Otitis Media NOS - New Diver Needs Help!

[Web Monkey]

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.

I actually get quite a chuckle out of it when someone goes to the doctor for a problem (middle ear, for example) and comes back with something like "Otitis media", which is Latin for inflammation of the middle ear.

Not that there's anything wrong with a diagnosis, but it always sounds much more official when it's in Latin.

Not sure if doctors could collect the co-pay if they just said "Yeah, that's all inflamed in there".

Terry

 

[doctormike]

Not that there's anything wrong with a diagnosis, but it always sounds much more official when it's in Latin.

Not sure if doctors could collect the co-pay if they just said "Yeah, that's all inflamed in there".

Terry

Is teneo nostrum specialis! Bonus vicis es super...

[He knows our secret! The good times are over...]

 

[Web Monkey]

Is teneo nostrum specialis! Bonus vicis es super...

[He knows our secret! The good times are over...]

My favorite was when I went to my doc and mentioned that the thumb I smashed with a mallet when I was 20-something was starting to bother me.

The medical diagnosis was "Yeah, it sucks to get old".

Terry

 

[doctormike]

The medical diagnosis was "Yeah, it sucks to get old".

Getting old is terrible, until you consider the alternative.

 

[TheBigPhillyFish]

Well got in to see the ENT doctor. And as usual everything has to be a project with me. So here is where we are. I will be out of commission for at least another 4 weeks. There is some type of infection, he is not 100% certain, but suspects URI. So he wants to get this cleared up first. Now when he examined the ears, nose and throat he found some ruputured blood vessels in the ears, he doesnt see any blood in the drum. He said I bruised both drums. They ran an audio test and I have bad pressures and hearing loss in both ears (i am assuming thats normal for this injury). While checking my nose he noticed, but wasent specific of a problem with my septum (and no I have never broken my nose). Also he said he see's some type of growth or something in the back of my throat next to my tonsils. Which he said we will address after the infection. So he put me on biaxin, flonase and saline nose solution. Return in three weeks.

Well it puts me at ease somewhat, that he has answered and explained many things. Hopefully this second dose of antibiotics will clear it up. And we can get to the bottom root of what happen.

 

[doctormike]

Well got in to see the ENT doctor.

...
Now when he examined the ears, nose and throat he found some ruputured blood vessels in the ears, he doesnt see any blood in the drum. He said I bruised both drums. They ran an audio test and I have bad pressures and hearing loss in both ears (i am assuming thats normal for this injury).
Well it puts me at ease somewhat, that he has answered and explained many things. Hopefully this second dose of antibiotics will clear it up. And we can get to the bottom root of what happen.

OK, keep us posted! You might ask about the specifics of the hearing loss - the amount and whether it is conductive or sensorneural (nerve). I'm hoping (and assuming) that it's probably conductive (which is better, and usually improves with time).

 

[TheBigPhillyFish]

He did say the right side was conductive. But he wasen't sure of the left. I did have some partial hearing loss in my left ear from Operation Desert Storm. (thanks to good ol' Uncle Sam saving a few bucks on hearing protection) but since this diving thing it has definately been worst. But I did tell him I had a baseline audiogram, and would get a copy for him. It was done 6 years ago, but it should be good for him.

Hey Dr. Mike, when he said brusied eardrums, I guess that would be the layman term for a hemorage , meaning don't blow so dam hard?

Again, Dr. Mike you are great, and I can't say enough, to thank you and the others who have helped me through this. I know its not a big deal, but being an inexperienced diver, definately cause's "EAR FEAR" like Dr. Kay talks of. You medical professionals are a great asset to this forum. Keep up the good work, and Kudos for all of you.

 

[doctormike]

He did say the right side was conductive. But he wasen't sure of the left. I did have some partial hearing loss in my left ear from Operation Desert Storm. (thanks to good ol' Uncle Sam saving a few bucks on hearing protection) but since this diving thing it has definately been worst. But I did tell him I had a baseline audiogram, and would get a copy for him. It was done 6 years ago, but it should be good for him.

Hey Dr. Mike, when he said brusied eardrums, I guess that would be the layman term for a hemorage , meaning don't blow so dam hard?

Again, Dr. Mike you are great, and I can't say enough, to thank you and the others who have helped me through this. I know its not a big deal, but being an inexperienced diver, definately cause's "EAR FEAR" like Dr. Kay talks of. You medical professionals are a great asset to this forum. Keep up the good work, and Kudos for all of you.

Hey, no problem, and thanks to YOU for your service..! This is the least that we can do...

I'm glad that the new hearing loss seems to be conductive. It would be very helpful to have your old (baseline) audiogram. I'm not quite sure what he meant by bruised eardrums - this could mean inflammation in the drum itself, or blood/fluid behind the drum in the middle ear. But you may have stressed the system a bit through ascent, descent and forced equalization.

Many new divers have trouble with this at first, but if they wait until they are ready, go slowly and try equalizing in shallow depths before a deep dive, most of them learn to do it just fine..

Keep us posted!

Best,

Mike

 

[TheBigPhillyFish]

Dr. Mike and others:

Well after all these doctors and tests. The ENT sent me for a CT Scan. I got the results back today.

"The osteomeatal units are patent bilaterally. There is some soft tissue as well as mucoperiosteal imagining associated with some of the ethmodia air cells. The soft tissue appears to represent a left sided retention cyst. There is a small retention cyst identified within the left maxillary sinus. There appears to be a retention cyst within the left sphenoid sinus.

Impression: 1. Mild ethmoid sinusitis associated with several small retention cysts. "

Well if Dr. Mike is reading this, why does this seem a lot more serious then I think it is? This would explain why, my headaches have progressively gotten worst since my dive. The headaches are so bad now asprin, narcotics dont even work. My left jaw, left eye, left brow and left forehead and temple hurt so bad my left eye is like a faucet. The headaches which are at least once a day, wipe me out energy wise. And I do get a slight fever with the headache. I have a follow up with the ENT monday, but for some reason I just feel this shouldnt wait till monday. The research on google (I know Doctors hate google, lol.) everything points to immediate medical intervention and treatment. Why? Not sure, possibly due to infection? Well if any doctors read this, help put my mind at ease till I see the treating ENT.

As for all you others out there in SCUBA world. Don't listen to your friends when they say nothing is wrong and just blow harder. Because there just could be something wrong. And always come to the SCUBA forums and get others input, because it helps.

Oh yah Dr. Mike, is this something that is going to prevent me from diving ever again?

I hope not.

Thanks

TheBigPhillyFish

 

[doctormike]

Dr. Mike and others:

Well after all these doctors and tests. The ENT sent me for a CT Scan. I got the results back today.

"The osteomeatal units are patent bilaterally. There is some soft tissue as well as mucoperiosteal imagining associated with some of the ethmodia air cells. The soft tissue appears to represent a left sided retention cyst. There is a small retention cyst identified within the left maxillary sinus. There appears to be a retention cyst within the left sphenoid sinus.

Impression: 1. Mild ethmoid sinusitis associated with several small retention cysts. "

Well if Dr. Mike is reading this, why does this seem a lot more serious then I think it is? This would explain why, my headaches have progressively gotten worst since my dive. The headaches are so bad now asprin, narcotics dont even work. My left jaw, left eye, left brow and left forehead and temple hurt so bad my left eye is like a faucet. The headaches which are at least once a day, wipe me out energy wise. And I do get a slight fever with the headache. I have a follow up with the ENT monday, but for some reason I just feel this shouldnt wait till monday. The research on google (I know Doctors hate google, lol.) everything points to immediate medical intervention and treatment. Why? Not sure, possibly due to infection? Well if any doctors read this, help put my mind at ease till I see the treating ENT.

As for all you others out there in SCUBA world. Don't listen to your friends when they say nothing is wrong and just blow harder. Because there just could be something wrong. And always come to the SCUBA forums and get others input, because it helps.

Oh yah Dr. Mike, is this something that is going to prevent me from diving ever again?

I hope not.

Thanks

TheBigPhillyFish

OK, I REALLY am going to go out on a limb here and break one of my rules, which is to never reassure ANYONE over the Internet. But I do think that a little perspective here would be helpful. Please promise me that you understand that I'm just talking in general terms here, and not diagnosing or treating you myself, you need to go over the scan with the doctor who ordered it...



The paranasal sinuses are air filled spaces surrounding the nose and draining into the nasal airway. There are four "sets" of sinuses: The maxillary sinuses (the big ones in your cheeks), the ethmoid sinuses (the little ones between your eyes), the frontal sinuses (in your forehead), and the sphenoid sinuses (deep in the center of the skull).

In a sinus CT scan, you see basically one of three shades on the image: black, white and grey. Black is air, white is bone, and grey is everything else (see my little diagram). When the radiologist reads the scan, he or she may use the term "retention cyst or polyp" to describe something like this:

http://www.scubaboard.com/forums/attachment.php?attachmentid=50140&stc=1&d=1222123336

Retention cysts / polyps are a sort of inflammatory reaction that happens to the lining of the sinuses. While technically the cysts and polyps are different, they look the same on the CT and are treated in similar ways. This is an extremely common finding, and in many cases, is of no clinical significance. That is, you don't really do anything about it if it doesn't cause any problems, and the only reason that you know that it is there is because you got a CT scan. In some cases, the polyps can be big enough to cause blockage of the sinus drainage pathways, and thus cause symptoms - this often is helped by surgery in which the sinuses are opened up to drain better and the polyps are removed.

Now, your scan mentions sphenoid sinus retention cysts. If you google sphenoid sinusitis (which I am guessing you did), you will find some very scary stuff. That is because the nerve of vision (optic nerve) and the main artery to the brain (internal carotid artery) run through the wall of the sphenoid sinus. For that reason, an ACUTE INFECTION in the sphenoid sinus is something that needs quick treatment, and can have real complications. HOWEVER, a small polyp or cyst is not the same thing as an acute infection (in which the sinus fills with pus). SO, as with most things, "the devil is in the details". An incidental finding of a small polyp in the sphenoid does not always need treatment at all...

It does worry me that you have such severe headaches, but the way that you describe the symptoms is not that typical for sinusitis. It is also unusual that you just go the report on the scan without any context - did it just get mailed to you or something? It's probably better that you speak with the ENT doctor about the findings - maybe you can call the office tomorrow and ask about them...

The bottom line is that CHRONIC sinus disease (with cysts, polyps etc...) is not really an infection at all, but rather a form of inflammation related to poor ventilation of the sinuses. The fact that both an acute infection and chronic inflammation can look similar on a CT (that is "grey") doesn't necessarily mean that they are the same condition (although there is some overlap).

Whether or not chronic sinus disease needs any treatment is based on the extent of the disease on the CT (your scan was read as "mild") and the clinical context (that is, your symptoms). Have your ENT doctor take a look a the scan and then decide with him or her if any treatment is necessary. I wouldn't think that this would prevent you from diving in the future, one way or the other...

Mike