It's been 24 hours and my ear is not equalized..

[O'Malley]

I, too, had difficulty equalizing during my OW dives...following dives experienced fullness in ears (right>left), crackling with swallowing/yawning/jaw side-to-side and a slight ache (again, right>left)...never drainage, vertigo/dizziness, nausea/vomitting or flu-like symptoms. Saw an ENT when symptoms had not resolved by 3rd day post-diving and diagnosed with barotrauma. I was prescribed prednisolone dose pack along with a decongestant and back diving 2 weeks later. My advice, consult an ENT to be safe, particularly an ENT with dive medicine knowledge. After posting my experience on SB, the following video was recommended...I found it insightful

http://faculty.washington.edu/ekay/

 

[doctormike]

My advice, consult an ENT to be safe, particularly an ENT with dive medicine knowledge.

Hi... just thought I would add my 2 cents... (I'm an ENT doc)..

There are a lot of misconceptions about ear problems with diving, and it's important to keep things straight. The problem is that people tend to view any pain or hearing loss as being the same thing, which is not always true.

To summarize- there are three places where you can have ear trouble during diving, and they all have different clinical courses, prognosis and treatment. If you have problem following along without a diagram, there is one on my othe Web site, http://www.kids-ent.com.

1) Outer ear problems: Water from the ocean can get stuck in the external ear canal, especially if there is a good plug of wax. Rarely, a tight wax plug can cause a squeeze in the outer ear, but this isn't very common. Also, you can get an irritation of the skin of the ear canal (swimmer's ear). People who spend a lot of time in cold water can get bony growths in their ear canals ("surfer's ear"), these can also trap wax and water if they get big enough.

Treatment (if it doesn't get better by itself) is careful office cleaning by an ENT doc with a microscope, possibly followed by medicated ear drops. If there is swimmer's ear, it is good to keep the ear dry. This is not always possible with multiple days of diving, but using a hair dryer or a 50:50 mix of rubbing alcohol and white vinegar may help prevent recurrence. The bony growths occasionally require surgery if they get too big. Q-tips can cause injury or further impaction of earwax against the drum- not a great idea.

2) Middle ear problems: The middle ear is the space behind the eardrum. Barotrauma (pressure injury) can be caused, as you all probably know, by not allowing for the Eustachian tube (the natural drainage pathway of the ear) to do it's thing and equalize the pressure from the airtight middle ear with ambient pressure. This usually happens when you descend too fast without equalizing (remember, equalize early and often), or when you dive with a cold (causing swelling of the Eustachian tube). Generally, this results in a clear fluid with or without blood in the space behind the eardrum. This does NOT lead to middle ear infections (pus behind the eardrum, as commonly seen in young children).

Treatment- Unblock the Eustachian tube by valsalva maneuvers (pinching the nose and blowing) or Toynbee maneuvers (pinching the nose and swallowing, or other maneuvers with the jaw to ventilate the ear. Medical therapy (decongestants, anti-inflammmatory agents like motrin, or steroids) can help to some degree. Very rarely, it will be necessary to make a hole in the eardrum. This usually is necessary when a "vapor lock" sets in and the fluid lasts more than a few weeks. I have only had to do this once or twice in the last 10 years.

3) Inner ear problems: The inner ear is the space deep in the ear bone where the cochlea sits. The cochlea is the organ of hearing (like the retina in the eye) that converts sound waves into nerve signals.

Diving related inner ear problems are very rare, but have the potential to cause permanent hearing loss. There are two types- inner ear decompression illness (a type of DCI in which the bubbles form in the inner ear), and inner ear barotrauma (leakage of inner ear fluids through a fistula). These require immediate attention, and in the case of a leaking fistula, may require emergency surgery.


Bottom line: The vast majority of pain after diving goes away in a short time, but without an examination, you may not be able to tell whether the problem is in the outer or middle ear. Furthermore, the ear is unfamiliar territory for many general doctors. I don't say this to get more business..! I very much respect the pediatricians that I work with. But I have realized over the years that it can be very difficult to accurately diagnose ear problems without a lot of experience and the right equipment!

 

[Sputt]

It is starting to get better. I have been taking sudafed and ibuprofin. If it's not any better tommorow im gonna get an appointment. Thanks a lot guys for all of your replies! I really appreciate it!

 

[vel525]

Wow, thanks doc. Very informative. I should have my friend read this. He always has problems equalizing.

 

[thuffman]

Hey Sputt, I encountered the very same things after my OW dives. I read up on several excellent dive medicine sites, and this board, and self-diagnosed barotrauma. A friend recommended I try using Arnica Montana, an herb with anti-inflamatory properties. I took homeopathic tablets for several days and the problem went away. Now, it may have healed anyway in that time. Homeopathy (extremely diluted solutions) may or may not be
voodoo, but I got better, and felt like I was doing something! Anyone else have experience with herbal or homeopathic remedies for dive ailments? Keep diving, and you'll find that your head will tell you how fast is too fast, and how to waggle your jaw "just right" (I am still awfully green:froggy:, so the above is only my experience.) Good Luck! Tim.

 

[pipedope]

Thank you doctormike for the great summary.

For those who like pictures and video there is also a great streaming video at;
http://faculty.washington.edu/ekay/


While earwax impaction is fairly rare in the general population, some of us are regular earwax factories. My ears make so much wax that I have to clean them frequently or I get plugged up even without diving. My Dr. taught me how to keep them clean so I didn't have to bug him so often.

I know that I have frequent problems with wax so I check that first. A quick look in your ears can tell if wax is excessive or not.

 

[doctormike]

While earwax impaction is fairly rare in the general population, some of us are regular earwax factories. My ears make so much wax that I have to clean them frequently or I get plugged up even without diving. My Dr. taught me how to keep them clean so I didn't have to bug him so often.

I know that I have frequent problems with wax so I check that first. A quick look in your ears can tell if wax is excessive or not.

Yep, that's right..! And using q-tips is NOT a good way to do it (they can pack it in even tighter).

There are a few commercial systems that you can use (if you know that you don't have an eardrum perforation)... some people just use a little diluted hydrogen peroxide once a week or so to keep the wax from accumulating. This all should be done only once someone with experience has had a look in the ear to make sure that there aren't other problems that could complicate things.

 

[Sputt]

Update :

For the past 2 days I thought it was getting better but today i got sharp pains in both ears but now thats gone and have pressure. I went to the doctor, he saw that he could see signs of bleeding and he prescribed me to methylprednisolone to reduce swelling/redness, a 6- day treatment. If this doesn't work he said he is going to send me to an ENT.. Wish me luck!

Yep, that's right..! And using q-tips is NOT a good way to do it (they can pack it in even tighter).

There are a few commercial systems that you can use (if you know that you don't have an eardrum perforation)... some people just use a little diluted hydrogen peroxide once a week or so to keep the wax from accumulating. This all should be done only once someone with experience has had a look in the ear to make sure that there aren't other problems that could complicate things.

 

[fairybasslet]

Update :

For the past 2 days I thought it was getting better but today i got sharp pains in both ears but now thats gone and have pressure. I went to the doctor, he saw that he could see signs of bleeding and he prescribed me to methylprednisolone to reduce swelling/redness, a 6- day treatment. If this doesn't work he said he is going to send me to an ENT.. Wish me luck!

I had bleeding in my ear once. Very painful. It was a long time ago so I don't remember what the ent gave me.

BTW, I learned a new way to equalize from the DM on the boat on my recent NC wreck dive trip. After you pinch your nose, breath in a little first before you blow out. He said it creates a vacuum in your ear making it easier to equalize. I tried it and it was phenomanal. Of course it wouldn't work all the time on my stubborn left ear, when only swallowing would work, but most of the time it make equalizing a lot easier. Plus I use Doc's proplugs and sudafed.

 

[doctormike]

BTW, I learned a new way to equalize from the DM on the boat on my recent NC wreck dive trip. After you pinch your nose, breath in a little first before you blow out. He said it creates a vacuum in your ear making it easier to equalize. I tried it and it was phenomanal. Of course it wouldn't work all the time on my stubborn left ear, when only swallowing would work, but most of the time it make equalizing a lot easier. Plus I use Doc's proplugs and sudafed.

Yes, that's a good point for someone who has problems equalizing- alternating positive pressure and negative pressure to break the lock. Valsalva causes increased pressure, which is what you ultimately want (to blow air up the Eustachain tube into the middle ear during descent), but "rocking" the tube like that can help. Another way to drop the pressure is to pinch your nose and swallow (Toynbee maneuver).