up something from the water.

Since then, I saw the GP & NP and ENT. We tried various things, and I went through a whole battery of tests for allergies. (mostly because I react to the Flonase after five days) Zilch allergies. ENT says my ears look 'beautiful', and he sees nothing wrong. Hearing tests show some slight decrease, but the . . . "audio reflex"? where they test the flexibility in your eardrum? . . . showed the right ear at 1.3 and the left ear at .6. Again, the ENT saw no problem with that . . . :w-t-f:

Currently
I am on Flonase for it . . . it seems to help, but the fluttering hasn't stopped nor is it going away. I still have no fluid behind the ear. I also take sudafed. I always use the 1/3 alcohol, 1/3 vinegar, and 1/3 distilled water in my ears after swimming or diving.

Has anyone heard of anything like this? I hate it that everyone is just saying, "you look fine, don't worry".

 

[Bubbletrubble]

It sounds to me like you have experienced more than one ear-related condition.

When you had fluid behind the ear drum which was successfully treated with antibiotics, you almost certainly had a middle ear infection (otitis media).

When you accidentally snorted water in the Sea of Cortez, you probably irritated the lining of the Eustachian tube, which led to some form of Eustachian tube "dysfunction." Chronic Eustachian tube dysfunction is often instigated by allergies. For this reason, it's not surprising that your medical team explored intervention along these lines. It's entirely possible that when you're swimming or diving, you are accidentally introducing water into the middle ear space, which causes irritation/inflammation leading to "ear fluttering" symptoms. Perhaps you just need to pay more attention to keeping water out of this space. While scuba diving, you could keep the reg in your mouth at the surface. For shore dives necessitating a long surface swim, a snorkel might be helpful. While swimming for exercise, you may have to work on your technique a little.

Something to keep in mind is that if you have a propensity for accumulating fluid in the middle ear (due to water exposure or allergies), this will increase the likelihood of a middle ear infection. Seek medical treatment when this occurs.

In rare cases, Eustachian tube blockage is caused by some anatomical anomaly, such as nasal polyps, a cleft palate, or a skull base tumor. In these cases, surgical intervention might be appropriate. I mention this not because I think you have any of these conditions but to make the point that anatomy can play a role in Eustachian tube dysfunction.

FYI, "ear beer" treatment (alcohol:vinegar:water mix) is a preventative measure intended to protect against infection of the outer ear (otitis externa or "swimmer's ear"). It shouldn't affect anything behind the tympanic membrane so long as the ear drum isn't perforated. Alternatively, you could try wearing Doc's Pro Plugs. Some swimmers have found it helpful in reducing the incidence of outer ear infection. I'm skeptical of the the manufacturer's claims that the product helps with ear equalization. YMMV.

Hope this helps...

 

[Jax]

Thanks -- I'm hoping someone has heard of this before.

The outer ear looks great -- no doubt about it. No outer ear infection ever, that I know of. I do not have a propensity for accumulating fluid in the middle ear. Insufficient diving to make any difference (4 trips a year).

The swimming, for an hour per day, since June 09. I only mention it because I almost always have fluttering episodes during the 2-3 hours following a swim.

 

[Bubbletrubble]

The outer ear looks great -- no doubt about it. No outer ear infection ever, that I know of.

Otitis externa is very common in swimmers. It's possible for people to be afflicted with an outer ear infection, not really be aware of it, and have it resolve on its own. One common symptom of otitis externa is "itchiness" of the ear. Water pooling in the external auditory canal will increase the incidence of infection. Many patients with an outer ear infection will also complain of pain upon gentle tugging of the ear lobe. YMMV.

I do not have a propensity for accumulating fluid in the middle ear. Insufficient diving to make any difference (4 trips a year).

To clarify, getting a teensy bit of water (salt or fresh) in the middle ear or just having allergies can initiate an inflammatory process which causes other "fluid" to accumulate in the middle ear. Sorry for the misunderstanding.

That being said, if you are diving infrequently and you have a history of ear issues, I would take precautions to guard against middle ear barotrauma when diving, e.g., descend slowly, equalize early/often, pre-pressurize at the surface, etc.

The swimming, for an hour per day, since June 09. I only mention it because I almost always have fluttering episodes during the 2-3 hours following a swim.

Did your ENT ever examine you while you were experiencing a fluttering episode? If not, it would make sense to induce the fluttering and then have him examine you in a timely manner.

If you can reliably reproduce the ear fluttering episode, why not go swimming right before an ENT appointment? With a simple otoscopy exam, the physician should be able to rule out any fluid accumulation in the outer ear. If it's not there, then it's probably in the middle ear.

Alternatively, you can use ear plugs that reliably dam up the ear canal. If you still experience the "fluttering" after removing the plugs post-swim, then you can probably rule out causes involving the external ear.

It might be helpful to take notes on when the symptoms seem to occur (an ear fluttering diary), i.e., how long after swimming the fluttering occurs, wearing ear plugs or not, doing certain strokes, etc. Sharing this kind of info with your ENT can facilitate diagnosis.

Be patient and I think you'll get to the bottom of this...

 

[Jax]

BT, I appreciate what you're saying . . . I am saying the docs that checked all this out; I've done the 'swim first' thing. I haven't tried sealing the ears with plugs . . . missed that BFO.

No history of ear issues except this one.

I'm just hoping some diver docs have heard of this sometime, somewhere.

This is the closest I've seen that describes my symptoms is http://forums.webmd.com/.eec29de.

One med board named something called "tensor tympani muscle spasm", but further research seems to rule that out as I have zero sensitivity to loud noise nor is there a popping sound.

Thanks for your help!

 

[Bubbletrubble]

Tensor tympani syndrome (TTS), or stapedial myoclonus, could be occurring secondary to irritation of the middle ear. Patients with chronic TTS have found relief via surgical intervention. However, I doubt that any ENT would advise surgery as a reasonable treatment option for your case. Physicians can also manage the condition medically with muscle relaxants, but I don't think you'd want to be taking those kinds of meds after every swim.

[-]BTW, the link in your previous post is broken.[/-] [Edited later: Thanks for fixing the link.]

 

[Jax]

Tensor tympani myoclonus or stapedial myoclonus could be occurring secondary to irritation of the middle ear.

BTW, the link in your previous post is broken.

Link fixed.

That's why I brought this up on this board. The local ENT pretty much blew off that I had an issue.

 

[Bubbletrubble]

@Jax: You may want to PM doctormike about this. He's a Diving Medicine moderator here on SB and a practicing pediatric ENT.

 

[Bubbletrubble]

BT, I appreciate what you're saying . . . I am saying the docs that checked all this out; I've done the 'swim first' thing. I haven't tried sealing the ears with plugs . . . missed that BFO.

I want to make it clear that you should only wear ear plugs when swimming at the surface. Do not wear ear plugs while diving. The one exception to this may be Doc's Pro Plugs.

Good luck...

 

[Jax]

Yes, thank you.