Inner ear barotrauma

[J.Angulo]

Hello everyone

I’m here seeking advice and experiences with anyone that has gone through something like this. 52 days ago I had a bad cold and my left Eustachian tube was a little clogged I tried opening by performing a ( VERY FORCEFUL VALSALVA MANUVER) what happened next was that my ear filled with air and I wouldn’t come out. I spent the whole night like this plus all my cold symptoms. Next day I had ringing in my ears and a clogged sensation fast forward to today ( 52 days later and these are the lingering symptoms. 1. Very low ringing in the morning and then gets higher 2. Sensation to sharp sounds like closing of doors plates banging against each other. 3. A little headache and a little nausea ever so often like 1 hour a day. 4. When I move my head around I can feel something moving sometimes and sometimes not. 5 And a weird sensation in my ear like a little bug is walking in there I would like to say that these symptoms have improved but are not gone and are affecting my quality of life

Also I’ve gone to and ent and audiologist

1. Ear drums not ruptured
2. No infection present
3. No fluid behind the ear
4. Hearing is great ( actually better in the messed up ear )
5. Ct scan of sinuses, and eras are perfect
6. On the event of the valsalva manuver, no vertigo, no hearing loss, no dizziness, no nausea

But the valsalva manuver is the only thing I can remember caused this, in all honesty I’m not even a diver, I’m just here trying to find an answer cause it seems like inner ear barotrauma is what I caused myself , and divers are the only ones familiar with it

So my final question is, did I self induce inner ear barotrauma and if so how long do you guys believe the healing could take

Also I’m kind of desperate for some comfort or help or your own experience, please help dont over look this message

 

[Brett Hatch]

So sorry to hear about this injury, I hope your situation improves

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A ScubaBoard Staff Message...

I'm moving this thread from the introduction section, to the dive medicine Q&A section, with the consent of the OP.

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[J.Angulo]

Thank you

 

[Duke Dive Medicine]

Hello everyone

I’m here seeking advice and experiences with anyone that has gone through something like this. 52 days ago I had a bad cold and my left Eustachian tube was a little clogged I tried opening by performing a ( VERY FORCEFUL VALSALVA MANUVER) what happened next was that my ear filled with air and I wouldn’t come out. I spent the whole night like this plus all my cold symptoms. Next day I had ringing in my ears and a clogged sensation fast forward to today ( 52 days later and these are the lingering symptoms. 1. Very low ringing in the morning and then gets higher 2. Sensation to sharp sounds like closing of doors plates banging against each other. 3. A little headache and a little nausea ever so often like 1 hour a day. 4. When I move my head around I can feel something moving sometimes and sometimes not. 5 And a weird sensation in my ear like a little bug is walking in there I would like to say that these symptoms have improved but are not gone and are affecting my quality of life

Also I’ve gone to and ent and audiologist

1. Ear drums not ruptured
2. No infection present
3. No fluid behind the ear
4. Hearing is great ( actually better in the messed up ear )
5. Ct scan of sinuses, and eras are perfect
6. On the event of the valsalva manuver, no vertigo, no hearing loss, no dizziness, no nausea

But the valsalva manuver is the only thing I can remember caused this, in all honesty I’m not even a diver, I’m just here trying to find an answer cause it seems like inner ear barotrauma is what I caused myself , and divers are the only ones familiar with it

So my final question is, did I self induce inner ear barotrauma and if so how long do you guys believe the healing could take

Also I’m kind of desperate for some comfort or help or your own experience, please help dont over look this message

Hi @J.Angulo ,

Sorry to hear about this injury. From my own non-ENT perspective, a forceful Valsalva maneuver is definitely a precursor to inner ear barotrauma (IEBT). Anatomically, the three bones in the middle ear: malleus, incus, and stapes, aka the ossicular chain, are all connected end to end. The malleus lies against the tympanic membrane (eardrum), and the far ends of the stapes connect to a part of the vestibular apparatus (the inner ear) called the oval window. A forceful valsalva can cause the tympanic membrane to bow outward; the force is then transmitted to the oval window via the ossicular chain. The oval window can then rupture, producing a fistula (tear). The force can also be transmitted through the vestibular apparatus to the round window, which basically compensates for the motion of the oval window and keeps the pressure in the vestibular apparatus relatively stable. If that happens, the round window could rupture as well. Mild IEBT may not produce a rupture of the round or oval windows (aka perilymph fistula) but could still damage the delicate vestibular apparatus and result in inflammation.

What you're describing is consistent with a relatively mild case of IEBT - no hearing loss or vertigo, but you do have some lingering tinnitus and hyperacuisis (the noise sensitivity you mentioned). So, if you did suffer IEBT, it's likely either non-fistulating or the fistula was not clinically significant. The only way to definitively diagnose a fistulating IEBT is via surgery, and if your medical team thought that was indicated in your case, it probably would have already happened.

Ear injuries like this are notoriously slow to heal. Your ENT would be the best person to address specifics about recovery time, having evaluated you personally. If he/she lacks experience in this area, DM me your location in FL and I'll see if I can point you toward some resources.

I'll tag @doctormike , our resident ENT, for his perspective as well.

Best regards,
DDM

 

[doctormike]

As usual, @Duke Dive Medicine said it best!

I kind of doubt that there is any intervention other than time that is going to help, especially if you have normal hearing at this point.

Here's my recent article on inner ear issues in diving...

 

[Angelo Farina]

Another victim of Valsalva. Very sad...
Instructors should stop teaching this equalization method as the first one, when several other methods are better and safer: BTV, Frenzel, Toynbee, Marcante-Odaglia, Lowry, etc...

 

[J.Angulo]

Hi @J.Angulo ,

Sorry to hear about this injury. From my own non-ENT perspective, a forceful Valsalva maneuver is definitely a precursor to inner ear barotrauma (IEBT). Anatomically, the three bones in the middle ear: malleus, incus, and stapes, aka the ossicular chain, are all connected end to end. The malleus lies against the tympanic membrane (eardrum), and the far ends of the stapes connect to a part of the vestibular apparatus (the inner ear) called the oval window. A forceful valsalva can cause the tympanic membrane to bow outward; the force is then transmitted to the oval window via the ossicular chain. The oval window can then rupture, producing a fistula (tear). The force can also be transmitted through the vestibular apparatus to the round window, which basically compensates for the motion of the oval window and keeps the pressure in the vestibular apparatus relatively stable. If that happens, the round window could rupture as well. Mild IEBT may not produce a rupture of the round or oval windows (aka perilymph fistula) but could still damage the delicate vestibular apparatus and result in inflammation.

What you're describing is consistent with a relatively mild case of IEBT - no hearing loss or vertigo, but you do have some lingering tinnitus and hyperacuisis (the noise sensitivity you mentioned). So, if you did suffer IEBT, it's likely either non-fistulating or the fistula was not clinically significant. The only way to definitively diagnose a fistulating IEBT is via surgery, and if your medical team thought that was indicated in your case, it probably would have already happened.

Ear injuries like this are notoriously slow to heal. Your ENT would be the best person to address specifics about recovery time, having evaluated you personally. If he/she lacks experience in this area, DM me your location in FL and I'll see if I can point you toward some resources.

I'll tag @doctormike , our resident ENT, for his perspective as well.

Best regards,

Thank you so much for the quick response, @doctormike do you think that it could be a weak oval or round window because of a possible implosion of the oval or round window? I’m at an ent that his profile said he’s distinguished in the area of barotrauma. I’m going to explain all my symptoms to him. I also notice that if I’m around loud sounds since I work in construction or drive a car with bad suspension then everything goes up a notch, the tinnitus, headaches, and dizziness, nausea ( all mild not debilitating just a feeling of un well ) also has anyone seen someone completely recover from a mild inner ear barotrauma. Or have they had eventually oval and round window reinforcement surgery in order to get rid of the symptoms? I know I might be asking more than what you guys are able to securely answer to, but I’m just very curious

 

[doctormike]

I'm not an otologist, I'm a pediatric ENT doc, so I don't really do inner ear surgery. But from what I understand, there really isn't "reinforcement" surgery as much as there is an exploration of the middle ear to look for fluid leakage in the setting of acute trauma. People can have all sorts of ear symptoms after barotrauma, but I doubt that exploration would be done in the absence of hearing loss or acute vertigo. But as I mentioned, I'm not really an expert in that!

 

[J.Angulo]

I'm not an otologist, I'm a pediatric ENT doc, so I don't really do inner ear surgery. But from what I understand, there really isn't "reinforcement" surgery as much as there is an exploration of the middle ear to look for fluid leakage in the setting of acute trauma. People can have all sorts of ear symptoms after barotrauma, but I doubt that exploration would be done in the absence of hearing loss or acute vertigo. But as I mentioned, I'm not really an expert in that!

Thank you , like I said it was a shot in the dark question but thank you for your help

 

[doctormike]

Sure... who are you seeing as an ENT doc?