Middle Ear injury?

[flashpackerhq]

Hey Scuba Experts,

I just finished my open water course a few days ago (2 days ago to be exact) and I have a couple questions.

First let me say that I loved it and plan to do much more diving in the future and, possibly, continue the original plan to get to DM.

I had no issues during the confined dives in the pool, but on our first two ocean dives, I had some issues equalizing doing down the line. I pushed through and things felt better after a certain point, but when I was finished I felt like I had water stuck in my left ear. I mentioned this to my instructor and he suggested getting Accufed for the following morning to make sure I was clear for dives #3 and #4. Everything felt fine sinus wise, but I still felt like I had water in my left ear from the previous day.

We went out for #3 & #4 and on dive #3 I moved slowly and still had some issues. Then, about 10 minutes down I'd guess, Things finally "popped" for both ears and I could actually hear the bubbles etc around me instead of just my own breathing. I figured I'd finally equalized the way I was supposed to. I also apparently had a nosebleed after the final dive but didn't feel anything and only knew because my buddy noticed red on my face and thought I'd gotten scratched.

Still felt the water in the ear thing after dives 3 and 4, but felt better about my diving. It's now two days later and I still have that muffled, water-in-the-ear feeling on the left side. I saw a local doctor last night and he said that the ear canal is clean, but that the drum looks dark/black when it should look white. The right ear looks normal. He said I probably have some minor middle ear damage that should go away, but no diving for a week. He prescribed cortizone and something else for swelling, both of which I'm taking 3 times a day until they're gone.

Questions:

1) Should I have pushed through on that first dive? Is that what initially caused the issue?

2) I read a bit online that says this type of injury is normal (called Barotitis Media), but wanted to get some thoughts from you more experienced divers.

3) I realize you aren't medical experts, but am I in danger of doing anything bad to my ears if I continue diving?

4) For the future, how do I ensure this doesn't happen again?

5) Any other thoughts?

I'm headed back to Koh Tao tomorrow morning and would like to continue with some fun dives after the week has passed, but don't want to do anything stupid or damaging.

I know there's a few of you living on the island. What areas do you frequent and would you like to get together for drinks or something?

Thanks all!

-Travis

 

[Bubbletrubble]

I saw a local doctor last night and he said that the ear canal is clean, but that the drum looks dark/black when it should look white. The right ear looks normal. He said I probably have some minor middle ear damage that should go away, but no diving for a week. He prescribed cortizone and something else for swelling, both of which I'm taking 3 times a day until they're gone.

I'm not completely sure what the doctor meant by "the ear canal is clean." Did he specify whether the eardrum had been ruptured? That may make a difference in your prognosis and how quickly you'll be able to resume diving. A dark/black eardrum is suggestive of hemotympanum. This implies significant barotrauma to the eardrum, which may involve rupture. If the tissue was not torn, it can heal in as rapidly as a week. If the tissue was torn, it could take a few more weeks for it to heal. It would be wise to avoid diving in the near future. Perhaps doctormike (an ear specialist) could comment further.

1) Should I have pushed through on that first dive? Is that what initially caused the issue?

No, you should never "push through" when it comes to ear equalization. Ascend a little until you can't "feel" the pressure anymore and then continue to use your equalization techniques as you descend slowly. If it hurts, you're doing it wrong. Equalize early and often. Did you know that there's more than one technique for ear equalization? There are several active and passive techniques. I prefer the Roydhouse Maneuver. Check out Dr. Kay's website (link in my sig). Once your ear heals up, give the various methods a try. Learn which technique works best for you.

2) I read a bit online that says this type of injury is normal (called Barotitis Media), but wanted to get some thoughts from you more experienced divers.

Barotitis media is very common in basic OW students and divers in general. Instructors should teach OW students multiple methods for ear equalization. Your instructor probably only taught you the Valsalva pressurization technique (pinch nose, close mouth, and try to blow air out of your nose). Better education may have prevented your ear injury.

3) I realize you aren't medical experts, but am I in danger of doing anything bad to my ears if I continue diving?

Don't dive until your ear condition resolves. You could do severe, permanent damage to your ears.

4) For the future, how do I ensure this doesn't happen again?

Learn how to equalize your ears properly.

5) Any other thoughts?

If you have any medical questions regarding scuba, don't hesitate to contact Divers Alert Network (DAN). A DAN representative will be happy to give you sound advice or a referral to a dive-savvy physician even if you aren't a DAN member. For areas served by DAN Asia-Pacific (such as Thailand), call +61-8-8212 9242 (emergency 24 hr hotline) or +61-3-9886-9166 (non-emergent inquiries). Visit the DAN website for more info.

Get well soon!

 

[kasdeva]

I struggled equalizing initially to the point where I ruptured my ear drum on my final dive during my open water course. I had to stop diving for a few weeks to get it to heal.

My biggest problem was that I kept forgetting to equalize early. There is so much happening on the first few dives. Getting down, getting air in your BC, stress, finding your buddy that it is easy to forget about your ears. I got the best advice for me from this board. "Your ears are the first priority, never get behind equalizing"

Once I had done a few dives, the problem disappeared. I am equalizing often and know what it feels like when there is pressure on my ear drum.

Knowing that I have problems equalizing, I practiced often pressurizing and clearing my ears. I have no medical evidence for this, but from my own experience, it feels like my eustachian tubes give much less resistance to clearing once I started practicing. I can now equalize once I am at the bottom of my dive by just swallowing or wiggling my jaw.

Good luck, I hope your ear heals quickly.

 

[Searcaigh]

Having had ruptured both eardrums at various times during my diving career I can tell you that one week is too short a time to get back in the water. Six to eight weeks will ensure that if there has been any perforation then it will be completely healed .... usually, everyone is different (my speciality is blood not ears).

There are several ways to equalize and as mentioned above, get to know them and practice.

Personally I equalize every meter I descend by inhaling through my reg and exhaling slightly through my nose whilst holding my mask in place to prevent it flooding, this works for me. The problem equalizing usually involves failure to equalize soon enough and the external pressure squeezes the Eustachian tubes linking the throat to the ears thus preventing equalization and leading to a possibility of barotrauma.

If you feel you cannot equalize, ascend and try again.

 

[flashpackerhq]

Thanks for the info all. Our instructor taught us we could hold our nose and blow, wiggle our jaw, and attempt to swallow. Those were the different methods he suggested. Yeah, I guess there were a couple issues. The first being I didn't really know what it felt like to actually be equalized, and now I'm thinking I might still not. I did as instructed and thought things were good, so I guess I thought wrong. I think it didn't help that I felt like I might be holding up the group, but next time I'll take my time no matter what.

I'm also going to give my ear as much time as it needs to heal, but I do want to get back in and see if this is a one time thing or something that will prevent me from diving again. I'm going to read through that article Bubbletrouble linked to and see what I can do better next time.

Appreciate all the advice! Thanks!

-Travis

 

[Midget]

If your eardrums are ruptured, there is no equalizing involved because the water just flows through them! Sheeeeez!

If you don't get treatment, chances are they will never heal properly. The last thing you want is a perma-hole in your eardrum that would require a tympanoplasty surgery. You need to be on Ciprodex ear drops (prescription only in the states) and stay out of the water (swimming included) for several weeks.

 

[Karibelle]

From the OP's description of what the doctor told him, it seems unlikely the eardrum is ruptured. It's more likely he's suffered a middle ear barotrauma, and the dark colour of the eardrum is due to fluid behind it. When the barotrauma occurs, the ear would equalize, with the fluid, not with the air we hoped would do it.

 

[Blue Sparkle]

I've mentioned this tip a few times before, so sorry to anyone reading it for the fourth time. But... it helped me out a lot, and I got it here, so I'll pass it on.

I'm the opposite of the OP - I've had trouble equalizing in the past, but I'm a bit paranoid about hurting my ears, so I would end up spending forever on the surface being sure all was okay. In the pool during OW, I could not get down at all during the first session. Ugh.

Of course pushing through is a big no-no, but spending ten minutes on the surface doesn't work all that well (especially) during a boat dive, where you do have some time limit, and where it may be rough on the surface. Plus, I always had this nagging doubt "Will I be able to equalize or not?"

The easy tip that worked for me was to equalize on the surface, *before* I put my head in the water to descend. This "pre-puffs" the eustachian tubes and makes equalizing routine for me.

One step beyond that is to equalize before jumping in (if boat dive) since your head may go low enough to start to put some pressure on the tubes.

I'll be forever grateful that a Scubaboarder posted that tip!

 

[MdMedic]

I had similar issues with my OW cert dives (see previous post listed as "It;s official"). I was diagnosed with a ruptured eardrum. My ENT performed a procedure she called a "paper patch". This was to ASSIST in the healing process. Apparently, it worked. I have regained hearing (no more muffled, filled-with-water feeling). It has been four weeks and I intend on waiting a few more before seeking a second opinion because she has recommended I discontinue diving indefinately. This is unacceptable because I have come to love diving. At any rate, I have the name of an ENT who has more knowledge of diving than my ENT. We will see what he says in a few weeks. I will reply here with any new information.

 

[Midget]

MdMedic, you're so lucky paper patches worked. I ruptured not from a dive ear injury but from an ear infection with a common cold. The hole never closed. I had a paper patch procedure that didn't work to close it. I had 2 tympanoplasty surgeries 11 months apart and both failed.
I now dive with a ProEar mask and have logged >80 dives with it. Bad ear luck, but I refuse to NOT dive and I get along fine using the ProEar. I also have met a few divemasters that dive with the ProEar because of an open ear drum. I'm prone to ear infections and my hearing loss is pretty significant in that ear. BUT! At least I can still dive!