Mystery ear pain

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sonofzell

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Greetings,

My [now] 16-year-old daughter got her ow certification last August. She logged another 9 dives since her checkouts, all of which were in the same freshwater quarry she certified in (the point being she is a very new diver and with just under 50 dives myself I don't have an abundance of experience to offer). During her checkouts and subsequent dives she did not have any trouble at all with equalization or pain.

On her first attempted dive of this year, she was unable to descend beyond 15' without "agonizing" pain in her ears. I aborted the dive, but stayed in the water with her and my other daughter for a good 20 minutes just to review equalization techniques. Even without gear in shallow water when was unable to free swim beyond 10' or so without experiencing the pain. While she reported pain bilaterally, she said it was significantly worse in her left ear.

She took an allergy pill in an attempt to reduce up any possible sinus inflammation/congestion and we attempted another dive about 2.5 hours later. During this surface interval, she reported zero pain or discomfort. On the second attempt, she claimed the pain was "worse than before", and presented almost immediately (<5' depth). With the diving day scrapped, I assumed it was simply some anomaly associated with her sinuses.

A few weeks ago, she flew to visit family in Florida (from PA). I did not travel with her, but she noted a similar, albeit less intense pain during takeoff and landing. When picking her up from her return flight she reported an identical experience. She did NOT experience the pain during the entire flight, which I suspect would be due to the full pressurization of the aircraft at cruising altitude. While she was in FL, I had asked her to try to spend some time at depth while swimming recreationally and she claimed to experience ear pain even while free-swimming to the bottom of the 8ft pool.

I made an appointment with her physician who examined her earlier this morning and claims that there is nothing remarkable to report. She prescribed Cipordex drops (which I admittedly am not familiar with at all, but my other daughter uses for 'swimmer ear'), but did not offer any specific advice for diving or flying.

My daughter will be returning to Florida this weekend, so I hope to have some feedback regarding the effect of the drops in flight. Regardless of the results, I am curious if there is anything I can or should be doing to prepare her for future dives. We have a tentative day planned in a few weeks and she is understandably apprehensive about returning to depth.

Thanks in advance for any thoughts or suggestions!

-K
 

rddvet

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I would see an ENT who is familiar with diving related issues. DAN has lists of Drs with dive specific training. The primary care likely heard ear pain and diving and automatically assumed it was an infection. It seems like a kneejerk reaction to me. If there was "swimmer's ear" I can't imagine it would only pop up in those particular situations. I would wonder if she's got inflammation in her eustachian tubes, typically related to allergies.
But I'm no ENT, so I wouldn't take my advice or anyone else's here, unless it's to go see a good ENT. Last thing you want is your daughter blowing her ear drum or getting a reverse. It's a surefire way to get a new diver to never want to dive again.
 

Brant Emery

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I would try to find an ENT that understands diving dynamics. A call to DAN should give you a list of local, qualified ENTs.
 
OP
sonofzell

sonofzell

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I would see an ENT who is familiar with diving related issues. DAN has lists of Drs with dive specific training. The primary care likely heard ear pain and diving and automatically assumed it was an infection. It seems like a kneejerk reaction to me. If there was "swimmer's ear" I can't imagine it would only pop up in those particular situations. I would wonder if she's got inflammation in her eustachian tubes, typically related to allergies.
But I'm no ENT, so I wouldn't take my advice or anyone else's here, unless it's to go see a good ENT. Last thing you want is your daughter blowing her ear drum or getting a reverse. It's a surefire way to get a new diver to never want to dive again.

Thank you!

I agree with your suggestion, but feel I should clarify that I don't belive our pcp offered swimmer's ear as a diagnosis... I only mentioned it because that was the indication for my older daughter having used the Cipordex drops (and the only reason I've ever heard of it). I am at work and was not present with my wife & daughter during the visit.

I have no lack of confidence in our pediatrician but did find it somewhat odd that she wasn't able to offer any possible diagnosis nor did she suggest any follow-up with a specialist (or advice/cautions regarding future attempts at diving). Again, I was not there so perhaps my questioning is premature. Once I get home this evening and get to talk to my wife (who was present and is an RN), I will definitely consider further examination by an ENT.
 

dmaziuk

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Swimmers ear drops contain antibiotic for bacterial infection (the actual "swimmer's ear") and a steroid to help with inflammation and pain. Mine are neomycin + hydrocortizone, ciprodex are a different antibiotic + different steroid. The steroid will help with pain and inflammation from barotrauma, too, and your PCP may not have a formulation w/o antibiotics on her approved list.
 

uncfnp

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@doctormike I know it’s difficult to help without an exam but any general advice?
 

rddvet

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Thank you!

I agree with your suggestion, but feel I should clarify that I don't belive our pcp offered swimmer's ear as a diagnosis... I only mentioned it because that was the indication for my older daughter having used the Cipordex drops (and the only reason I've ever heard of it). I am at work and was not present with my wife & daughter during the visit.

I have no lack of confidence in our pediatrician but did find it somewhat odd that she wasn't able to offer any possible diagnosis nor did she suggest any follow-up with a specialist (or advice/cautions regarding future attempts at diving). Again, I was not there so perhaps my questioning is premature. Once I get home this evening and get to talk to my wife (who was present and is an RN), I will definitely consider further examination by an ENT.

Gotcha. I presume the pediatrician was covering their butts with the antibiotics. Thouggh maybe she thought the steroids were indicated to relieve inflammation. I think most drs aren’t educated in the specifics of diving maladies and it affects how they treat those patients.
 

Duke Dive Medicine

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Greetings,

My [now] 16-year-old daughter got her ow certification last August. She logged another 9 dives since her checkouts, all of which were in the same freshwater quarry she certified in (the point being she is a very new diver and with just under 50 dives myself I don't have an abundance of experience to offer). During her checkouts and subsequent dives she did not have any trouble at all with equalization or pain.

On her first attempted dive of this year, she was unable to descend beyond 15' without "agonizing" pain in her ears. I aborted the dive, but stayed in the water with her and my other daughter for a good 20 minutes just to review equalization techniques. Even without gear in shallow water when was unable to free swim beyond 10' or so without experiencing the pain. While she reported pain bilaterally, she said it was significantly worse in her left ear.

She took an allergy pill in an attempt to reduce up any possible sinus inflammation/congestion and we attempted another dive about 2.5 hours later. During this surface interval, she reported zero pain or discomfort. On the second attempt, she claimed the pain was "worse than before", and presented almost immediately (<5' depth). With the diving day scrapped, I assumed it was simply some anomaly associated with her sinuses.

A few weeks ago, she flew to visit family in Florida (from PA). I did not travel with her, but she noted a similar, albeit less intense pain during takeoff and landing. When picking her up from her return flight she reported an identical experience. She did NOT experience the pain during the entire flight, which I suspect would be due to the full pressurization of the aircraft at cruising altitude. While she was in FL, I had asked her to try to spend some time at depth while swimming recreationally and she claimed to experience ear pain even while free-swimming to the bottom of the 8ft pool.

I made an appointment with her physician who examined her earlier this morning and claims that there is nothing remarkable to report. She prescribed Cipordex drops (which I admittedly am not familiar with at all, but my other daughter uses for 'swimmer ear'), but did not offer any specific advice for diving or flying.

My daughter will be returning to Florida this weekend, so I hope to have some feedback regarding the effect of the drops in flight. Regardless of the results, I am curious if there is anything I can or should be doing to prepare her for future dives. We have a tentative day planned in a few weeks and she is understandably apprehensive about returning to depth.

Thanks in advance for any thoughts or suggestions!

-K

Hi @sonofzell ,

From your description, this sounds like middle ear barotrauma. Ciprodex drops will not do anything to relieve that.

Inflammation from middle ear barotrauma is notoriously slow to resolve. Unfortunately, her second attempt to descend in the quarry and her attempts to equalize in the swimming pool in Florida probably re-traumatized the area. I would recommend she wait several weeks before even attempting to clear her ears again.

There is a lot of information out there on ear equalization techniques. The traditional Valsalva (pinch the nose and blow) maneuver has its place but can result in serious injury if performed too vigorously. The Toynbee (pinch the nose and swallow) maneuver works well but takes some practice to get correct. Whichever method she uses, she should begin equalizing before her head goes under water and keep equalizing even though it doesn't feel like she has to. You may also want to consider getting her into seeing a good otologist as @Brant Emery suggested above.

Best regards,
DDM
 

Jayfarmlaw

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I have developed ear issues over years of diving. The solution that works for me is Flonase and Sudafed before a dive and earbeer afterwards. Sudafed works best for me but in countries where Sudafed may not be legal, I can get by with any of the common allergy pills. I also keep Ciprodex on hand if it feels like it's getting away from me.

I use the 50/50 alcohol/white vinegar ear beer but have been wanting to brew up some of the Everclear Grain Alcohol and Boric Acid solution. I met a member of another dive team and that's what he uses. He has decades of experience on me and he swears by it.

Ear issues take proper management BEFOREHAND or they can escalate. I also start GENTLY clearing my ears a few days before a dive as well. Flonase and Sudafed the morning of the dive And earbeer when diving is done for the day.

Sometimes my right ear will seem to be wet for a couple of days afterwards but Flonase and Sudafed usually clears it up quickly. Any pain and the ciprodex comes out.

Good luck,
Jay
 

rddvet

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I have developed ear issues over years of diving. The solution that works for me is Flonase and Sudafed before a dive and earbeer afterwards. Sudafed works best for me but in countries where Sudafed may not be legal, I can get by with any of the common allergy pills. I also keep Ciprodex on hand if it feels like it's getting away from me.

I use the 50/50 alcohol/white vinegar ear beer but have been wanting to brew up some of the Everclear Grain Alcohol and Boric Acid solution. I met a member of another dive team and that's what he uses. He has decades of experience on me and he swears by it.

Ear issues take proper management BEFOREHAND or they can escalate. I also start GENTLY clearing my ears a few days before a dive as well. Flonase and Sudafed the morning of the dive And earbeer when diving is done for the day.

Sometimes my right ear will seem to be wet for a couple of days afterwards but Flonase and Sudafed usually clears it up quickly. Any pain and the ciprodex comes out.

Good luck,
Jay

2 things: try phenylepherine instead of sudafed. It may work as well and won't predispose to ox tox. Secondly, be every cautious of excessive use of a fluoroquinolone antibioitic. It's a good way to spark a future antibiotic resistance. Overuse of fluoroquinolones is the primary cause of the severe resistance we see nowadays.
 
https://www.shearwater.com/products/peregrine/

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