Middle ear barotrauma

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Hi all,

I just completed my OW certification in Mexico last weekend. We did two days of diving -- 1 day practicing skills and diving in a calm cenote, and 1 day in the open water (2 dives each day). I thought I was equalizing properly, but apparently not. The day after we were done diving, I noticed a persistent feeling of water and fullness in my L ear. I've since seen a doctor at home and have fluid behind my L ear drum. My right ear drum was a bit red too. So it looks like I developed at least 1, if not 2, middle ear barotraumas.

Now that I know my symptoms are really indicative of a diving injury, I want to learn all I can to avoid such problems in the future. I may have been more prone to ear problems b/c I had a serious case of influenza about 2 wks. before I went diving, and still had sinus problems just a few days before. But with Sudafed and sinus rinses, my sinus pressure had cleared and I thought I was good to dive. (Probably mistake #1, eh?) How does one know when one it's safe to dive again after a sinus or upper respiratory problem?

During my dives, I would attempt to equalize using the Valsalva manuever (pinch and blow). I'd do it before I felt discomfort and when I felt a bit of ear pressure/discomfort. Was that wrong? If I feel any pressure or discomfort at all, should I ascend and THEN try to equalize, rather than trying to equalize where I am when I feel the pain? A couple of times, I had to blow really hard to get my ears to pop/to relieve the pain. Is that wrong? Did that set me up for problems?

After day 1 of diving, I had a lot of continued popping/clicking my ears. I noticed it while at dinner, etc. Should that have been an alarm bell of some sort for me? As a new diver, I thought it was normal.

The second day of diving, when I came up after my first dive, I had bloody mucus in my mask, from my nose. Was that another alarm signal?

From what I've read, flying isn't advised until after a barotrauma has healed. But 1) I didn't realize that at the time, and 2) I had to go home; staying in Mexico for a few additional weeks wasn't an option. Did I potentially make things worse by flying?

Right now, I'm taking Sudafed and a nasal steroid spray. There's been no noticeable improvement in my symptoms, but it sounds like it could take awhile. Sometimes I do notice my ears popping, esp. on the R (the side that's not so bad) when I swallow or blow my nose. Is that a sign of progress? My plan is to schedule an appt. with an ENT doc if I've been home a week without noticing any improvement. Good plan?

Any other advice you can share with me re avoiding/treating barotraumas is welcome as well!
 
The best advice I can give you is to take it easy. Just last weekend I made the questionable decision to dive all weekend even though I had been congested recently (though was feeling better). It was.... uncomfortable. It took me about five minutes to descend to ~60-70 ft and even longer to ascend. Afterwards I felt the crackling sensation but I'm pretty sure that was just my ears continuing to slowly depressurize. I felt better the next day.

If this has been going on for over a week and you had bloody mucus I would think you might want to consult with a doctor. I think in general if there is ever blood involved or persistant symptoms it's probably a good idea to get professional help. You can also try calling DAN or reposting in the dive medicine category and I'm sure the medical mods will help you out.
 
Quick question. Have you been sick at all within the last week to a week and a half? Even though you might be feeling better your body has many not have been fully recovered especially if you have a case of sinestus going on which can cause the nose bleed (had it happen to me after having the flu one time which is why I run the rule of if I'm stick I don't dive till 2 weeks after I've been sick).

As for equalizing. You should equalize when you feel pressure not pain. Feel pain and then damage is being done or about to be done. One thing that is very common with new divers (when I just started as well) is equalization issues. I would suggest after your ears get better to practice every day once or twice and hour for about a week equalizing on land. But wait to do this after you see and ENT if needed. My barotrauma took about 2 weeks to clear up but the popping ect was there. it was annoying but honestly didn't cause anything. the biggest sign of progress is when it clear up I noticed when it started to clear I could roll my head to one side and hear perfectly fine but I'm not Doc so take it for what its worth. Heres a good vid that should help you a bit long at 45 min but the bulk of the good info is in the first 30 or so min.

Doc's Diving Medicine Home Page

I practiced my equalizing during my time away from the ocean during Christmas back home for about a week and a half. I went from having issues with my right ear to being able to dive down as fast as I want without having issues equalizing. so like any skill it need to be practiced. I honestly don't know why they don't suggest doing it during OW as the instructors I know say at least 1 in 5 students have this issue.
 
https://www.shearwater.com/products/teric/

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