Odd ear fullness again

[jfksabal]

To the Community --

Just returned from AWESOME diving in Maui and on my last dive my ears got congested and now, four days later, they're still congested and "full" and popping and not clearing all the way.

I never had any pain while or after diving although I typically have some difficulty equalizing, but I always immediately ascend, equalize via Toynbee and then am eventually able to get all the way down. I always ascend slowly and don't have pain on surfacing so I don't think I ever had any middle or inner ear barotrauma. Interestingly, when I equalize, I usually hear little hissing/crackling sounds as the pressure releases and when I surface, it takes a couple of minutes for the crackling to stop.

During the week my ears were fine but just on the last dive to Cathedral #1 did they seem to "fill up" and stay congested. (During the week of diving, my ears would get slightly congested but then the congestion would resolve overnight so I'd be fine diving the next day.)

I saw a nurse practitioner yesterday who said my ears are clear and everything looks ok with the ear drum, not infected, etc. but it definitely seems I have some fluid or mucus buildup somewhere in there as both my ears seem "full." She suggested I try Flonase but after 1 day it hasn't helped yet.

My hearing is affected but improves if I tilt my head to one side so it doesn't seem permanent and, this happens every dive trip so I'm used to it now.

My ears cleared up last night -- with full hearing restoration -- but then they were full again this morning so I'd really like to know what's going on. It usually takes 1+ week for everything to resolve, but my ears pop with every swallow and it's kind of annoying, not to mention the hearing loss/stuffiness/head congestion feel.

Please help!

Thanks in advance,

John

 

[Imla]

Sounds like barotrauma. Late/incomplete equalization causes pressure/trauma/stress on structures in the ear.
You might need a long lasting systemic decongestant like fenylpropanolamin, fenylefrin, pseudoephedrin or similar.
The mechanics is that you have a cycle of swelling/deswelling depending on position of head and medications. (Kindof like a sprained foot kept elevated, that deswells and swells depending on position)
Talk to your ENT about it for acute relief, and make a plan with your doc for future prophylactic medication, and make adjustments to your diving to be even more cautious with ascents/descents to allow for equalisation without causing stress on your ENT tissues.

Disclaimer: I am not a doctor, these are but friendly explanations to further understanding. Errors may occur as english is not my primary language.

 

[jfksabal]

Thank you Imla.

Any idea on the fluid source/location? Mucus? Inside cochlea?

I realize it's just a guess on your part but I'm really curious. FYI -- I just made an appointment with an ENT doc...

 

[scubaozy]

You probably have mild middle ear barotrauma. You will need to use decongestants to flush out the fluid in your middle ear. You also need to ensure that it is not becoming a middle ear infection. Great that you already have appointment with ent. You might want to have a look at this link: Middle-Ear Barotrauma (MEBT) - Divers Alert Network

 

[jfksabal]

You probably have mild middle ear barotrauma. You will need to use decongestants to flush out the fluid in your middle ear. You also need to ensure that it is not becoming a middle ear infection. Great that you already have appointment with ent. You might want to have a look at this link: Middle-Ear Barotrauma (MEBT) - Divers Alert Network

Thank you @Ucarkus -- excellent link.

Is there a particular decongestant that is preferred for this, such as pseudoephedrine vs. phenylephrine?

Any idea what the fluid may be and why an initial examination shows my ears are "clear"? It must be deep within, eh?

 

[scubaozy]

Thank you @Ucarkus -- excellent link.

Is there a particular decongestant that is preferred for this, such as pseudoephedrine vs. phenylephrine?

Any idea what the fluid may be and why an initial examination shows my ears are "clear"? It must be deep within, eh?

I do not have medical training, so, better to get the medication recommended by the doc . You will probably will be prescribed nasal sprays like with oxymetazoline, as well. Pseudoephedrine has different combinations like codein, ibuprofen or paracetamol. Just get what the doc is telling you.
Hard to say why nurse did not spot anything, normally they blow little air with otoscope to your t. Membrane and can see whether there is fluid behind.

 

[Doctorfish]

you have serous otitis media due to mild barotrauma and it will clear up over time as the fluid is resorbed. I have had this several times and IMO medications will just have potential side effects without a significant benefit.

 

[jfksabal]

I do not have medical training, so, better to get the medication recommended by the doc . You will probably will be prescribed nasal sprays like with oxymetazoline, as well. Pseudoephedrine has different combinations like codein, ibuprofen or paracetamol. Just get what the doc is telling you.
Hard to say why nurse did not spot anything, normally they blow little air with otoscope to your t. Membrane and can see whether there is fluid behind.

Thank you again for your reply. My guess is it's clear because the fluid is deep within. I'll find out more on Thursday and let you know.

 

[jfksabal]

you have serous otitis media due to mild barotrauma and it will clear up over time as the fluid is resorbed. I have had this several times and IMO medications will just have potential side effects without a significant benefit.

Thank you @Doctorfish ! That sounds about right. I just googled it and it's along the lines of otitis media with effusion (no infection).

You say you've had this several times...is that typically at the end of 7 days of diving? I don't want to schedule dive trips and worry about otitis media on day 1. My experience has been that my ears get full and hearing is impacted toward the end of my trips.

What do you know about Doc's Proplugs?

 

[scubaozy]

Doc’s Proplugs are against otitis externa -> swimmers ear. Will not help for your condition. You need to nail it down to root cause. Is it wrong technique you use for equalisation or late equalisation or your eustachian tubes gets swollen due some allergy or another medical condition etc. You mentioned during the week your ears were congested mildy, this should have already ringing the alarm bells. If I had blocked ear overnight, I would skip next few dives (I know it is a tough call especially on a liveboard), use nasal decongestants, and this will actually give you better chances to dive for rest of your holiday.