Otitis Media NOS - New Diver Needs Help!

[TheBigPhillyFish]

Ok, I have searched the forums and read all the posts regarding Otitis Media. Some of the posts are really old and they really didn't seem to help to much. So I was hoping to post a new one, in hopes someone could point me in the right direction.

Background: I am a new diver in fact, I am in sitting here in Florida right now (stuck inside because of Fay). I was out doing 2 of 4 checkout dives with my instructor. We were diving Midigation Reef area depth 15 feet. Came up from first dive really no issues. Started on second dive and could not equalize right ear at all. I had pretty good pain and discomfort in my ears. So I got back on the boat and called it a day.

Symptoms: pain and discomfort in both ears, small amounts of fluid in ears, redness and elevated temperature in ears, crackling in both ears, later in the evening I had a slight fever.

Treatment: Went to a local physician his diagnosis was Otitis Media NOS. Start Bactrim DS tablet 800mg -160mg x2 day, prednisone tablet 20mg x1 day 7 days.

Now after reviewing the 2007 Lange Current Medical Diagnosis & Treatment book. I strongly feel that Auditory Tube Dysfunction or Acute Otitis Media is my problem. Now I was hoping to possibly finish my checkout dives and get my card before I left Florida. How long must I wait to return to the water, I have heard and read so much from a week to 3 months. I was planning on going to an ENT before leaving to have him check it out to see if I could squeeze in my last two check out dives. Any ideas on wait period? Also after reading the information on the two possibilities, it seems they are primarly caused by an upper respiratory infection. But I didn't seem to have any severe colds prior, some slight cogestion.

So what kind of time frame for returning to the water? What questions should I ask the ENT doctor? Should I avoid OTC decongestants?

Thanks for your help guys, hopefully I can salavge some of this trip.

Ed

 

[Jim Lapenta]

Go to the ENT! If he says no then it's no. Salvaging a couple dives is not worth ending your diving for good. Crack open some cold ones, watch the weather channel, and relax. It'll still be there next time. Finish your checkouts when you get home.

 

[TSandM]

Distinguishing between acute otitis media and barotrauma can be tough. Both produce fluid behind the drum, both can cause redness and pain and decreased hearing. Fever would be far more typical of an infectious process like otitis -- but then again, what is "a little fever"? And what caused your inability to clear? If you had a bit of a cold, you could end up with barotrauma from inability to clear, and have a low grade fever from the virus. It could be very difficult to sort everything out.

The conservative (or perhaps liberal, depending on which side of the otitis media controversy you sit on) approach is to treat with antibiotics, on the theory that they are unlikely to harm and may be helpful. Steroids are generally not used for acute otitis, nor for barotrauma unless the inner ear is involved (symptoms of this are generally balance issues or persistent hearing loss).

It is probably unwise to dive until the symptoms have resolved. When your hearing is back to normal and the pain is gone, you can cautiously test your ability to clear.

Have you watched THIS video? (Warning: It's about 45 minutes long.) It's quite educational, and I think you can get an idea from it of how difficult it can be for a physician to determine with certainty whether there is any infectious process present in the ear.

Some people have found decongestants (eg. pseudoephedrine) and anti-inflammatories (like Ibuprofen) to be helpful in speeding the resolution of middle ear barotrauma. Assuming you have no contraindications to the use of such medicines (high blood pressure, abnormal heart rhythms, or ulcers are examples) it might be useful to make a trial of them.

Good luck with your trip. Hopefully the video will help you understand how to equalize more frequently and effectively, to avoid this problem in the future.

 

[doctormike]

Hi, Ed...

Welcome to diving, and to ScubaBoard..!

I think that you are a little caught up on ICD-9 terminology, which is very useful for medical billing, but that's about it! ICD-9 is a government mandated way of labeling every patient with a diagnosis code, for research and billing purposes, but it rarely is very helpful in actually diagnosing and treating a patient. I'm assuming that the doctor checked off Otitis Media NOS on the sheet that he or she gave to the receptionist, which is where you got the term from. NOS means "Not Otherwise Specified", it's just a code that people use.

Actually, many very good general physicians and pediatricians are confused about this terminology as well, so I'll go over it a bit for you first.

Auditory Tube Dysfunction (also known as Eustachian Tube Dysfunction, or ETD): This means that for whatever reason (diving, upper respiratory tract infection, childhood, etc..), you are having trouble getting air into and out of the space behind your eardrum.

Acute otits media (AOM): This means pus behind the eardrum, and ETD is almost always an underlying problem.

Otitis media with effusion (OME): "Water" behind the eardrum - more accurately, fluid that is not infected. This is also caused by ETD, commonly seen after diving problems. The water may have blood in it if caused by barotrauma ("hemotympanum").

Swimmer's ear: A skin infection of the outer ear canal. This has nothing to do with the Eustachian tube or the space behind the ear canal.

Otitis Media NOS: This means that the person who diagnosed otitis media wasn't exactly sure about the status of the middle ear. Not always a bad thing, and sometimes it can be hard to differentiate between AOM and OME. It is actually a reasonable label to use if you aren't sure, especially since the treatment you got might be helpful for either type of otitis. The doctor has pretty much covered several bases by giving you antibiotics and steroids.


Now, what should you do? Unfortunately, I really can't tell you much without seeing your ears myself. I will tell you that it would definitely be worthwhile seeing an ENT doctor, preferably one with experience in diving medicine. A precise diagnosis is very important, since the symptoms of many different types of ear problems overlap. Therefore, it is hard to say much based just on a description of symptoms, without an examination. And, as I implied above, many excellent non-ENT physicians have trouble with this area (no offense to my colleagues!).

Generally, if you can equalize in a pool, that's a good prognostic sign. Unfortunately, it may not be possible to predict how long it will take for your Eustachian tubes to start working again, even with the steroids... Although many people swear by them, there isn't a lot of good research evidence that OTC decongestants really help with this sort of problem, but they might tip the balance a bit in a marginal case...

Good luck, find an ENT doc, and keep us posted!

Best,

Mike

 

[TheBigPhillyFish]

Well should I seek an ENT in Florida this week, or is condition take a few weeks to clear up.

 

[doctormike]

Well should I seek an ENT in Florida this week, or is condition take a few weeks to clear up.

I guess that depends on your schedule, your ability to travel, and how much you want to try to salvage some diving from this week.

If are hearing normally and aren't dizzy, then you probably don't need to see someone on the road if you don't mind deferring your checkout dives for this trip. And no matter what any doctor says, don't try a checkout dive until you try equalizing in a few feet of water in a pool first..!

 

[lamont]

You're probably overthinking this *quite* a bit.

Just keep in mind that pain is bad. If you're having pain, don't go back into the water. Once the pain clears up its generally okay to go back into the water. If you get pain while descending on a dive, stop descending. If the pain doesn't clear up see a doctor. Just listen to the pain and don't let your wanting to "get something" out of this vacation lead you to trying to "push through it" and wind up blowing your eardrum out...

And take things slow. Descend slowly and equalize early and often.

I had a lot of anxiety after my OW course because I managed to get mild barotrauma and I spun that up into my head into worrying about some syndrome that would prevent me from ever diving again. That can happen, but its very unlikely. What is very likely is for a new diver to give themselves some mild inner ear barotrauma, and as they dive more, they'll learn how to avoid that.

Dr Kays video is also what I used to learn how to equalize...

 

[TheBigPhillyFish]

I first wanted to thank everyone for there feedback with my problem. I have decided to return home saturday, and follow up with ENT doctor and return to Florida for some diving in a month after I am cleared from my doctor. But since were still flooded in from the tropical storm. I decided to look at some more dive equipment. Low and behold look what I found Pro Ear 2000 Mask. This may help others out there with chronic ear problems. I may just get this mask as a back up or primary mask to avoid any future ear issues.

I will keep you posted on the medical condition.

 

[doctormike]

I first wanted to thank everyone for there feedback with my problem. I have decided to return home saturday, and follow up with ENT doctor and return to Florida for some diving in a month after I am cleared from my doctor. But since were still flooded in from the tropical storm. I decided to look at some more dive equipment. Low and behold look what I found Pro Ear 2000 Mask. This may help others out there with chronic ear problems. I may just get this mask as a back up or primary mask to avoid any future ear issues.

I will keep you posted on the medical condition.

Sounds like you made a good decision (and the storm probably helped make it easier!). Hopefully, you have many happy safe years of diving ahead of you... welcome to ScubaBoard!

The ProEar mask has been discussed a good bit here, and many people who use it swear by it. It clearly helps keep water out of the outer ear canal, which can be an issue for people prone to swimmer's ear, surfer's ear (osteomas), etc...

For middle ear problems (such as difficulty equalizing) the mechanism by which it helps is less obvious, but apparently using this system is useful for people with marginal function of their own Eustachian tubes. It seems that the Pro Ear system slows the rate of change of ambient pressure in the external ear, making it easier for the diver to match this pressure in the middle ear space (i.e. equalization). This would be similar to the action of EarPlanes plugs, which helps people who have difficulty equalizing during air travel.

There is a chart on the ProEar Web site that goes over the benefits that the company claims for the mask. Will this work for you? The only way to know is to try it out... But the bottom line is that no matter what you do, at some point you need to make the pressure behind the eardrum approximately equal to the pressure in the ear canal, which ultimately needs to match ambient pressure at depth. If your own Eustachian tube is not working at all (and your eardrum is intact), no mechanical system can compensate for this problem, once you descend more than a few feet underwater...

 

[TheBigPhillyFish]

DoctorMike,

I really appreciate your help with all this. I am heading back to Philadelphia tomorow, and already have a follow up appointment with my family doctor. Now the nurse that I am staying with looked in my ears and says it looks so much better. I just wanted to get some more information from you, so that I can make sure I ask the right questions. Also if you happen to know a good diving ENT doctor in Philadelphia, or a way to find one that would be great.

So hear is where I am, I still get some slight muffled hearing loss in the left ear only first thing in the morning when i wake and a couple seconds of slight pain in the left or right ear maybe once or twice a day. I have only one pill left of the Pedisone, and still have a few days of the Bactrim left. I also found this on the web which listed the use of Chlorpheniramine maleate 4mg to help speed the healing process, they also list proteolytic enzyme tablets to help open the Eustacian tubes. I still notice a very small amount of swelling in the left lymph nodes. I have never used this Bactrim DS antibiotic before, any time I have been sick, they always give me biaxin. So I am wondering if trying another antibiotic may be better for me?

Is there any postive tests that will really pin point a better diagnosis. The first was Otitis Media, but I guess Auditory Tube Dysfunction or Barotrauma could also fit in there? I have been slightly congested the last few days, if that means anything. Maybe this all started from a sinus infection that I wasen't aware I had, and the pressure just pushed it out to the ears? I know I am being a pain in the you know what, but I really just want to get this licked and do everything I can to avoid this in the future. I am one of those guys who has to know the where, when and why something is.

Oh yah let me know if that link helps out any!