Returning to diving after middle ear barotrauma?

[freedc]

In almost 100 dives I have rarely had trouble equalizing but I did have a problem one day a couple months ago and resulted in a painful week of post-diving ear pain followed by some substantial hearing loss in the affected ear diagnosed via an hour-long test with audiologist. The eardrum was not ruptured but there was some fluid in the middle ear. The ENT grounded me (no diving or flying) and put me on a prednisone course. Symptoms disappeared and hearing came mostly back, but the ear specialist said to never dive again. He also said something like "Legally, I have to tell you that." He was pretty casual about having me stop diving for the rest of my life. Should I get another opinion? I am supposed to do another hearing test in a few months to see if I'm back to 100% there, but he said that once the cochlear nerve endings are damaged they never heal and that leaves you permanently vulnerable.

Should I just continue to dive, but carefully? They said to take decongestants pretty much every time I fly or dive, if I continue diving. The weird thing is that I did not feel congested that particular day and I don't get congested much. When I do have congestion I usually skip the dive (duh) so it's never been an issue.

Or am I done diving forever <crying emoji>?

 

[chillyinCanada]

Did you call DAN and see what they had to say?

 

[outofofficebrb]

OMG! I would definitely call DAN as @chillyinCanada suggested, but because it is a recommendation that affects a big part of your life, I would definitely seek out a second opinion as well. In picking your second opinion ENT, I would take a closer look at their credentials and where they went for undergrad, med school, residency, and internship, and how long they have been practicing for because that may indicate their experience and how many cases they have seen, etc.

Good luck and please keep us posted!

 

[rsingler]

Well, he might be trained in dive medicine, and having seen something that puts you at significant risk of another event, he might have meant "MEDICOlegally, I NEED to tell you that you can never dive again, so that if you do, and you become deaf, I can defend myself when you sue me."

Alternatively, he might just be covering himself, and not really understand the risks. On one point, he is correct. The nerve endings will not improve further, after a certain point. You may not get your full auditory acuity back. However, absent an anatomic reason why you would be more susceptible than I to further barotrauma, just having had one event does not, by itself, put you at additional risk.

As noted above, you need a second opinion, from an ENT with diving expertise.
At that time, you need to assess your own risk benefit profile. E.g., "I had a permanent hearing loss event only 100 dives into my career. If I am careful, and if I don't have an anatomic problem, how important is it to me to be able to continue diving, even if I become deaf in one/both ears?"
@doctormike , comments?

Diving Doc

 

[Duke Dive Medicine]

In almost 100 dives I have rarely had trouble equalizing but I did have a problem one day a couple months ago and resulted in a painful week of post-diving ear pain followed by some substantial hearing loss in the affected ear diagnosed via an hour-long test with audiologist. The eardrum was not ruptured but there was some fluid in the middle ear. The ENT grounded me (no diving or flying) and put me on a prednisone course. Symptoms disappeared and hearing came mostly back, but the ear specialist said to never dive again. He also said something like "Legally, I have to tell you that." He was pretty casual about having me stop diving for the rest of my life. Should I get another opinion? I am supposed to do another hearing test in a few months to see if I'm back to 100% there, but he said that once the cochlear nerve endings are damaged they never heal and that leaves you permanently vulnerable.

Should I just continue to dive, but carefully? They said to take decongestants pretty much every time I fly or dive, if I continue diving. The weird thing is that I did not feel congested that particular day and I don't get congested much. When I do have congestion I usually skip the dive (duh) so it's never been an issue.

Or am I done diving forever <crying emoji>?

@freedc , what was your diagnosis? Did you force a Valsalva maneuver? From the information in your post, it sounds like you may have suffered from inner ear barotrauma. If this is the case, then the recommendation to not dive again if there is permanent damage is a reasonable one, and you need to weigh the likelihood of you experiencing another injury and perhaps incurring more damage with the desire to return to diving.

Best regards,
DDM

 

[freedc]

Thanks for the responses! They did not diagnose as inner ear problem. I believe it was middle ear barotrauma. I had no dizziness, nausea, or fever at any point. They were unwilling to give a cause, either, even though I was able to describe the conditions in pretty good detail: I did one pair of ~20' dives in cold water (wearing hood) and I got impatient and pushed pretty hard on the first dive when I was trying to equalize. I had no congestion or problems leading up to the dive, but I had been swimming a lot pre-dive prior (3x/week triathlon training sessions in the pool and in open water) so a prior undiagnosed ear infection was *possible*.

These docs (the ENT and the ear specialist) appeared to know absolutely nothing about scuba diving so they just nodded when I told them all this. They probably wondered why anyone would ever want to submerge themselves in water.

Back in the days when I had a post-marathon running injury I shopped around for a podiatrist who was a runner himself and got completely different advice. The first podiatrist wondered why I would ever even want to run. Maybe I need a more scuba-aware ENT who can assess the risk/reward tradeoff better but still give me objective advice.

 

[Trailboss123]

I suffered a middle ear barotrauma after what I believe was my 15th ever dive. I had done enough DAN research on my own after the symptoms started that I felt pretty sure I had a middle ear barotrauma before I got into see my ENT. When I went in, I explained to him what I was experiencing and that I was scuba diving, etc... He did a very thorough exam and declared it middle ear barotrauma. He could see the blood floating around in there and explained that my symptoms of disequilibrium, some nausea and hearing impairment were a result of the blood swirling around in there. He told me that there wasn't a whole lot to do about it and that it would just take time for the blood to dissolve and then I would be symptom free and could continue diving after another check with him. That's what I did. After symptoms subsided (about 2-3 weeks, if I remember correctly), i went back in and got checked and he give me an "all good to go". Over 1,000 dives later, here I am and have had zero issues.

Again, I was diagnosed with a middle ear barotrauma-- not an inner ear barotrauma. Also, I believe, but I don't know for sure, that mine was a result of a quick uncontrolled ascent due to equipment malfunction. I had no issues equalizing on descent or during the dive. The symptoms didn't manifest immediately either. I had a 3 hour drive home after the dive and felt pretty much OK-- They presented later that evening.

I would definitely get with another specialist if I were you. Check with DAN and see if there is anyone they can recommend you to in your area.

 

[doctormike]

With most of these second hand reports, the problem is that the precise details are crucial in making any sort of diagnosis and giving any sort of prognosis, but they are often lost in transmission. What you have said doesn't really all fit together, so I'm not sure exactly what happened to you. There is always a lot of confusion about the difference between conductive and sensorineural hearing losses, here is my page about that stuff.

So I really can't add much without an exam and seeing your audiogram (feel free to post it here). Middle ear barotrauma should cause a conductive hearing loss, be reversible and be avoidable through technique, etc... assuming that you were able to dive in the past. In rare cases, there are progressive causes of Eustachian tube dysfunction which require more aggressive intervention.

Inner ear barotrauma, on the other hand, can be permanent, can get worse with further injury, and may be related to pre-existing anomalies of the temporal bone.

Sorry I can't be more helpful...

 

[freedc]

With most of these second hand reports, the problem is that the precise details are crucial in making any sort of diagnosis and giving any sort of prognosis, but they are often lost in transmission. What you have said doesn't really all fit together, so I'm not sure exactly what happened to you. There is always a lot of confusion about the difference between conductive and sensorineural hearing losses, here is my page about that stuff.

So I really can't add much without an exam and seeing your audiogram (feel free to post it here). Middle ear barotrauma should cause a conductive hearing loss, be reversible and be avoidable through technique, etc... assuming that you were able to dive in the past. In rare cases, there are progressive causes of Eustachian tube dysfunction which require more aggressive intervention.

Inner ear barotrauma, on the other hand, can be permanent, can get worse with further injury, and may be related to pre-existing anomalies of the temporal bone.

Sorry I can't be more helpful...

This was very helpful! From what I can tell this was a middle ear barotrauma with effusion, no eardrum rupture. I did have some sensorineural and conductive hearing loss. No other symptoms of inner ear injury though.

I was treated with steroids. Here is the audiologist report on 6/27 and then on 7/12. We don't have a baseline, but can assume the right ear is a good baseline for the left.

 

[DeepSeaExplorer]

I have some pretty serious hearing loss myself. Not sure how much is diving related vs dumb things I did in younger days.

My hearing goes up and down dramatically. So, over the years, I’ve been through the whole process twice. GP refers me to ENT, then to Audiologist, then MRI, then back to ENT, who explains there’s nothing that can be done, then back to GP, who asks how it went. Twice in 10 years. Then GP writes prescription for steroids that has a 50% chance of clearing things up.

Diving strangely enough sometimes clears my ears and so does driving in the mountains. In Hawaii there were hills close by that I could drive up and attempt to clear my ears.

This past year, I got hearing aids, which don’t help much. They don’t compensate for distortion and noise that I hear that isn’t really there.

Anyway, everyone’s different, but I would caution not to expect much. Once past the mechanical stuff, hearing is still mysterious.

Also, your hearing will change. Mechanical problems are the easiest to overcome. It may just take a while, but I suspect you’ll get a lot back.

Here’s my chart. One ear is much better than the other on this particular day.