Possible reverse squeeze?

[joejoe25]

I was performing a 70' dive in full dry suit and full face mask, during the descent I had no trouble equalizing, I spent only a matter of 20 minutes from descent to beginning the ascent.

I had a safety stop at 15' for 3 minutes, somewhere in this range I felt like I got a drop of water in the ear canal, no pain, no "woosh", no pop, vertigo, etc... everything was normal. After stripping my hood and bonnet, I found I had approximately a volume equal to a pea of blood in my ear, it still felt as if I had minor water in my ear canal due to the very slightly muffled audio which went away by the next morning; once again, no pain, pressure or any other symptoms. The only thing I did notice was the hood seemed to pull tighter to my ears than normal. I was still able to adjust my jaw and feel the normal pressure equalization in my ears at surface.

I did go to a general physician immediately, who stated that he couldn't see the entire ear drum due to some blood blocking his view but believed there may have been a rupture of the ear drum due to the symptom only, however he believed that I should flush the ear and be able to resume normal diving after approximately a week if no other symptoms present.

Before I ask my questions I will preface that I will be seeking a second opinion from an ENT as soon as possible on Monday.

After doing some more reading and research, I believe the most likely injury was a reverse squeeze, due to the dry suit hood constriction on ascent. Does this seem to be an accurate hypothesis or is there a possibility that the ear drum wasn't ruptured and the injury was to the ear canal itself? Or is there any other possible injuries that I'm missing? I'm highly pressurized that, if I did in fact rupture the ear drum, that there was/is no pressure, pain, that it appears I can still clear and equalize and I don't notice the noise of air moving through the membrane. While there is still some dried blood in the ear canal, by the next morning, I no longer had the feeling of water in the ear (presumably from the blood that was present), when I did have the sensation I still had 90% of my hearing, it was a very minor reduction.

Further research that I found through DAN (found here: http://www.diversalertnetwork.org/medical/articles/Common_Ear_Injuries_While_Diving
) suggests that it's also possible that a blood vessel could burst in the ear canal, presenting similar symptoms to mine.

I was a bit shocked when he GP stated I didn't need antibiotics, could flush the ear and could resume diving after a week, it seems to go against what I've read, which is the reason I will be seeking a second opinion from an ENT.

Even if there is a minor rupture of the ear drum, since I am not exhibiting trouble with ear whistling past and equalizing, no pain and no other symptoms, is there a chance (after consulting with an ENT) that I could resume diving to 20-30' depths with care (slowly and carefully) after a week's time? I'm simply asking if there is a chance, not for advice on whether I should or should not with that question in particular.

I am ensuring that I am taking Claritin-D (generic), Ibuprofen, and using a sinus rinse as the labels prescribe just to assist any healing that may be going on, in the meantime.

You thoughts and hypotheses?

Any help, insight, advice and suggestions are most appreciated, thank you in advance.

 

[doctormike]

I did go to a general physician immediately, who stated that he couldn't see the entire ear drum due to some blood blocking his view but believed there may have been a rupture of the ear drum due to the symptom only, however he believed that I should flush the ear and be able to resume normal diving after approximately a week if no other symptoms present.

I have great respect for general physicians, but in my experience over the past 20 years, I find it very rare that a good thorough exam is done in a situation like this without a thorough cleaning of the ear canal of dried blood and debris, usually using a microscope. This is not something that is typically done by anyone other than an ENT doctor.

You should definitely not flush the ear canal if there is a question of an eardrum perforation.

I can't really say anything specific over the Internet, this situation simply requires a good examination. As you read, there are a number of possible injuries, including swimmer's ear, barotrauma without perforation, barotrauma with perforation, etc...

Decongestants and nasal irrigation may help with sinus squeeze but they have very little effect on middle ear ventilation.

Here is my article on ear disease and diving, perhaps it will be helpful.

Keep us posted!

Mike

 

[drrich2]

Decongestants and nasal irrigation may help with sinus squeeze but they have very little effect on middle ear ventilation.

From your article:

Many divers swear by the use of decongestants and/or nasal steroid sprays to treat this problem or prevent its development. While these drugs can help prevent barotrauma of the nasal sinuses, there is not much data to suggest that they help middle ear disease any more than time and the ET maneuvers alone.

Didn't read the while thing, just scanned for the part that addressed what I quoted 1st.

Surprised me to see this. I use long-acting (12 or 24) hour Sudafed, and it makes equalizing much easier for me, so much so that it's become a standard part of my dive regimen.

That's anecdotal, but it gave me the data I needed. Be interesting to see whether others will post on the issue.

Richard.

 

[doctormike]

From your article:



Didn't read the while thing, just scanned for the part that addressed what I quoted 1st.

Surprised me to see this. I use long-acting (12 or 24) hour Sudafed, and it makes equalizing much easier for me, so much so that it's become a standard part of my dive regimen.

That's anecdotal, but it gave me the data I needed. Be interesting to see whether others will post on the issue.

Richard.

See, Rich... you are one of the many divers who swear by them!

And remember, I didn't say that there was evidence that they don't work, just that there wasn't much evidence that they do. Now let's talk about whether diving nitrox makes you less tired after the dive...

 

[Duke Dive Medicine]

Hi Joejoe,

It would be nearly impossible to get a hood so tight that it would cause reverse barotrauma on ascent. However, if the hood was tightly sealed against your ear, it could in theory lead to extravasation of blood from the external ear canal on descent. It will be interesting to hear what the ENT physician says. And ditto DoctorMike regarding irrigating the canal - leave that to the professionals if there is a possibility of eardrum rupture.

Best regards,
DDM

 

[joejoe25]

Thank you all for your insight and support, doctormike, drrich2, Duke Dive Medicine. I had a visit with the ENT today. They first ran me through a couple of tests. The first was a vaccuum type device that places slight pressure on the ear drum to see if it moves with the pressures (not sure what this test/device is called) which indicated that the ear drum was intact on both ears, to the suprise of the technician. Next they tested my hearing in the booth which came back nearly perfect.

Lastly I was seen by the ENT. He stated that he actually found dried blood in my right ear also, which I was unaware of. He cleaned out my left ear to the point where he could see about half of the ear drum. The last bit of blood in the left ear, he stated, was sticking rather well to the canal, which indicates to him that is probably the source of the blood. After cleaning he was able to see about half of the ear drum. I explained to him the nature of the dive and the equipment involved as well as the possible injuries that I was aware, being careful not to come across as all knowing or arrogant, I completely respect the fact that any MD has endured years of education and experience of which I will not scoff at.

Based on this information, he surmised that the injury sustained to my left ear occurred in the outer ear, in the ear canal, most likely due to a rupture of the blood vessels.

I also emailed DAN, whose response was similar to those posts here and was informative and a great resource.

To be more specific on the equipment; I am in public safety and am working toward my public safety certification. The dry suits that we are using are hazmat rated, such that the hood and full face mask seal with the face mask overlapping on top of the hood. During the dive, I did feel the hood physically constricting more around my ears than in any dive previous. I suppose this negative air space in the ear canal caused the injury. In previous dives I didn't have as good of a seal between the mask and hood and some air would travel into the hood, giving the balloon effect. This dive it did not happen and I was unaware to watch out for this condition. In future dives I will attempt to intentionally purge air from the mask and into the hood to see if that's possible or play with the tightness of the seal between the mask and hood.

For now, however, I have another week until my next scheduled round of dives (for which the ENT stated I was clear to proceed forward with). I will most likely stick with wet suit and descend/ascend especially gingerly/careful to be on the safe side and until I know the injury is fully healed.

Thank you all again. I will update this post next week after my next dives. I hope that this post will help anyone who may experience something else in the future or more importantly, be of some use in preventing future injuries.

 

[dumpsterDiver]

I agree with that. You had an external ear hicky from the hood sucking on the outside of your ear canal. I wonder if it is possible for the eardrum to leak blood like that, without a full rupture. Maybe some fluid and a little blood.

I would think it would have been very uncomfortable- painful even..

 

[joejoe25]

I agree with that. You had an external ear hicky from the hood sucking on the outside of your ear canal. I wonder if it is possible for the eardrum to leak blood like that, without a full rupture. Maybe some fluid and a little blood.

I would think it would have been very uncomfortable- painful even..

That's what was throwing me off, is I didn't experience any pain or discomfort due to the hood. During the descent I felt the hood tightening up around my ears, but nothing more than I've experienced with any other portion of my dry suit. We were using a communication system during the dive, the speakers over my ears (on the outside of the hood and attached to the straps of the mask) felt as if they were being pulled inward as well, but again, oddly enough there was no noticeable pain, however I did find at one point during the descent I wasn't equalizing properly, at which time I stopped descending, ascended approximately 5 feet and was able to clear and then resumed the descent. While I only have approximately 17 logged dives, I would hope that I would recognize any pain or uncomfortable situations that I can't remedy relatively quickly as a red flag to abort the dive.

One thing I did forget to add to my post from this afternoon was that this morning I awoke with a small blood discharge from my left ear and a very minor "soreness" to my left ear the went away quickly. Presumably the discharge (was just blood) was not unlike any other scab that might leak from cracking or moisture, the soreness I presume from the ear canal and ear drum being irritated from the injury and existing debris.

I feared that those additional signs further pointed to a ear drum rupture and an impending infection. After getting the debris cleaned out it seems the irritation seems to slowly be dissipating, time will tell. I continue to use over the counter ibuprofen and claritin-d as preventive.