Ears - what to do next?

[islanddream]

I was diving in Cozumel from April 6 - 12 and did about 18 dives. When I left for vacation I had a bit of a cough and some congestion but attributed it to allergies. While diving I was able to clear my ears with no problem. On one dive my right ear started to hurt (at about 80 ft) and once I got to about 60 feet it stopped hurting. During the week I still continued to cough and had some congestion. I always take a decongestant and spray Afrin in my nose prior to dives. (An ENT recommended this years ago.) It's not unusual for my ears to act up after a dive trip and most times I end up with an infection.

During the week I could feel water in my ears but seemed to get it out by tipping my head to the side and shaking it out. Upon arriving home on Saturday, both ears became plugged but there was no pain. By Monday my ears were very plugged and got in to see the PA (my dr. not available) on Tuesday afternoon. She saw water in my ears, redness, and puss. She put me on Cefdinir300 mg capsules and a Methylprednisolone 4 mg dosepak. Both meds were for only five days. By the fifth day the hearing in my left ear improved but my right ear got worse. I went back to the doctor (my internist) this last Monday and my left ear had a little bit of infection but my right ear was very infected and had puss. I'm now on Amox Tr-K CLV 875 -125 mg. tablet every 12 hours for 10 days. I'm taking one Mucinex D tablet in the morning. I'm also doing a nasal rinse every evening and using Flomax right after. My right ear is very plugged and I have very little hearing in it. My doctor said it could take up to two weeks for my ears to get back to normal and if they aren't I'm to see an ENT.

My question: Do you believe I'm taking the correct meds at this time? I've been on them for four days now and have no improvement in my right ear. Should I see the ENT sooner?

And suggestions you can give me will really be appreciated! Thanks!

 

[JohnN]

I was diving in Cozumel from April 6 - 12 and did about 18 dives. When I left for vacation I had a bit of a cough and some congestion but attributed it to allergies. While diving I was able to clear my ears with no problem. On one dive my right ear started to hurt (at about 80 ft) and once I got to about 60 feet it stopped hurting. During the week I still continued to cough and had some congestion. I always take a decongestant and spray Afrin in my nose prior to dives. (An ENT recommended this years ago.) It's not unusual for my ears to act up after a dive trip and most times I end up with an infection.

During the week I could feel water in my ears but seemed to get it out by tipping my head to the side and shaking it out. Upon arriving home on Saturday, both ears became plugged but there was no pain. By Monday my ears were very plugged and got in to see the PA (my dr. not available) on Tuesday afternoon. She saw water in my ears, redness, and puss. She put me on Cefdinir300 mg capsules and a Methylprednisolone 4 mg dosepak. Both meds were for only five days. By the fifth day the hearing in my left ear improved but my right ear got worse. I went back to the doctor (my internist) this last Monday and my left ear had a little bit of infection but my right ear was very infected and had puss. I'm now on Amox Tr-K CLV 875 -125 mg. tablet every 12 hours for 10 days. I'm taking one Mucinex D tablet in the morning. I'm also doing a nasal rinse every evening and using Flomax right after. My right ear is very plugged and I have very little hearing in it. My doctor said it could take up to two weeks for my ears to get back to normal and if they aren't I'm to see an ENT.

My question: Do you believe I'm taking the correct meds at this time? I've been on them for four days now and have no improvement in my right ear. Should I see the ENT sooner?

And suggestions you can give me will really be appreciated! Thanks!

So you're asking someone based on imperfect information (your reports), to second guess your PCP who directly observed you?

If you're unhappy with your treatment, get another opinion.

 

[islanddream]

I'm sorry, JohnN, if you believe my information is not perfect. I posted this question here because I know there are doctors who specialize in ear problems associated with diving who are kind enough to answer questions on SB. My doctor is not a diver, nor does she specialize in dive medicine. I am not unhappy with her treatment. In reading replies on this forum that have to do with ear problems, I believe there are professionals who can respond with useful information....that's why I posted in the DIVING MEDICINE forum.

I don't believe snarky comments help anyone.

 

[t4e]

FWIW did you ever try rinsing your ears with medicinal alcohol after each dive?
the presence of puss indicates a middle ear infection due to germs getting in, the alcohol helps kill those germs before they set up camp, its worth a try

please note that i am not a doctor, just recommending something that kept us ear infection free

 

[islanddream]

FWIW did you ever try rinsing your ears with medicinal alcohol after each dive?

I haven't done that before but will start doing so during our next dive trip. An ounce of prevention......

 

[TSandM]

The problem is that I'm unsure from your report what kind of infection you have. HERE is an essay on ear problems in divers -- otitis externa is treated quite differently from otitis media, and involves a different bacterial spectrum. You should be aware, as well, that barotrauma can look very much like infection in the ear, and does not respond to antibiotics.

If you are not improving, and particularly if there is hearing loss in the affected ear, I'd request a referral to an ENT doc sooner rather than later.

 

[islanddream]

The problem is that I'm unsure from your report what kind of infection you have. HERE is an essay on ear problems in divers -- otitis externa is treated quite differently from otitis media, and involves a different bacterial spectrum. You should be aware, as well, that barotrauma can look very much like infection in the ear, and does not respond to antibiotics.

If you are not improving, and particularly if there is hearing loss in the affected ear, I'd request a referral to an ENT doc sooner rather than later.

Thanks, TSandM for the information. Since the hearing loss seems to be getting worse in the right ear, I will call my doctor tomorrow and ask her to refer me to the ENT she mentioned.

 

[doctormike]

Hi, Islanddream...

I think that it's totally reasonable to seek opinions in a dive medicine forum, even after an exam by a physician. It's hard to say this without sounding arrogant, but it is very rare to find a doctor who is not an ENT doc or a pediatrician who can accurately describe findings on otoscopy or diagnose ear disease. I know that most general doctors are far smarter than I am and know more than I will every know, but I also know that without a good cleaning of the ear canal, using ear instruments and an office microscope, and careful examination of the ear by someone with experience, you usually get an inaccurate diagnosis.

When someone reports that they were told that they had "water, redness and pus", that's pretty much a red flag for me that the doctor was not sure what they were looking at. There is a whole detailed discussion about the difference between middle and outer ear problems, how they have overlapping symptoms but are completely different - here is my article about that: http://www.rothschilddesign.com/ear_scuba

Here are a few quick points that may be helpful. See the article for a more thorough discussion.

1) Acute otitis media involves yellow pus behind the eardrum in the middle ear space. It is extremely rare in adults, even after diving. The ear looks yellow, not red. It is treated with antibiotics, which kills the bacteria but does not do anything to the leftover fluid, which may take weeks to resolve. Most diagnoses of AOM in adults are wrong.

2) Barotrauma results in blood or clear fluid behind the eardrum. It causes a temporary hearing loss, and may take weeks to resolve. It is treated with steroids, and less effectively with decongestants. Rarely, an office myringotomy (hole in the eardrum) may be done to relieve pain or hearing loss.

3) Outer ear problems (swimmer's ear) are a skin inflammation of the space outside of the eardrum. They are treated by careful cleaning of the ear canal, antibiotic/steroid drops, and may be prevented by those ear wash mixes (e.g. a pint of rubbing alcohol with a few tablespoons of white vinegar) or by using an ear dryer.

Good luck, and feel free to PM me if you want a local referral, I may be able to find you someone...

 

[islanddream]

Thanks so much, doctormike, for the valuable information. I will definitely read your article to help me understand the difference between middle and outer ear problems. Could a doctor (not ENT) be able to see clear fluid or blood behind the eardrum with the instrument she uses to look in my ears? Or is there a special instrument that the ENT uses to check for barotrauma?

I appreciate your offer to help find me a local referral. I'll definitely PM you if it comes to that point.

 

[CajunDiva]

and may be prevented by those ear wash mixes (e.g. a pint of rubbing alcohol with a few tablespoons of white vinegar) or by using an ear dryer.

I am so happy to see you write that I found out early in my diving days that I am susceptible to ear infections when diving. All of our diving is done in multi-day trips, and after a couple of days I was always battling water in my ears. I was taught to mix 50% Alcohol and 50% Vinegar in a squirt bottle and apply it to my ears after each dive.

Some people seem to think that's an old wive's tale, but for the last 450 dives since I learned this neat little trick I have had absolutely zero ear trouble.