(ma-) lingering ear

[wrybosome]

Hi all,

On a dive 12 days ago I needed both hands to render some assistance to a diver on the anchor line near the surface and wound up with some mild left side middle ear barotrauma. The initial symptoms of feeling of fullness and discomfort started about 24 hrs post dive, and escalated to pain and inability to clear that ear, muffled hearing. Tried pseudoephedrine but that didn't resolve the problem. Went to my primary doctor, who noted a bulging eardrum, agreed it was a barotrauma, and put me on prednisone (30mg 1x daily) + augmentin for the next week. No sign of perforation. While on the prednisone the symptoms were reduced but would reappear late at night as the serum levels of drug dropped. Now that I've been off it for two days I was just woken up this morning at 0 dark 30 by a painfully blocked left ear. I can valsalva successfully but only in one direction, ie, I can open the tubes and push air into the middle ear, but then it just sits there at greater than ambient pressure.

Today is Friday, and I have a spot on a boat to dive one of my favorite wrecks on Sunday. I'm sure I could equalize fine on descent, but I am concerned about the ascent. Going to try pseudoephedrine again today and see if that does anything now. Unfortunately it's probably too late to see my doc again before the weekend.

So...I have questions

1. There was no pain at the time of the injury, is that common? I don't even recall any discomfort at the time, although I had some adrenaline going.

2. Anything I can do to address this over the next 48 hrs? I'd really hate to miss the dive.

3. I have no history of ear problems. Is it at all likely that I'm about to start having ongoing problems now?

4. Doc said that although there was no sign of perforation of the eardrum, it could have happened relatively painlessly and healed over in the 3 days before I saw her. Is that right? I was surprised to hear that.


Sorry if these questions have been covered over and over before in other threads, I will also check the archive here while I wait to see what you folks have to say.

Cheers.

 

[doctormike]

1. There was no pain at the time of the injury, is that common? I don't even recall any discomfort at the time, although I had some adrenaline going.

2. Anything I can do to address this over the next 48 hrs? I'd really hate to miss the dive.

3. I have no history of ear problems. Is it at all likely that I'm about to start having ongoing problems now?

4. Doc said that although there was no sign of perforation of the eardrum, it could have happened relatively painlessly and healed over in the 3 days before I saw her. Is that right? I was surprised to hear that.


Sorry if these questions have been covered over and over before in other threads, I will also check the archive here while I wait to see what you folks have to say.

Cheers.

Hey! Hope you are better soon...

1) Usually you have some pain or at least a sensation of fullness at the time that you develop barotrauma (on the dive), but delayed pain is possible too - reverse squeeze, bleeding into the middle ear, etc... Late developing pain could also be a sign of outer ear inflammation ("swimmer's ear"), but I assume that your doc would have seen that.

2) Steroids and decongestants may help, but if you can't easily equalize in a pool or other shallow water, you should not dive. Some people just have baseline chronic poor Eustachian tube function, and they take a long time to equalize on descent. But in this case, you are talking about an acute injury, so you shouldn't tough it out on descent - that sets you up for a reverse block, which is a potentially serious problem. With a regular block, you can always abort the dive. With a reverse block, you may end up in the situation of running low on gas and having to injure your ear (painfully and possibly permanently) when you ascent. Descents are optional, ascents are mandatory!

3) Usually, a transient episode of barotrauma in a patient with normal ears at baseline will resolve. Beating up your ear while it is healing (i.e. by diving before you are ready) is a way to end up with ongoing issues.

4) Yes, that is theoretically possible. I you had a draining perforation, that could have caused some pain by contaminating the ear canal ("swimmer's ear"), and then it just happened to heal before you saw her. Seems less likely.


If you don't get better soon, may be a good idea to see an ENT doc. Feel free to PM me with your location and I'll see if I can find someone for you... Or you can call DAN for their referral line.

Dive safe!

Mike

 

[wrybosome]

Hey! Hope you are better soon...

1) Usually you have some pain or at least a sensation of fullness at the time that you develop barotrauma (on the dive), but delayed pain is possible too - reverse squeeze, bleeding into the middle ear, etc... Late developing pain could also be a sign of outer ear inflammation ("swimmer's ear"), but I assume that your doc would have seen that.

2) Steroids and decongestants may help, but if you can't easily equalize in a pool or other shallow water, you should not dive. Some people just have baseline chronic poor Eustachian tube function, and they take a long time to equalize on descent. But in this case, you are talking about an acute injury, so you shouldn't tough it out on descent - that sets you up for a reverse block, which is a potentially serious problem. With a regular block, you can always abort the dive. With a reverse block, you may end up in the situation of running low on gas and having to injure your ear (painfully and possibly permanently) when you ascent. Descents are optional, ascents are mandatory!

3) Usually, a transient episode of barotrauma in a patient with normal ears at baseline will resolve. Beating up your ear while it is healing (i.e. by diving before you are ready) is a way to end up with ongoing issues.

4) Yes, that is theoretically possible. I you had a draining perforation, that could have caused some pain by contaminating the ear canal ("swimmer's ear"), and then it just happened to heal before you saw her. Seems less likely.


If you don't get better soon, may be a good idea to see an ENT doc. Feel free to PM me with your location and I'll see if I can find someone for you... Or you can call DAN for their referral line.

Dive safe!

Mike

Thanks for taking the time to reply, Mike. The possibility of a reverse block is definitely worrying me. My doc is fitting me in later today and I will call DAN to get the name of a local ENT.

As much as I would hate to call the dive, I'd rather that than more damage. We will see how the next 24 hours go.

Safe diving to you too.