Middle ear barotrauma several days after diving...PLEASE HELP!

[travisfull]

Hi guys,

I read all the different thread concerning ETD and middle ear barotrauma but I did not find anything similar to my case. Below the main points of my history, for which I ask for your kind help, especially because diving is really part of my happiness and life :

• dived always during summer (hot temperature) for several years, never had a problem;
• 2021, it was the first winter during which I started diving: November 2021, I experience middle ear barotrauma (probably related to a badly cured cold). However, I had NO PROBLEMS with compensation in that specific dive, and symptoms of barotrauma started only 48 HOURS AFTER THE DIVES;
• Visited ENT, gave me medicines and apparently everything was ok: no issues with flights, and no issue with a first 20mt dive.
• however, I started having problems especially after divings below 30mt, but, as above, NEVER EXPERIENCING DISCOMFORT DURING DIVES (no problem at all compensating) but only 48-72 hours after the dive. Sometimes it was diagnosed only tympanic thickening and others mild middle ear barotrauma, and never swimmer's ear due to bacteria. Except for the first time (november 2021), symptoms lasts always few days and included: mild ear pain only if I touched them, itching to the external ear and always ear fullness (sometimes only if I pull my lobes), sometimes in both eats or sometimes in right or left one (with no specific pattern);
• In all this time, I was followed by at least 2 ENT specialist, one of them was recommended by DAN. They prescribe me: politzer therapy with sulphur water, spray Avamys and Otovent. I also had a CT SCAN which was totally clean: no mastoiditis, no specific issues to flag up;
• the only period when I recorded a series of 5 different dives (all at different depth, from 18 to 35mt) without any issues at all was when I used Otovent 5 times a day and Avamys few days before any dive;
• The doctors diagnosed ETD due to either cold water or the first middle ear barotrauma of November 2021(which was weird anyway since I did not experience any problem at all during the dive), even if they can't explain why I don't experience any issue compensating and the symptoms arise ALWAYS and only a couple of days after the dive, which, theoretically, does not make any sense since the symptoms of barotrauma arise during or immediately after. One of them recommended to keep diving at least during the summer season so to have a clear picture, since cold water could have a major role to play, and after that he suggested to consider eustachian tube dilation.

I ask help to this big community of divers like me because I have anything left to do:

1. anyone like me? Any suggestions?
2. I kindly ask for any help for ENT specialist here in the blog, especially from @doctormike

I thank you in advance.

PS: If needed, I have all my diving and related issues recorded on paper so to have a full set of data to analyse: depth, any issue before or after diving, what symptoms and when came up and all my ENT examination.

 

[doctormike]

Hey, wish I could help more, but not sure what to make of this. Symptoms arising 48-72 hours after the dive and never during the dive is pretty unusual for barotrauma, or even inner ear DCS (which seems unlikely given what I know of the profile).

If there is any change in your symptoms associated with touching or moving your ears, that makes an outer ear process (like swimmer's ear) more likely. Hard to say without seeing your ear canals.

ET dilation is pretty new and controversial, but I would like to see some actual objective evidence of ET dysfunction (like an abnormal tympanogram) before considering that. Did you get an audiogram that you can share?

Sorry I'm not so helpful.

 

[travisfull]

Thanks a lot @doctormike, very much appreciated!!!

Of course, I took several, and specifically every time I experienced an issue. Im attaching all the tympanogram I have from the first one to the last (the name of the file is the date, European style - d/m/y): in the one I had on 16th february you'll see "pre" and "post" because he wanted me to compensate to see my right ear how was reacting.

Today I had my last ENT because on tuesday evening I started having discomfort to the left ear after a dive I had on sunday (again, no issue at all compensating or any pain afterward). During today's visit my ENT, that by now know well my history, did not consider necessary to take a tympanogram since he can see I had a 1st degree middle ear barotrauma caused by rinite (I have seasonal allergy, I normally take kestine during april ) and gave me Zhekort to help me with it. What's the irony? The barotrauma was only on my right ear which did not hurt at all, I just have fullness if I pull the lob.

From the 20/11/2021 when I first had my first issue, which was quite strong even if (as always) 2 days after the dive, I had 17 dives, and I went diving ONLY WHEN my ENT, especially the one advised by DAN, authorised me to go.

The only pattern I can see (which may mean nothing) are as follow:

• I experienced issues when I went over 30mt: my ENT said it does not make any sense since the strongest pressure is during the first 10 metres;
• When I had issues, my symptoms came ALWAYS at least 48 hours later any dive;
• I've never had any issue compensating, except for once but I did not force it and I just ascend and gently did it.

Im desperate guys, I just wanna come back diving with serenity and lightheartedness!

 

[dlofting]

Does your doctor think that your allergies have anything to do with the problem?

 

[travisfull]

Does your doctor think that your allergies have anything to do with the problem?

According to my ENT, since my allergies are seasonal (from april to may), he believes that they had a role only during my last dive of monday, but not during winter since I’ve never experienced any other kind of allergies.

 

[Duke Dive Medicine]

Hi guys,

I read all the different thread concerning ETD and middle ear barotrauma but I did not find anything similar to my case. Below the main points of my history, for which I ask for your kind help, especially because diving is really part of my happiness and life :

• dived always during summer (hot temperature) for several years, never had a problem;
• 2021, it was the first winter during which I started diving: November 2021, I experience middle ear barotrauma (probably related to a badly cured cold). However, I had NO PROBLEMS with compensation in that specific dive, and symptoms of barotrauma started only 48 HOURS AFTER THE DIVES;
• Visited ENT, gave me medicines and apparently everything was ok: no issues with flights, and no issue with a first 20mt dive.
• however, I started having problems especially after divings below 30mt, but, as above, NEVER EXPERIENCING DISCOMFORT DURING DIVES (no problem at all compensating) but only 48-72 hours after the dive. Sometimes it was diagnosed only tympanic thickening and others mild middle ear barotrauma, and never swimmer's ear due to bacteria. Except for the first time (november 2021), symptoms lasts always few days and included: mild ear pain only if I touched them, itching to the external ear and always ear fullness (sometimes only if I pull my lobes), sometimes in both eats or sometimes in right or left one (with no specific pattern);
• In all this time, I was followed by at least 2 ENT specialist, one of them was recommended by DAN. They prescribe me: politzer therapy with sulphur water, spray Avamys and Otovent. I also had a CT SCAN which was totally clean: no mastoiditis, no specific issues to flag up;
• the only period when I recorded a series of 5 different dives (all at different depth, from 18 to 35mt) without any issues at all was when I used Otovent 5 times a day and Avamys few days before any dive;
• The doctors diagnosed ETD due to either cold water or the first middle ear barotrauma of November 2021(which was weird anyway since I did not experience any problem at all during the dive), even if they can't explain why I don't experience any issue compensating and the symptoms arise ALWAYS and only a couple of days after the dive, which, theoretically, does not make any sense since the symptoms of barotrauma arise during or immediately after. One of them recommended to keep diving at least during the summer season so to have a clear picture, since cold water could have a major role to play, and after that he suggested to consider eustachian tube dilation.

I ask help to this big community of divers like me because I have anything left to do:

1. anyone like me? Any suggestions?
2. I kindly ask for any help for ENT specialist here in the blog, especially from @doctormike

I thank you in advance.

PS: If needed, I have all my diving and related issues recorded on paper so to have a full set of data to analyse: depth, any issue before or after diving, what symptoms and when came up and all my ENT examination.

Hi @travisfull ,

@doctormike is our resident expert so not much to add here. As Mike said, pain with pulling on the earlobe would be more indicative of an external ear (ear canal) process, but if it's all happening at once (difficulty equalizing and pain in the external ear canal), that suggests some sort of chronic inflammatory process that affects both the external and middle ears. Has infection been ruled out? Do you have any other symptoms like hearing loss, tinnitus (ringing in the ears) or vertigo?

Best regards,
DDM

 

[doctormike]

that suggests some sort of chronic inflammatory process that affects both the external and middle ears.

They really are separate systems. One is more of a dermatological problem, the other is an extension of the upper airway. The only time you have middle ear issues causing an outer ear problem would be perforation and drainage... A very strange case! Sorry I can't be more helpful...

 

[scubaozy]

They really are separate systems. One is more of a dermatological problem, the other is an extension of the upper airway. The only time you have middle ear issues causing an outer ear problem would be perforation and drainage... A very strange case! Sorry I can't be more helpful...

I am wondering whether it is possible that TM is actually perforated permanently and ENT failing to detect it with some reason. Wouldn't sea water exposure cause OM in few days?

 

[doctormike]

I am wondering whether it is possible that TM is actually perforated permanently and ENT failing to detect it with some reason. Wouldn't sea water exposure cause OM in few days?

Very much doubt that. ENT would have found it, tympanogram would have picked it up, and diving with a perforation is pretty obvious to the diver!

 

[travisfull]

Hi @travisfull ,

@doctormike is our resident expert so not much to add here. As Mike said, pain with pulling on the earlobe would be more indicative of an external ear (ear canal) process, but if it's all happening at once (difficulty equalizing and pain in the external ear canal), that suggests some sort of chronic inflammatory process that affects both the external and middle ears. Has infection been ruled out? Do you have any other symptoms like hearing loss, tinnitus (ringing in the ears) or vertigo?

Best regards,
DDM

Hi! Thanks a lot for your message. Below the response to your interesting points:
1. As mentioned previously, I’ve never had issues equalizing and never pain during or after diving; when I experienced pain it started ALWAYS 48 hours after diving.
2. No hearing loss, no tinnitus, no vertigo
3. As far as I know, both ENT - including the one suggested by DAN - agreed that it is a very particular form of ETD, and nothing to do with external ear…I’ve had several appointments with them, and I hope that at least one of them could have seen an external ear issue, right?

The one suggested by DAN advanced the hypothesis that cold water may cause my problem, especially because I’ve never had this problem during summer season.
He also said that delayed symptons for middle ear barotrauma are not unheard of.

Im sorry for the outburst but Im so frustrated: I’m in the middle of my DM course, I’ve done almost 100 dives without issues until this winter…lets hope that once the water ger hot in the coming weeks it will be solved, because at this point I have minor hopes for a medical solution.