Recent Experience with Barotrauma and Tinnitus

[doctormike]

Hi doctormike,

Can you elaborate on the significance of the ringing stopping at depth? It was a strange sensation since at depth my ears felt fine. It was only after I surfaced that the symptoms of barrotrauma and tinnitus returned.

Thanks,

Matt

Hi, Matt...

There are two possible explanations that I can think of for ear symptoms resolving at depth and recurring on ascent - reverse block of the middle ear, and inner ear DCI (decompression illness). Reverse block would be more common by far, although tinitus (ringing in the ear) is usually an inner ear symptom. It is possible, though, to hear noises related to middle ear problems as well. Outer ear blocks are theoretically possible but not that common in practice (usually related to partially obstructing ear plugs, etc..)

The fact that your hearing is normal at the surface now at the surface also makes an inner ear injury less likely as well. These usually leave the patient with residual nerve hearing loss. However, as I say far too often, "there is a bell curve for everything!".

It is hard to say for sure over the Internet, but if you had pain that improved at depth and returned on ascent, that sounds more like a reverse block. It also sounds like the symptoms improved over time after the dive, also suggesting a middle ear source of the problem, which is now better.

I'm glad that you found an ENT doc with diving experience.. Feel free to keep us posted!

Mike

 

[austinspace]

SeaQuestFX: Do you still have the ringing in your ears / tinnitus?

Stirring up an old thread here, but I'm interested in knowing if barotrauma can lead to tinnitus overvtime. I suffered a middle-ear barotrauma during my open water course in 2007. Took a month to get fully decongested. Now the ringing is quite noticeable, when I' in a quiet room, especially so in the past few months. Wondering if the injury two years ago was the cause (rather than being close to the stage at a Who concert when I was a kid ... I'm 43 now).

 

[DocVikingo]

Hi Austinspace,

It is very unlikely that middle-ear barotrauma sustained more than two years ago is the sole cause of tinnitus with onset and worsening within the past few months.

However, damage to the inner ear (expressed as tinnitus, hearing loss, etc.) most certainly can be cumulative, including damage from SCUBA-related barotrauma and exposure to high decibel levels (e.g., rock concerts, noisy work environments). Age-related changes in ear anatomy and function also can contribute, but this is rarely a major contributor prior to ~age 60.

Tinnitus also can be the result of certain medications, disease processes, injuries and other causes. As such, it would be prudent for the affected individual to be evaluated by an ENT or allied ear specialist.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[among millions]

I have had a similar occurrence. I did a 3 day live a board and on my second of 8 dives I had a very hard time equalizing and there was some pain. As I surfaced as per usual, my ear became very sore like I had and ear infection or swimmers ear and my hearing was dampened. The dive instructors on board gave me some drops and some sinus stuff that I took and within a few hours the pain had vanished but my ear still seemed plugged. I continued to dive 6 more times without much trouble equalizing but I could hear while equalizing what sounded like liquid in my ear (but no pain) like a squirting sound. After we had finished diving I noticed my ear ringing fairly loudly and my hearing dampened. I noticed that if I tipped my head sideways, forwards, backwards, or upside down I would get my full hearing back. The ringing wouldn't leave but the hearing would return but as soon as I straighten out, bam, back to being plugged up.
I have read similar threads on this but non with the fact that i can regain my hearing by tipping my head. Is this a sign of a specific diagnoses or just tannitus and Barotrauma?

Should I seek medical treatment or will the ringing pass and the plug and or fluid in my ear eventually subside? I am living in Bangkok at the moment and won't be returning home for a few months and as some of you who have travelled or lived in Bangkok might know, the hospitals here like to give you whatever they can to make a buck which isn't very encouraging. To say the least, I would like to avoid the doc if possible but I am also a musician and can't afford to have permanent hearing damage.

Any tips or info will help.

Thanks so much.

 

[austinspace]

My advice would be to call DAN and speak with someone there about your issue. That's what I did - AFTER I went to an Ear Nose Throat specialist, and the person at DAN gave me the same advice that the ENT charged me $500 for ... which was to get some Sudafed, and nasal decongestant spray, and it'll pass in a few days. In my case it took a few weeks, but the fluid blockage/congestion did clear up completely.

 

[s-n]

Hi!

Just want to share my experience with complications after diving, because it was so extremely similar to yours.

I am a highly experienced self-taught amaterur freediver, living in Egypt most of the year. With regard to equalization I have never had any problems whatsoever, since I can fully control the muscles that open the eustachian tubes. I suffered multiple ear infections when I was a kid, but in the last 20 years my ears have been trouble free.

I never dive deeper than 20 meters, since I dislike the feeling of pressure on my chest.

About 2 weeks ago I did some simple freediving, just like I have done hundreds of times before. This usually means diving to 12-15 meters, staying down there for maybe a minute or so watching the corals and fish, and then resurfacing. There were no complications during the dive, and I keep my eustachian tubes continuously open during the entire dive, so problems related to equalization can be ruled out for sure.

After going down 4 times I was getting cold and decided to warm up on the beach. When I got onto the beach I had a sensation of fullness in my left ear. I tried to shake my head to get out the water that I suspected was causing this, but it didn't work out. Nevertheless, I gave up and decided to lay down on the beach to work on my suntan. After maybe a minute, the fullness feeling was accompanied by very loud tinnitus in the ear. It was loud for maybe 10 minutes and then gradually decreasing to moderate loudness. I noticed my hearing was bad in the upper frequencies, but I was not until I left the beach and walked home that I realized how bad the hearing really was. Upper frequencies were totally gone, and at the same time my ear seemed overly sensitive to certain high-frequency sounds, such as whistling, crashing porcelain and utensils together, crumbling of some plastic bags...

The same night I read this thread on scubaboard, but felt hesitant to start a stearoid treatement due to possible side effects. So I decided to wait a day and see if the condition improved. But the next day, the condition was no better, and I decided to do more freediving since I had no other problem or pain in my ear. The dive went fine, but the condition didn't change.

The second day after the onset of the problem, I went to see a doctor. I also explained that I read about steroid treatment on the web for a condition identical to mine. But he didn't like the idea of my symptoms being due to some "mild inner ear barotrauma". Instead he suggested that maybe something was causing pressure on my auditory nerve,

He gave me medications that would improve the blood circulation in the ear region: betahistine and vincamine. I also got a corticosteriod nasal spray.

I took the meds, but there was no improvement of the condition.

On day 4, he suggested to try hyperbaric oxygen treatment, which meant breating pure oxygen in a high pressure tank for two hours. The doc was kind enough to give me this treatment for free, since my insurance turned out to be invalid.

On day 5 there was still no improvement, the doc suggested there was not much more we could to, so I should continue with the medications.

On day 6 there was some imrovement in the upper frequency hearing, but I was still highly sensitive to some sounds. In fact, the oversensitivity was much more annoying than the loss of hearing, starting from day 1.

From day 7 to day 16 there was a very slow gradual improvement of the condition. Whether due to the meds, oxygen treatment, or self healing I cannot know. Noticable during this time was the sensation of itching, almost like small drops of fluid in my inner ear. And on one day there was a strange sound and feeling almost like I had worms crawling around in there. There were also many attacks of (increased) tinnitus during this time.

My hearing is now (day 16) almost completely restored (subjective 98% good) and the over-sensitivity is gone. I'm hoping to be 100% restored, but even like it is now is very acceptable and does not cause any problems on a normal day.

I'm very curious what the correct diagnosis to this problem is. IEBT? Nerve problem? Some small leak of fluid from the inner ear? Spontaneous bleeding in the ear region? Who knows...

 

[austinspace]

Glad you're feeling better. Sounds like IEBT to me. How can one know, for sure, that a eustacian tube is sufficiently 'open'?

 

[s-n]

Thanks! (I'm not saying hooray yet, I was off the meds for a day and noticed how some oversensitivity to certain sounds came back, so I'm now back on the meds again.)

Well, an open eustachian tube significantly affects the acoustic properties of the ear, so I can "hear" that it is open, even underwater. A good analogy would be the effects of cutting a big hole in a sealed loudspeaker box - that would produce a very different listening experience...

My doctor said IEBT (fluid leak) gives inevitable vertigo. Wikipedia seems to disagree on this. And I'm not sure if there is a variant of IEBT without any fluid leak, and in this case what kind of physical damage the ear really has suffered.