Possible Inner-Ear Barotrauma, Blood from Nose

[olof]

Hey, after reading a few threads (never ask a question that someone has already answered right?), I think I may have experienced IEBT. The dive was 11 days ago, and the only thing that was noticeable was that there was some blood in the mucus in my mask after I took it off, I had cut myself shaving the previous day, so wasn't so concerned at the time. The dive was uneventful, safety stop and all, did have some problems equalizing, but went up a little, and it sorted itself out. Total of 2 dives with around 26m in max depth, over an hour surface interval, and was diving on Nitrox. Now my right ear (can't really distinguish which ear) has been ringing intermittently (more frequent today than the past few) since the dive and was more today, so booked an appointment with my GP for tomorrow morning, after talking to a doctor at our local hyperbaric medicine department, where she recommended getting an audiogram with an ENT referral from the GP. I'm also getting on a flight tomorrow evening, so should I be looking at options to cancel or rebook my flight?

Is there anything else that I have missed looking into? The doctor at the hyperbaric chamber sounded a little concerned but didn't think I needed re-pressurization, especially since so much time had passed since the dive.

 

[Angelo Farina]

Repressurization can only be harmful after an ear barotrauma.
Also flying could be bad.
Consult an ENT for proper treatment.
Just a question: which equalisation method did you use? Valsalva?

 

[Pearlman]

I had exactly the same “blood in mucus leaking into the mask” once a few years back after surfacing from a recreational dive. The bleeding stopped in a minute (I had to expel bloody mucus a few times) and I continued diving as normal the rest of the days diving 3 times a day without any further consequences. I do not recall experiencing any unusual problems in equalising on that dive or subsequently (perhaps a mild cold?). I just didn’t even bother to do anything about it although I was a bit worried initially.

 

[olof]

Repressurization can only be harmful after an ear barotrauma.
Also flying could be bad.
Consult an ENT for proper treatment.
Just a question: which equalisation method did you use? Valsalva?

Yup, mostly Valsalva ( after reading all of the threads, who would have thought...) I have been working on pushing out my jaw technique as well but seems like I should be doing the swallow technique in the future. I tried to go to ENT directly, DAN didn't have one to recommend, but everyone here in Australia wants a referral and will see a good GP in the morning. I don't know why she suggested the chamber, but maybe suggested it because of in-ear DCS but seemed like a stretch, but I'm not a doctor, especially a doctor specializing in hyperbaric medicine like she was.

 

[olof]

I had exactly the same “blood in mucus leaking into the mask” once a few years back after surfacing from a recreational dive. The bleeding stopped in a minute (I had to expel bloody mucus a few times) and I continued diving as normal the rest of the days diving 3 times a day without any further consequences. I do not recall experiencing any unusual problems in equalising on that dive or subsequently (perhaps a mild cold?). I just didn’t even bother to do anything about it although I was a bit worried initially.

Yeah, I didn't even have to do it more than once, really minimal and the surface conditions were 16C and raining so could definitely have gotten cold/congestion. I have also been out to bars and nightclubs in the past week so could have something to do with tinnitus, when I first started searching about bloody mucus a lot of others said the same as you. Regardless probably worth checking out with an ENT, was planning on doing a good bit of diving in December.

 

[scubaozy]

Blood from nose is rather a barotrauma in sinus, not necessarily iebt. Ringing could be both iebt or mebt, the latter is more common injury.

 

[olof]

Blood from nose is rather a barotrauma in sinus, not necessarily iebt. Ringing could be both iebt or mebt, the latter is more common injury.

Thanks, sorry for the mix-up. It might be good to add that on my surface interval, I did experience nausea and ended up vomiting, but it was pretty rough surface conditions (so probably good old sea sickness), and I wasn't the only one on the boat who did... But I felt great back on land after.

 

[olof]

I just returned from seeing my GP, who had been a dive medic for a year. No inflammation of any kind in my ears. He suspected just fluid build-up being my eardrum, prescribed steroid nasal spray, and got a referral to an ENT if it didn't get better in the next two weeks.

 

[Duke Dive Medicine]

I just returned from seeing my GP, who had been a dive medic for a year. No inflammation of any kind in my ears. He suspected just fluid build-up being my eardrum, prescribed steroid nasal spray, and got a referral to an ENT if it didn't get better in the next two weeks.

Sounds like you're getting the care you need. Has the tinnitus gotten any better?

As @scubaozy mentioned above, bloody mucus in the mask is a sign of sinus barotrauma, but if you have a cold or something else that's causing general inflammation in the mucus membranes of your upper airway, it could certainly be accompanied by ear barotrauma.

The nausea immediately post-dive suggests that you might have had some vertigo as well. Definitely agree with the audiogram, and sooner rather than later. Can you get it moved up? Do you notice anything else besides the tinnitus, e.g. a spinning feeling or hearing loss, and has the tinnitus improved since the injury?

As an aside, IEBT can be very difficult to differentiate from inner ear DCS. Recompression is contraindicated in IEBT because it can cause further damage. That may have been part of the hyperbaric physician's thought process as well.

Best regards,
DDM

 

[olof]

Sounds like you're getting the care you need. Has the tinnitus gotten any better?

As @scubaozy mentioned above, bloody mucus in the mask is a sign of sinus barotrauma, but if you have a cold or something else that's causing general inflammation in the mucus membranes of your upper airway, it could certainly be accompanied by ear barotrauma.

The nausea immediately post-dive suggests that you might have had some vertigo as well. Definitely agree with the audiogram, and sooner rather than later. Can you get it moved up? Do you notice anything else besides the tinnitus, e.g. a spinning feeling or hearing loss, and has the tinnitus improved since the injury?

As an aside, IEBT can be very difficult to differentiate from inner ear DCS. Recompression is contraindicated in IEBT because it can cause further damage. That may have been part of the hyperbaric physician's thought process as well.

Best regards,
DDM

Tinnitus is pretty much all gone, hearing is good, no spinning feeling either. Tinnitus can sometimes happen on my balcony, but it's all gone the second I leave, or just wait for it after a few seconds. I have been traveling and hiking NZ for the past week, so I've had a lot of elevation changes. As well as a fair bit of busy ambient environments with no ringing whatsoever. The nausea is pretty sure that it was seasickness; as said, I wasn't the only one who puked. Thanks for all of the advice! Funny that you're based in Durham, I grew up in NC.