Question Full ear/hearing loss but can equalize fine?

[mkivtt]

Hi folks, thanks for letting me ask this.

I'm a 46 yr male who's been (free)diving for over 30 yrs with only only issue ever (reverse tooth squeeze, 29 yrs ago). I'm in excellent condition.

I traveled to the USVI to snorkel/freedive last week. On day 1,I snorkeled 3 hrs and dove no deeper than 20 ft. No pain, no issues equalizing. When I left the water I tilted my head left and right as always to drain my outer ear. Oddly, the left ear remained muffled. Maybe 20-30% hearing loss. I assumed sone earwax was pushed against my eardrum which I've had it once before.

Next day I again snorkeled to max 20 ft. Left ear was almost back to normal after so I assumed the wax had flushed out.

However, waking up the next morning, my left ear was about 75% deaf. I wear ear plugs so assumed it was still earwax and went to a local Dr. He said my outer ear is completely clear and prescribed Zyrtec D, a decongestant. But I'm not congested and can equalize just fine still... He didn't have any other suggestions.

Now, 2d later, it's even worse and I probably only hear 5% with that ear. I have a constant ringing sound as well and the ear feels "full."

What could this be? Water in the middle ear? Barotrauma? If so how could that happen when my eardrum is intact (I think) and I equalized with no issues? Right now, on land, I can still pop my ears both with positive and negative pressure in both directions using val salva. How could there be water (assuming it's water in the middle ear)? How would that even have gotten there? Through the ear drum or eustachian tubes? I don't understand.

I'm scared it's sudden hearing loss which is apparently a medical emery requiring steroids ASAP or you could lose your hearing for good. But logic says it's related to my snorkeling and descents. But then I don't understand why it got progressively worse especially overnight just sleeping. I have no pain, just almost total deafness and ringing in left ear.

My flight back isn't until 3d from now and nothing earlier is available. There's no ENT Dr here who can see me and I'm paranoid about why I'm suddenly deaf in one ear with no pain or apparent equalization issue during my dives or now on land. Can I still snorkel? The local Dr said yes but I don't know if you should if you already have water in the middle ear.

Thanks!

 

[mkivtt]

Ok, three days later, and i can hear a tiny bit better. So I assume it's draining.

I've also come up with a working theory. I defog my mask with spit, but since I snorkeled 3-4 hours that wore off over time. I then resorted to putting some water in my mask and moving it around every minute or so. I know this caused quite some slimy mucus in my nose as I blew it out a few times. I assume that while equalizing going vertically down, or while blowing my nose, some if it was forced into the middle ear.

What I don't understand is why it takes so long to drain when I'm not congested and have no allergies and am very fit. I'd assume when I equalize now on land and force air into my middle ear, that would in turn push the liquid out through the eustachian tube. Oh well. Pretty scary to go almost deaf for no apparent reason but I assume it will slowly keep draining.

 

[Duke Dive Medicine]

Hi folks, thanks for letting me ask this.

I'm a 46 yr male who's been (free)diving for over 30 yrs with only only issue ever (reverse tooth squeeze, 29 yrs ago). I'm in excellent condition.

I traveled to the USVI to snorkel/freedive last week. On day 1,I snorkeled 3 hrs and dove no deeper than 20 ft. No pain, no issues equalizing. When I left the water I tilted my head left and right as always to drain my outer ear. Oddly, the left ear remained muffled. Maybe 20-30% hearing loss. I assumed sone earwax was pushed against my eardrum which I've had it once before.

Next day I again snorkeled to max 20 ft. Left ear was almost back to normal after so I assumed the wax had flushed out.

However, waking up the next morning, my left ear was about 75% deaf. I wear ear plugs so assumed it was still earwax and went to a local Dr. He said my outer ear is completely clear and prescribed Zyrtec D, a decongestant. But I'm not congested and can equalize just fine still... He didn't have any other suggestions.

Now, 2d later, it's even worse and I probably only hear 5% with that ear. I have a constant ringing sound as well and the ear feels "full."

What could this be? Water in the middle ear? Barotrauma? If so how could that happen when my eardrum is intact (I think) and I equalized with no issues? Right now, on land, I can still pop my ears both with positive and negative pressure in both directions using val salva. How could there be water (assuming it's water in the middle ear)? How would that even have gotten there? Through the ear drum or eustachian tubes? I don't understand.

I'm scared it's sudden hearing loss which is apparently a medical emery requiring steroids ASAP or you could lose your hearing for good. But logic says it's related to my snorkeling and descents. But then I don't understand why it got progressively worse especially overnight just sleeping. I have no pain, just almost total deafness and ringing in left ear.

My flight back isn't until 3d from now and nothing earlier is available. There's no ENT Dr here who can see me and I'm paranoid about why I'm suddenly deaf in one ear with no pain or apparent equalization issue during my dives or now on land. Can I still snorkel? The local Dr said yes but I don't know if you should if you already have water in the middle ear.

Thanks!

Your symptoms are concerning for inner ear barotrauma. Did I read this correctly in that you wear ear plugs while snorkeling? If so, what type of ear plugs are they?

Best regards,
DDM

 

[mkivtt]

Your symptoms are concerning for inner ear barotrauma. Did I read this correctly in that you wear ear plugs while snorkeling? If so, what type of ear plugs are they?

Best regards,
DDM

Hi, thank you, no I only wear ear plugs to sleep. Sorry I should've been more clear. How could I have barotrauma when I can still equalize and a regular physician said the outer ear and eardrum look fine? I thought I just got some water into my middle ear which would eventually drain. Now I'm all worried again I'm seeing an ENT Friday but went freediving again today with no issues (although my ear is still 60-70% deaf but no pain or issues equalizing).

Thanks!!

 

[Duke Dive Medicine]

Hi, thank you, no I only wear ear plugs to sleep. Sorry I should've been more clear. How could I have barotrauma when I can still equalize and a regular physician said the outer ear and eardrum look fine? I thought I just got some water into my middle ear which would eventually drain. Now I'm all worried again I'm seeing an ENT Friday but went freediving again today with no issues (although my ear is still 60-70% deaf but no pain or issues equalizing).

Thanks!!

Thanks for clarifying about the earplugs.

For clarity, I'm not diagnosing you via the internet and it's certainly not my intent to cause any worry or distress, but I would reiterate that your symptoms are concerning. I'm assuming that the provider who examined your outer ear would have noticed whether there was fluid behind the eardrum or something else that could otherwise explain your symptoms. Hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the ear are hallmarks of inner ear barotrauma. The only thing missing is vertigo, which isn't always present. Classically with IEBT there's a history of difficulty equalizing and a forceful Valsalva, but in the absence of another clear explanation for your symptoms (e.g. middle ear squeeze/congestion or infection), I don't think it can be ruled out. If this is IEBT (and again, I'm not diagnosing, just providing information), continuing to free dive could stress the area and aggravate the injury.

Best regards,
DDM

 

[mkivtt]

Thank you very much! I'm going to take it easy tomorrow before I fly back on Thursday. Hopefully the ENT can figure out what's going on on Friday.

I've never had issues equalizing in the past or during this trip. Fingers crossed it's "just" water or slime in the middle ear that somehow drains. I'll update the topic later on Friday after I hopefully know more (it drives me crazy when people don't post a follow-uo for others who search and hope to read more details).

 

[mkivtt]

Well not so great news. Finally made it back tot the US. As I suspected I didn't have any barotrauma or water in my middle ear. I could and can still equalize perfectly fine. The ENT diagnosed me with ISSHT which is a medical emergency and needs a steroid treatment within 2 weeks or the loss is permanent. 33% of patients recover some hearing, another 33% almost all, and 33% nothing. Sigh... fingers crossed. Most likely nothing to do with freediving. The cause of most ISSHT cases remains unknown.

 

[tursiops]

Well not so great news. Finally made it back tot the US. As I suspected I didn't have any barotrauma or water in my middle ear. I could and can still equalize perfectly fine. The ENT diagnosed me with ISSHT which is a medical emergency and needs a steroid treatment within 2 weeks or the loss is permanent. 33% of patients recover some hearing, another 33% almost all, and 33% nothing. Sigh... fingers crossed. Most likely nothing to do with freediving. The cause of most ISSHT cases remains unknown.

That sucks. I had ISSHL in my right ear on my way to the airport for a dive trip to Cayman Brac, 4 years ago. After I got home to decent medical facilities, I received several inner-ear steroid injections, with only moderate success. Apparently the gold standard now is immediate hyperbaric O2 (chamber rides), but it was too late for that. My hearing has partially returned, but less so my verbal comprehension on what I hear in that ear; the brain is slowly rewiring against the damaged cilia in the inner ear, I've been told.

 

[Duke Dive Medicine]

Well not so great news. Finally made it back tot the US. As I suspected I didn't have any barotrauma or water in my middle ear. I could and can still equalize perfectly fine. The ENT diagnosed me with ISSHT which is a medical emergency and needs a steroid treatment within 2 weeks or the loss is permanent. 33% of patients recover some hearing, another 33% almost all, and 33% nothing. Sigh... fingers crossed. Most likely nothing to do with freediving. The cause of most ISSHT cases remains unknown.

That's also an indication for hyperbaric oxygen therapy if it's caught right away.

Best regards,
DDM

 

[Tigerpaw]

Thanks for clarifying about the earplugs.

For clarity, I'm not diagnosing you via the internet and it's certainly not my intent to cause any worry or distress, but I would reiterate that your symptoms are concerning. I'm assuming that the provider who examined your outer ear would have noticed whether there was fluid behind the eardrum or something else that could otherwise explain your symptoms. Hearing loss, tinnitus (ringing in the ears), and a feeling of fullness in the ear are hallmarks of inner ear barotrauma. The only thing missing is vertigo, which isn't always present. Classically with IEBT there's a history of difficulty equalizing and a forceful Valsalva, but in the absence of another clear explanation for your symptoms (e.g. middle ear squeeze/congestion or infection), I don't think it can be ruled out. If this is IEBT (and again, I'm not diagnosing, just providing information), continuing to free dive could stress the area and aggravate the injury.

Best regards,
DDM

I've been reading this thread and have a question about earplugs. What type of earplugs can divers wear and not have any issues. I remember during OW training that there are special earplugs for divers but I didn't research it further. THANKS!