First time...

[DeepSeaDan]

... this has ever happened to me. Over 36 years of diving, I've not routinely dried my ears post-dive; the exception being saturation diving, where daily use of Domeboro Otic Solution was mandated. I know I should dry them post-dive, but never formed the habit, and until now, never suffered a consequence...

Was teaching advanced & a night specialty up in terrific Tobermory Ontario last weekend. Was in the water the better part of 10 hours over 3 days. As usual, I neglected to dry my ears after diving. On the way home Sunday evening my right ear started to ache. Initially, the symptoms were indicative of "Otis Externa" ( swimmer's ear ), but the following day, I began to experience a "fullness" of the right ear, along with pressure & pain, thus leading me to suspect an inner ear infection might be present as well. The next day my physician confirmed my suspicions, prescribing meds. for both conditions.

One thing I did several times over the weekend's diving was to sip some tasty Georgian Bay water, to alleviate the cursed compressed-air / dry-mouth syndrome. So here's my question: Do you think it possible I might have introduced a bacterium ( from the water I sipped ) into my inner ear? Methinks it might have travelled up a eustachian tube during an ear-clear ( I'm lucky - I don't have to honk to clear, simple tongue-to-roof-of-mouth compression will do it for me ).

I should mention also that at the time of this writing, I am feeling like a cold infection is working on me ( severe fatigue, scratchy throat ), thus I'm now pondering the idea that the inner ear issue might be a product of a virus.

I await your learned wisdom!

Regards,
DSD

( BTW, regardless, I'm a now going to change my ways & treat my ears properly post-dive! I am missing some dives right now due to this ear problem, and that SUCKS!!! ).

 

[doctormike]

... this has ever happened to me. Over 36 years of diving, I've not routinely dried my ears post-dive; the exception being saturation diving, where daily use of Domeboro Otic Solution was mandated. I know I should dry them post-dive, but never formed the habit, and until now, never suffered a consequence...

Was teaching advanced & a night specialty up in terrific Tobermory Ontario last weekend. Was in the water the better part of 10 hours over 3 days. As usual, I neglected to dry my ears after diving. On the way home Sunday evening my right ear started to ache. Initially, the symptoms were indicative of "Otis Externa" ( swimmer's ear ), but the following day, I began to experience a "fullness" of the right ear, along with pressure & pain, thus leading me to suspect an inner ear infection might be present as well. The next day my physician confirmed my suspicions, prescribing meds. for both conditions.

One thing I did several times over the weekend's diving was to sip some tasty Georgian Bay water, to alleviate the cursed compressed-air / dry-mouth syndrome. So here's my question: Do you think it possible I might have introduced a bacterium ( from the water I sipped ) into my inner ear? Methinks it might have travelled up a eustachian tube during an ear-clear ( I'm lucky - I don't have to honk to clear, simple tongue-to-roof-of-mouth compression will do it for me ).

I should mention also that at the time of this writing, I am feeling like a cold infection is working on me ( severe fatigue, scratchy throat ), thus I'm now pondering the idea that the inner ear issue might be a product of a virus.

I await your learned wisdom!

Hey, Dan... thanks for writing! I don't think that anything that you swallowed would make it into the middle ear space, the anatomy just doesn't work like that. On the other hand, contaminated water can definitely cause outer ear problems.

This comes up a lot, and the first thing that I always say usually sounds pretty obnoxious, but unfortunately it is often true. Now I don't know your doctor, and he/she may be exactly right, but in my experience middle ear infections can be VERY difficult to accurately diagnose, especially if there is a significant swimmer's ear. This is because swelling and debris in the external ear makes it hard to see the eardrum, and to determine whether or not there is also a middle ear problem. Usually, for stuff like this, it helps to go to an ear doc (ENT). Just to recap -

Outer ear: the tube that goes from the outside world down to the eardrum. Infections here are called swimmer's ear, they are skin infections made worse by wet conditions. Sometimes, they require cleaning of the ear with a microscope and suction, along with ear drops.

Middle ear: The space behind the eardrum. Problems here are usually related to barotrauma, and cause temporary hearing loss. Occasionally, you can get an ear infection in this space (rare in adults), which would be treated with antibiotics. Fluid in the middle ear either resolves on its own, is treated with decongestants (limited help) or rarely requires surgical drainage.

Inner ear: This is almost never involved in diving problems, but very rarely you could see inner ear DCI or a perilymph fistula. Problems here involve dizziness and occasionally permanent hearing loss.

Bottom line - probably best to see an ENT doc if your ear doesn't clear up soon. If you tell me where you are, I would be happy to try to give you a local recommendation...

Finally, for keeping your ears dry, THIS is really good...!

Best,

Mike

 

[PatW]

Doctormike above recommended Mack's dry ear (which you would find if you hit the link). It is like a miniture hairdrier that gently and quietly blows dry air into your ear. My wife used to get ear infections all the time when she went on diving vacations. She got the dry ear several years ago and has not had a problem since. I get to use it too and it is effective.

 

[DeepSeaDan]

Hey, Dan... thanks for writing! I don't think that anything that you swallowed would make it into the middle ear space, the anatomy just doesn't work like that. On the other hand, contaminated water can definitely cause outer ear problems.

This comes up a lot, and the first thing that I always say usually sounds pretty obnoxious, but unfortunately it is often true. Now I don't know your doctor, and he/she may be exactly right, but in my experience middle ear infections can be VERY difficult to accurately diagnose, especially if there is a significant swimmer's ear. This is because swelling and debris in the external ear makes it hard to see the eardrum, and to determine whether or not there is also a middle ear problem. Usually, for stuff like this, it helps to go to an ear doc (ENT). Just to recap -

Outer ear: the tube that goes from the outside world down to the eardrum. Infections here are called swimmer's ear, they are skin infections made worse by wet conditions. Sometimes, they require cleaning of the ear with a microscope and suction, along with ear drops.

Middle ear: The space behind the eardrum. Problems here are usually related to barotrauma, and cause temporary hearing loss. Occasionally, you can get an ear infection in this space (rare in adults), which would be treated with antibiotics. Fluid in the middle ear either resolves on its own, is treated with decongestants (limited help) or rarely requires surgical drainage.

Inner ear: This is almost never involved in diving problems, but very rarely you could see inner ear DCI or a perilymph fistula. Problems here involve dizziness and occasionally permanent hearing loss.

Bottom line - probably best to see an ENT doc if your ear doesn't clear up soon. If you tell me where you are, I would be happy to try to give you a local recommendation...

Finally, for keeping your ears dry, THIS is really good...!

Best,

Mike

I was hoping you'd answer me!

Alrighty then - I meant "middle ear" when I said "inner ear". My Dr. said my tympanic membrane was quite inflamed; further, I can feel fluid sloshing up against my ear drum when I shake my head, thus I likely have a middle ear infection as you described. The antibiotics seem to be working - the pain & feeling of pressure is gone, just the fluid
appears to remain.

So my theory of nasties scurling up the eustachian tube is out-to-lunch, eh? I always thought that when one had a head cold, if they honked too hard when blowing their nose, they could possibly force some infected mucous up the tube, possibly resulting in a middle ear infection...another theory BUSTED!!

I guess my one-in-36 years-of-diving-middle ear infection supports your statement that such infections in adults is "rare".

Thanks for the clarity!

Regards,
DSD

{ BTW, my wife says I don't need any fancy ear-driers, she can cover that off when she blows in my ear to give me a "refill"! Why did we ever give em' the vote?? }

 

[WetDawg]

There is an excellent article on the DAN website that states:

"Despite what most people believe, otitis externa is not caused by bacteria in the water: instead, it's triggered by the bacteria normally found in your external ear canal. Here's how these normally innocuous bacteria can become troublesome.

With frequent immersion, water swells the cells lining the ear canal. Eventually, these cells pull apart - far enough for the bacteria normally found on the surface of your ear canal to get underneath the skin, where they find a nice warm environment and start to multiply. "

 

[DeepSeaDan]

There is an excellent article on the DAN website that states:

"Despite what most people believe, otitis externa is not caused by bacteria in the water: instead, it's triggered by the bacteria normally found in your external ear canal. Here's how these normally innocuous bacteria can become troublesome.

With frequent immersion, water swells the cells lining the ear canal. Eventually, these cells pull apart - far enough for the bacteria normally found on the surface of your ear canal to get underneath the skin, where they find a nice warm environment and start to multiply. "

Interesting article, especially the part where the author talks of his recommendation of Domeboro for saturation divers - that is probably the study that convinced my employers to make such therapy a daily routine in sat. I must agree that it works, as I never experienced Otis Externa while saturated.

Best,
DSD

 

[doctormike]

I was hoping you'd answer me!

Always happy to help as best as I can... feel free to PM any time!

Alrighty then - I meant "middle ear" when I said "inner ear".

Yup, people do that here a lot..!

My Dr. said my tympanic membrane was quite inflamed; further, I can feel fluid sloshing up against my ear drum when I shake my head, thus I likely have a middle ear infection as you described. The antibiotics seem to be working - the pain & feeling of pressure is gone, just the fluid
appears to remain.

Excellent! It may take a few weeks for the fluid to go away... you can do gentle valsalvas, or the Toynbee maneuver (swallowing while pinching your nose) to help...

So my theory of nasties scurling up the eustachian tube is out-to-lunch, eh? I always thought that when one had a head cold, if they honked too hard when blowing their nose, they could possibly force some infected mucous up the tube, possibly resulting in a middle ear infection...another theory BUSTED!!

Yeah, actually the Eustachian tube is pretty hard for fluid to traverse, although air makes it up OK. The reason that middle ear infections follow upper respiratory tract infections is that the whole lining of the head and neck is involved, so the ear becomes even less well ventilated, and may become contaminated as well. But it's not really a bulk liquid flow phenomenon unless you have an unusual condition (patulous ET, sometimes seen after radiation therapy, etc...). Even if it was, water you swallow usually wouldn't make it up into the back of the nose and into the ET under normal circumstances...

I guess my one-in-36 years-of-diving-middle ear infection supports your statement that such infections in adults is "rare".

Hopefully it will be another 36 years before it happens again!

{ BTW, my wife says I don't need any fancy ear-driers, she can cover that off when she blows in my ear to give me a "refill"! Why did we ever give em' the vote?? }

You are a lucky guy...

 

[Gene_Hobbs]

Interesting article, especially the part where the author talks of his recommendation of Domeboro for saturation divers - that is probably the study that convinced my employers to make such therapy a daily routine in sat. I must agree that it works, as I never experienced Otis Externa while saturated.

You'll notice the DAN article was authored by the late Ed Thalmann. It was his work at NEDU in 1974 that showed this to be true.

Thalmann, ED. 1974. A Prophylactic Program for the Prevention of Otitis Externa in Saturation Divers. Navy Experimental Diving Unit Technical Report. NEDU-RR-10-74 RRR ID: 3372

That work was later followed up by Dibb in 1985.

Dibb, WL. In vitro efficacy of Otic Domeboro against Pseudomonas aeruginosa. Undersea Biomed Res. 1985 Sep;12(3):307-13. RRR ID: 3012

 

[Blue Sparkle]

There is an excellent article on the DAN website that states:

"Despite what most people believe, otitis externa is not caused by bacteria in the water: instead, it's triggered by the bacteria normally found in your external ear canal. Here's how these normally innocuous bacteria can become troublesome.

With frequent immersion, water swells the cells lining the ear canal. Eventually, these cells pull apart - far enough for the bacteria normally found on the surface of your ear canal to get underneath the skin, where they find a nice warm environment and start to multiply. "

Well that's interesting. I'm one of those who always assumed it was from the water. I still kind of wonder, because it seemed like certain freshwater lakes (up north where I'm from) were more "notorious" for giving swimmer's ear. But maybe that was something unrelated, like those lakes had more people swimming in them. On the other hand, I spent hours and hours every day in summer in one of those lakes, and never had an ear infection (?). I can't believe my ears ever dried from June to September.

Also, although I'm religious about using my 50/50 ear solution (these days) for five minutes after swimming in lakes/rivers/oceans, I've never used it after swimming in a pool, even when it's been hours and hours of time submerged. I had assumed it was okay because that water is somewhat "sterilized" by chlorine or whatever they use. But if it's just one's ears becoming saturated, then maybe my logic is faulty?

 

[tracydr]

What Mike said. I use a prescription ear drop, something that cleans and is antibacterial on dive trips. It's called pragmatic and I've had great luck with it.