Fistula like symptoms but....

[Dough18]

Thought I'd post here and get the SCUBA docs feedback. I have had some right ear tinnitus startup without apparent cause and the symptoms (some) are like. a perilymph fistula...but only some. An ENT consult today produced no clear causes nor feedback on next steps...

Background, including all potential sources of barotrauma:

Male, 52 yrs of age, 6'1, 205 lbs
Diving 30 years (equalize very easily); fly about 200-300k airmiles/yr
Run 5k 3x week, light weights to maintain tone

-Dec Jan 2018 - week in Grand Cayman, 6 dives, no issues
-in Jan sometime on two separate occasions, crackling (like. modem downloading info) in R ear...very low levels. No reoccurrence.
-Jan 11-13 - Trip to Canada (4 flights) - no issues
-Jan 26-31 - Switzerland on business (4 flights) - no issues

-Feb 8-10 - Trip to Canada (4 flights) - no issues
-Feb 12- mild echo in right ear (slightly off phase echo)
-Feb 13-17 - Roatan (4 flights), 6 dives and free-diving (30 ft), no issues; slight humming on the Sunday night
-Feb 18 - echo back in right ear, mild intensity, high pitches noises mostly
-Feb 19- GP consult: no infections, no fluid, nasal steroid (OTC - which I didn't take properly I just learned)
-Feb 23-Mar 1- Switzerland on business (4 flights), 25th: clogged R ear, hearing in right ear a little less; 26: R ear humming; 27th: louder humming, hearing in meeting room with multiple discussions difficult (like white noise), put in earplugs and it was tolerable; improved rest of the trip but ear still clogged and humming was mild

-March 1 - consult with GP; maybe saw mild sinus issues and prescribed steroids and antibiotics
-March 1-10 - Bangkok on business (3 flights there, 4 on the way back). Morning after landing: both ears clogged and hearing down, hot shower cleared up L ear; R ear clogged (but less after shower) and humming, shaking head felt like fluid in inner ear (for 1 day), slightly clumsy (only this one time); 5th: humming turned to ringing in right ear (and some hearing loss )and sleeping was a challenge (needed headphone and music), 6th: ringingly turned back to humming and gradually improved; cancelled my Similian Island SCUBA trip because of this unknown issues and flew back 9th (landed 7:30 am Sunday). Online hearing test in Thailand showed marked difference between left and right ears at higher frequencies.
March 11-now at home (minimal activity, trying to stay in bed): humming in right ear, fluid feeling in R ear (lasts about. day); 12th: felt more clogged in R ear, now also bilateral ringing (very low, only notice when very quiet)...fullness (clogged) feeling in R ear a little less each day. Hearing ok.
- March 15,16th: same as usual plus mild headaches
- March 18th - fullness in ear really improved and ear feels only like it has cotton in it, hearing seems fine
- March 19 - no humming, fullness gone. Humming does come back later in the day; bilateral low level ringing still there (maybe it was always there and I never noticed it)
- March 19th ENT appointment: hearing in both ears within range, all other audiology parameters good, Tympanometry tests fine.

ENT (actually NP) not worried and cleared me to fly. I am worried this was brushed off too soon. Too many symptoms (hearing loss, tinnitus, fullness, worse after flying) that worry me. Prescribed nasal antihistamines, given exercise for the neck and jaw, proper nasal steroid spray use, use my night-guard (clenching). Low level Tinnitus remains (bilateral) and R humming seems to be minimal.

Any thoughts? Am I over-analyzed (cursed Google symptom checker).

 

[Duke Dive Medicine]

Hi @Dough18 ,

From your detailed description it sounds like you keep aggravating an existing injury. Did you perform a forceful valsalva at any point?

Best regards,
DDM

 

[Dough18]

Not that I recall. At least nothing that stayed with me. What kind of injury would recovery with normal hearing in two weeks and clean tymp tests?

Cleared to fly and leaving this weekend. I guess I’ll see what happens. Just worried about causing a serious injury.

 

[Dough18]

Update. Completed 5 flights and ok. Tinnitus a bit louder but the fullness I experienced in the R ear previously did not return to the same extend (little cotton sensation). ‘Course these were all shorter flights (<3hrs)...heading to Melbourne today...it’ll be the real test.

 

[Duke Dive Medicine]

Not that I recall. At least nothing that stayed with me. What kind of injury would recovery with normal hearing in two weeks and clean tymp tests?

Cleared to fly and leaving this weekend. I guess I’ll see what happens. Just worried about causing a serious injury.

Sorry for the delayed response. There is such a thing as non-fistulating inner ear barotrauma - symptoms are likely due more to inflammation than leakage of fluid. That could be one explanation.

Best regards,
DDM

 

[Dough18]

Let me provide another update. Since my last post I have flown to Australia and domestically several times. The ‘fullness’ in my ear has not returned. But, I continue to have low level bilateral tinnitus. Also, approx two days after flying I get humming in my right ear that resolves ~ 8-10 days after flying. I have no problems equalizing and focus on chewing gum during landings.

Also been to a DAN affiliated ENT. Hearing also normal, tempanogram still ok. Did CT scans on ear and sinuses. Ear images clean. Sinuses a bit narrow. Performed a balloon sinuplasty (10 days post procedure now) and breathing is definitely better but not an earth shattering difference.

Non fistulating inflammation may be the case but would it explain the reoccurring humming in the right ear after flying? I should add that I have not gone more than 2 weeks between flying.

I am happy it’s not a major structural Issue but still look for a resolution of the humming and tinnitus.