Middle vs Inner Ear Barotrauma

[Phenomdives]

Hi all,

5 days ago I jumped into a pool of water from a zipline, water shot up my nose but other than that everything felt fine, probably went under 6-8 ft from dropping into the water from a decent height. Fast forward to 3 hours later and I had a mild pain in my ears that became more painful as the night went on and my ears began to feel full.

Next morning my ears felt totally clogged and I couldn't hear very well, but there was no more pain. Unfortunately, my return flight was that day and my ears were popping like crazy during ascent/descent, though again there was no pain (just very uncomfortable/frequent popping), seemed able to equalize on the flight just had to do so very frequently.

Two days later felt intermittent shooting pains in ear drum area so went to doc, who looked and said both ear drums were very red/inflamed (not ruptured), RXed sudafed and amoxicillin in case of infection. Today is the third day on the meds and I feel no improvement in fullness of ears or crackling/popping sensations inside my ears.

I'm wondering how long I should wait to consider revisiting the doctor or asking to see an ENT. I wasn't diving at an extreme depth, but given the symptoms I'm concerned it could be inner ear barotrauma or an ear infection that isn't responding to amoxicillin. No fever but I've had some headaches (though could be due to pressure in the ear).

As of now some intermittent/mild tinnitus, lots of crackling in my ears when my jaw moves, headache, and feeling of fullness in my ears remains. Every once in a while I've gotten a brief spell of vertigo, similar to the feeling you get after having too much to drink, but typically subsides within minutes and has only happened a couple times since the incident. Almost not sure if the vertigo is just in my head or if it is real, it hasn't caused any falls or nausea.

One more thing to add... I've noticed a few small pieces of solid ear wax of yellow/dark color coming out of my left ear today.

 

[Duke Dive Medicine]

Hi Phenomdives,

Sorry to hear about your injury. It's hard to tell from your post alone exactly what's going on. From what you've written, ear infection seems unlikely given that there's a known mechanism of injury, but it can't be completely ruled out if one or both TMs perforated. A minor perf could heal in a couple of days so the fact that the physician didn't see one doesn't necessarily mean you didn't have one. You almost certainly have middle ear barotrauma, and the tinnitus and vertigo are worrisome for inner ear barotrauma but it's reassuring that they are mild and intermittent. It is possible to have non-fistulating inner ear barotrauma, that is, there is no tear in the vestibular apparatus as often happens in IEBT.

The only way to definitively diagnose IEBT is via surgery and you didn't mention that so I assume that that isn't planned for you. Empiric treatment for IEBT involves strict bed rest with the head of the bed elevated, no lifting, and stool softeners to obviate the need to bear down when having a bowel movement.

I would expect that you'd hear frequent pops and cracks until the inflammation in your middle ear subsides. However, if the vertigo and tinnitus do not begin to improve over the next day or two, a follow-up visit with your ENT would definitely be in order.

Best regards,
DDM

 

[Phenomdives]

Hi DDM,

Thanks a ton for the thorough response... you are correct in that there is no planned surgery at this point. As of now I haven't seen an ENT at all, I went to my primary care doc.

Assuming the trauma is constrained to the middle ear & TMs, and the crackling/popping continues, at what point should I be concerned that it isn't improving. I ask because I've heard middle ear barotrauma can sometimes take a couple weeks to heal.

Also, in the meantime I've been going with Sudafed and ibuprofen to encourage drainage and reduce inflammation. Is this a reasonable treatment plan, along with rest and not straining for the meantime?

This is currently the end of day 5 since the trauma initially occurred for me, and I saw the doc initially on day 3.

Thanks

 

[Duke Dive Medicine]

Hi Phenomdive,

The cracks and pops, though bothersome, are relatively benign. I was referring more to the intermittent tinnitus and vertigo. If those are still present today I would recommend going to see an ENT physician immediately. If you try and can't get an appointment with an ENT today I'd recommend going to an ED or urgent care.

Best regards,
DDM

 

[Dr Simon Mitchell]

Hello,

Just a quick comment to add to those of DDM.

The loss of hearing caused by middle ear barotrauma is "conductive" (caused by interference with the vibration of the ear drum and small conducting bones of middle ear) and in inner ear barotrauma it is "sensorineural" (an injury to the neural neural hearing mechanism in the inner ear). The latter is potentially serious and permanent, whilst the former almost always recovers spontaneously over time. A relatively east way to tell them apart is to perform an air-bone audiogram. Basically the audiologists test your hearing with sound delivered to your ear (that's the air part) and to the bone just behind your ear. If hearing is reduced through the ear, but normal through the bone this indicates that the problem is in the middle ear. The latter would be very reassuring in your case.

Such a test would be relatively easy to organise.

Simon M