Otitis Media NOS - New Diver Needs Help!

[DandyDon]

The hot mask with ear guards may be a helpful idea; learning to dive would be preferable. The 45 minute vid on Equalizing below in my Sig has helped many, along with alcohol-vinegar mix.

DAN can maybe refer you to a local ENT experienced in dive injuries. If your Instructor signed you up as a Student Diver Member temporarily insured by DAN, they may even pay for your treatments. Worth a try. My Inst didn't tho; don't know how many do?

 

[doctormike]

DoctorMike,

I really appreciate your help with all this. ... Also if you happen to know a good diving ENT doctor in Philadelphia, or a way to find one that would be great.

Sure, no problem! I know a few pediatric ENT docs in Philadelphia, but no one who has dive experience. As DandyDon says, DAN is an excellent source for local referrals, they have a big database about this sort of thing.

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?

Again, with ear stuff (as with most medical problems), "the devil is in the details". Symptoms of outer ear and middle ear problems do overlap, and without a good examination it can be very difficult to determine what the actual problem is. And treatment is very much dependent on the precise diagnosis. You seem to have been given a number of different treatments, but there is no substitute for exam by and ENT doctor. I say that all the time, and I really hope that it doesn't come off as sounding arrogant. I have a lot of respect for ER docs, family docs, pediatricians and nurses. But the bottom line is that few have the training, experience or equipment to really manage complex ear problems. This involves:

1) Cleaning out the ear in the office using a microscope and curette or suction.

2) Examining the ear under the microscope

3) Getting an audiogram (which will differentiate between a number of potential different conditions)

So to say that biaxin is good but bactrim isn't sort of misses the point. True acute otitis media (pus behind the eardrum) is very rare in diving, and this would be the main thing that would be treated with oral antibiotics. Swimmer's ear usually responds to microscopic cleaning and antibiotic/steroid drops, and only requires antibiotics in rare, severe cases. In such cases, we usually use an antibiotic that is active against the pseudomonas bacteria (such as Cipro, Levaquin, etc..).

Dr. Grossman's Web site is a good resource... I have met him, he was one of the original ENT docs on the Internet!

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?

Again, those are really different ways of describing similar middle ear conditions (as I mentioned above). You really need to differentiate middle ear problems from outer ear problems. And it is true that an upper respiratory tract infection can make you more likely to have middle ear problems.

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.!

Not at all! That is why we are here... we all love trying to help as best as we can. While we can't really diagnose you over the Internet, our main goal is to help you get better so that you can get back to diving as soon as possible...

Thanks for writing, hope you feel better soon, please keep us posted..!

Best,

Mike

 

[TheBigPhillyFish]

Kudos for Doctor Mike!

Now that I am back in Philadelphia, I didn't have sound on the computer in Florida. I finally got to watch the entire video, and wow so much to learn from the video. I am going to get some syringes to practice equalization. And the first thing with the ENT is for him to check to see if my ear drums are equalizing. I think it would be a fair assumption that if they are equalizing, I must have had some type of sinus/ear infection just sitting there and waiting for the right moment to say "Hello". There is also a really good possibility that either an allergy may have caused tube congestion also. Now Dr. Kay made a statement regarding nasal polyps. I am not to sure how they would come into play, but I checked with my mother (who knows my medical history better then me, so typical) and she said years ago and x-ray showed to sinus polyps. Mike, if you wouldn't mind explaining how this could effect equalization? Now I know why there are doctors and there are ENT doctors. A whole lot of piping and electrical running up there and it gets real confusing.

By the way Mike, called DAN for a referral for a diving ENT in my area.

 

[Web Monkey]

Kudos for Doctor Mike!
I am going to get some syringes to practice equalization.

That sounds scary. What are planning to do with them?

Terry

 

[TheBigPhillyFish]

That sounds scary. What are planning to do with them?

Terry

If you watch the video that someone posted above somewhere, Dr. Kay uses a finger cot over a syringe (no needle in it body only) to blow out one nostril to practice equalization.

 

[doctormike]

Kudos for Doctor Mike!

Now that I am back in Philadelphia, I didn't have sound on the computer in Florida. I finally got to watch the entire video, and wow so much to learn from the video. I am going to get some syringes to practice equalization. And the first thing with the ENT is for him to check to see if my ear drums are equalizing.

...

Now Dr. Kay made a statement regarding nasal polyps. I am not to sure how they would come into play, but I checked with my mother (who knows my medical history better then me, so typical) and she said years ago and x-ray showed to sinus polyps. Mike, if you wouldn't mind explaining how this could effect equalization?

By the way Mike, called DAN for a referral for a diving ENT in my area.

That's great... glad that you are going to see a local ENT doc...!

Polyps are actually pretty uncommon, but a lot of people get misdiagnosed with them by x-ray or physical exam. They are what happens if you have bad enough chronic inflammation in the sinuses (air filled spaces in the facial bones that drain into the nasal cavity). What happens is that the lining of the nose and sinuses gets thicker and thicker due to chronic inflammation and eventually becomes a sort of lump that can be seen and can fill the nose, causing obstruction of breathing.

It is rare for polyps to be bad enough to affect equalization... the Eustachian tubes drain into the back of the throat, behind where the sinuses drain into the nose. They would have to completely block the nasal airway, which rarely happens except in cases of severe sinusitis or systemic diseases (like cystic fibrosis).

Occasionally, people will have small polyps within the big sinuses in the cheeks which will show up on x-ray (since they are silhouetted against the large air-filled maxillary sinuses). They often do not cause symptoms, and are just incidental findings on x-rays.

Keep us posted!

Mike

 

[doctormike]

If you watch the video that someone posted above somewhere, Dr. Kay uses a finger cot over a syringe (no needle in it body only) to blow out one nostril to practice equalization.

Here's something that's even easier.. I give these out to kids in my practice. Makes a better seal than a syringe, and is easier to get.

 

[lamont]

And the first thing with the ENT is for him to check to see if my ear drums are equalizing. I think it would be a fair assumption that if they are equalizing, I must have had some type of sinus/ear infection just sitting there and waiting for the right moment to say "Hello".

After diving for 5 years, I know now that I have reasonably good ears. I still managed to get middle ear barotrauma after my OW course. Just because you can equalize on the surface doesn't mean that you can do it correctly while you're diving.

What you need to do is step away from the medical diagnoses and try going diving again and taking it slow on your descents. You will probably learn how to equalize and will have no future troubles. Only if you've got repeated ear issues should you start worrying about medical issues.

 

[TheBigPhillyFish]

After diving for 5 years, I know now that I have reasonably good ears. I still managed to get middle ear barotrauma after my OW course. Just because you can equalize on the surface doesn't mean that you can do it correctly while you're diving.

What you need to do is step away from the medical diagnoses and try going diving again and taking it slow on your descents. You will probably learn how to equalize and will have no future troubles. Only if you've got repeated ear issues should you start worrying about medical issues.

Lamont, this is what caused the problem, I couldn't equalize at all. I started on the surface, and dam near held my nose and tried to equalize every foot or so. It just wouldn't equalize. Now from watching the video, maybe and by Dr. Kays theory, I am not putting enough pressure behind my equalizing attempts. This is why I want to use the balloon gadget and I have started doing Dr. Kays methods in the mirror. I am assuming because they put me on steroids and antibiotics and the doctor saying I had some type of infection. This was the under lying reason I couldn't eqaulize.

Thats what I wanted to do was just hop in a pool, and dive and just keep trying. But everyone else was telling me no, until I am cleared by the ENT doctor do not get back in the water. So to play it on the safe side, i won't go back in till cleared. i understand this is the most common diving injury. But with the luck I have, it will be something bad causing my problem. So as PADI teaches us, be more then conservitive.

Heading to the ENT monday will keep you posted.

 

[doctormike]

What you need to do is step away from the medical diagnoses and try going diving again and taking it slow on your descents. Only if you've got repeated ear issues should you start worrying about medical issues.

Lamont makes an excellent point, and goes along with what I was saying in my first post. People often get hung up on a diagnosis as if it was some sort of underlying truth that must be identified and then which is taken into account forever when doing any activity.

Sure, there are many conditions that are like that (cancer, lupus, congenital heart disease, etc..). But a lot of "diagnoses" are simply names we give to descriptions of points on the normal bell curve of human physiology.

We all have "auditory tube dysfunction" to one degree or another - even world champion free divers need to manipulate their Eustachian tubes to keep the equalization going when stressed by rapid descents. Even a diagnosis like asthma is just an arbitrary point on the bell curve of airway reactivity. Every one of us will wheeze if stressed enough - if you rode an exercise bike in a room filled with cold, dusty air, you would experience constriction of the muscles surrounding the air passages in your lungs. We call people who experience this more easily "asthmatics", because they can be pushed into airway spasm in a normal environment.

So while I still think that it is worthwhile for you to see an ENT doctor, you may be able to equalize in the future just fine (despite your diagnosis of "otitis media NOS").

BigPhilly, I'm glad that you understand both the potential problems AND the fact that nothing is written in stone...! Looking forward to hearing the results of your consultation..

Mike