Hello my location is south Florida, but I will literally drive anywhere in the USA if there is a specialized doctor in barotrauma
Inner ear barotrauma
- Thread starter J.Angulo
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No such thing as a specialist in barotrauma, but it looks like Dr. Hoffer is an experienced neurootologist, which is what you want. I would defer to him.
Johnboy70_99
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I have an injury that sounds very similar as well. I have a follow up in 4 weeks with an ent near me. Following this thread for updates.
Hi John, had my Appt with neuro-otologist. I suggest you talk to one as well. These guys are a sub specialty of ENT that have specific training / focus on the ear/ nerves etc.
I saw Hoffer at UMiami. He has been the first to suggest surgery could help. He also helps DAN write protocol for IEBT. The surgery is both exploratory and corrective. The only way to know id you have a tear in the membrane in oval or round window is by visualization. (They put a scope in your ear and look). If a tear is found they take a fat graft and repair the defect. Hoffer said 30-40% chance I have a tear, I’d I have one 80-90% chance the surgery will help/ resolve my issues. Biggest complaint now is constant high pitch tinnitus & hearing loss. It’s a value proposition in the end, take the risk or hope it heals and resolves on its own.
Johnboy70_99
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Thanks for your response. At the moment the tinnitus and hearing loss above 7k are my only symptoms. The tinnitus isn't constant, if I walk around for a while it goes away. If I lay or sit down it comes back most of the time although I have had days that are mostly free of the ringing. I saw an ent yesterday. They said I am stable. They think I may have a minor fistula, and if the ringing persists they want me to come back in 3 months for an MRI. They said I am ok to start lifting weights again but not to dive until I see an ent who specializes in diving to see what my options are. I have an appointment with Mass eye and ear in about 3 weeks to see what they say, but I would like to find an ent knowledgeable in diving in my area.
Are you going to proceed with the surgery? Did they say there is a chance it will heal on its own eventually?
Hoping @Duke Dive Medicine and @doctormike see this. Roger (husband) and I got a nasty virus back in November (actually, I got it in October and R became symptomatic in November) - one feature was a lot of sinus and chest involvement, but the sinus was the worst. Both of us had absolutely unclearable ears for at least a week. Mine eventually cleared up, very slowly. Here we are on December 27th and R went to an ENT (NP) who said he has fluid behind one ear and the gold standard is Flonase (he's been on it for 2 weeks) and prescribed a stronger steroid. We are going to Cozumel on January 20th and the NP he saw was dubious about flying or diving that soon. She wants him to see the doctor (January 15th) to determine if he might need to have the ear drained. I don't know if that means tubes or just putting a hole in his ear for it to drain? Also don't know the recovery time. I'm ok with missing a Cozumel trip, but we've got a PI trip on the books for the end of March. Wondering what the normal medical course is for something like that - I guess 'bad case scenario' if not 'worst case scenario'. We can miss trips - won't be the end of the world (bought trip insurance). But I really was looking forward to PI.
Any info appreciated. Now I'll go over to DAN to see if they have any articles too, so take your time. Thanks so much!
Any info appreciated. Now I'll go over to DAN to see if they have any articles too, so take your time. Thanks so much!
Hi,
I can't give you specific advice, since I haven't seen him myself, but I can make some general comments.
1) I don't feel that there is good evidence of Flonase having any effect on middle ear fluid. Since this is a condition that almost always resolves spontaneously, there are a lot of anecdotal reports of people taking nasal steroids and their ears getting better. Same goes for systemic or topical decongestants.
2) Oral steroids are the only medical therapy that I know that hastens the resolution of middle ear fluid, for patients who don't want to wait for spontaneous improvement.
3) GENTLE Valsalva and Toynbee maneuvers can also help middle ear fluid resolve faster.
4) Office myringotomy (draining the fluid from the middle ear) is generally done for adults who are very symptomatic with middle ear fluid and really want it fixed right away, not wanting to wait for natural resolution, steroids or Valsalva/Toynbee to work. If you do that, you can't dive until the ear is healed.
5) It would be unusual to recommend tubes for an adult with short term middle ear fluid related to an upper respiratory tract infection - those are for people with long term ET dysfunction (i.e. young children).
6) Commercial air travel (as opposed to military or cargo aircraft) really don't have enough of a pressure swing to make flying dangerous in most cases of barotrauma (this would be an issue with inner ear DCS). In fact, if the ear is completely filled with fluid, that's actually protective against ear pain on descent or ascent, since what hurts is expanding gas.
7) If you can't equalize (ears or sinuses), you can't dive. So it might make sense to take a mask and try it in a pool before making any decisions.
Good luck!
I can't give you specific advice, since I haven't seen him myself, but I can make some general comments.
1) I don't feel that there is good evidence of Flonase having any effect on middle ear fluid. Since this is a condition that almost always resolves spontaneously, there are a lot of anecdotal reports of people taking nasal steroids and their ears getting better. Same goes for systemic or topical decongestants.
2) Oral steroids are the only medical therapy that I know that hastens the resolution of middle ear fluid, for patients who don't want to wait for spontaneous improvement.
3) GENTLE Valsalva and Toynbee maneuvers can also help middle ear fluid resolve faster.
4) Office myringotomy (draining the fluid from the middle ear) is generally done for adults who are very symptomatic with middle ear fluid and really want it fixed right away, not wanting to wait for natural resolution, steroids or Valsalva/Toynbee to work. If you do that, you can't dive until the ear is healed.
5) It would be unusual to recommend tubes for an adult with short term middle ear fluid related to an upper respiratory tract infection - those are for people with long term ET dysfunction (i.e. young children).
6) Commercial air travel (as opposed to military or cargo aircraft) really don't have enough of a pressure swing to make flying dangerous in most cases of barotrauma (this would be an issue with inner ear DCS). In fact, if the ear is completely filled with fluid, that's actually protective against ear pain on descent or ascent, since what hurts is expanding gas.
7) If you can't equalize (ears or sinuses), you can't dive. So it might make sense to take a mask and try it in a pool before making any decisions.
Good luck!
Thank you! I think walking around feeling the fullness in his ear for two weeks is also driving him nuts - and the directionality of where sounds is coming from it all cock-eared for him. He's not in pain - he was for a couple of days but no longer. Poor guy. I'm passing along all the info. Thanks again.
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