Returning to the water after a barotrauma

[LWB]

I was diving in early January off of West Palm Beach, FL. The water was fairly cold (72-74F) and I had not been diving in about 6 months. On the way down, I got just a little bit of a squeeze and had to ascend a few feet. BTW, I don't think it had anything to do with it, but this was my first Nitrox dive and I had an EAN36 tank. Well, I was able to equalize and continued down to the reef in about 80 fsw. The dive lasted about 35 minutes and at some point I noticed just the slightest pain in what I think was my ET, when I swallowed. The pain continued every so often and I didn't think much of it at the time. We hit the boat for an hour or so service interval and moved on to the next site. This dive was on a reef in about 60 fsw. I didn't have any trouble equalizing on the descent, but I did feel the same pain every so often. After another 35-40 minutes I was back on the boat. I probably hadn't been onboard for more than about 15 minutes and my ear really started to throb. I kept a towel over my ear for the boat ride in so that the wind would not blow in my ear canal. By the time I got to the dock the pain was almost unbearable. I never got nauseous and I didn't have any vertigo.

I went to see the doctor the next day. The pain had got a little better, but now I had severe ear blockage and I just about could not hear anything out of that ear (which was worse than the pain). I also had very loud ringing in that ear. Anyway, the doctor said everything looked very inflamed and that she could see some fluid behind my ear drum. She thought I had an ear infection as well as a barotrauma. She prescribed omoxicilian, told me to keep the ear dry, and to use debrox. I took the whole prescription (I think it was about 7 days) and my symptoms never seemed to get better. With previous ear infections, I got relief almost instantly after taking meds. So I tried to go see an ENT, but could not seem to find one that could get me in within the next two weeks. I call the first doctor and she doesn't really give me any encouraging news. I suck it up, but over the next 5 days or so I don't seem to be getting better. So some friends come to town and we head out to a bar. It was probably just luck, but if you ask me the best medicine was the 8-10 beers I had that night. I felt relief before I ever left that place. I got better with each passing day after that. My hearing seems to be back where it was and my ears don't ring anymore than usual (I'm a pilot, comes with the job). I have only had one instance where my ears have seemed to have fluid in them since then.

Well fast forward 2 1/2 months and I am 3 days away from going to Roatan. I figure I have to get my feet wet at some point. I just hope I don't have a problem on day one...that would be a real bummer. I have purchased, but not tried, the Docs Pro Plugs. I have read the reviews and most people seem to have a favorable response to them. Otherwise, besides using a rinse after I get out of the water, does anybody have any advice for me? I guess I'm just nervous that my ear is going to ruin my vacation. On that note, what if any kind of medical services are available on the island for ear conditions?

Thanks

 

[doctormike]

Well fast forward 2 1/2 months and I am 3 days away from going to Roatan. I figure I have to get my feet wet at some point. I just hope I don't have a problem on day one...that would be a real bummer. I have purchased, but not tried, the Docs Pro Plugs. I have read the reviews and most people seem to have a favorable response to them. Otherwise, besides using a rinse after I get out of the water, does anybody have any advice for me? I guess I'm just nervous that my ear is going to ruin my vacation. On that note, what if any kind of medical services are available on the island for ear conditions?

Thanks

Hi, LWB.... welcome to the forum!

From your description of the problems and treatment, it seems like you are mixing up some things that are really quite different. Also, it sounds like you might have seen a general practitioner, and not an ENT doctor. As always, I really can't give you a specific diagnosis over the Internet, but I can make some general comments.

The middle ear is the space behind the eardrum, and the outer ear is the space outside of the eardrum (where earwax builds up). There is also the inner ear, which is deeper and separate from the middle ear, and is rarely involved in these problems. The first thing to learn is that these are completely different spaces, which have nothing to do with each other unless there is a hole in the eardrum (in which case, you shouldn't be diving), or an inner ear leak (in which case you DEFINITELY shouldn't be diving).

Second of all, we should understand the difference between these very different conditions:

1) Middle ear fluid (AKA middle ear effusion, usually a thin watery liquid, sometimes containing blood). This is usually related to barotrauma, or inadequate equalization of the ears during ascent or descent. It causes a clogged sensation and a temporary hearing loss (a "conductive" hearing loss). The hearing loss gets better when the fluid clears. There is no good medical treatment for the fluid, although steroids are occasionally used. Prevent or treat this with gentle ear insufflation. See this page, if you haven't already: Doc's Diving Medicine Home Page

2) Middle ear pus (an "ear infection", treated with antibiotics). This usually happens in children. It can happen in adults, but rarely. Also (not to sound arrogant!) often when a non-ENT looks in your ear and says that you have an ear infection and gives you antibiotics, the diagnosis may be incorrect. Rarely associated with diving.

3) Swimmer's ear (a skin inflammation of the outer ear). This can be very painful, and is treated with antibiotic/steroid drops put in the ear from the outside, along with careful drying of the ear to prevent it. There are rinses which also help with this condition, lots of threads about them here... This has nothing to do with diving specifically, but more with water exposure. However, sometimes earwax can trap water in the outer ear due to pressure changes with diving, and make it worse. This is a great gadget for drying the ear: Sahara Dry Ear - Warm Air Ear Dryer

4) Inner ear problems (perilymph fistula, inner ear decompression sickness, etc..). Very serious, can cause permanent hearing loss, and beyond the scope of this answer.


SO, as with most cases, the devil is in the details. The best thing to do would be for you to see an ENT doctor and get a full audiogram, then to try equalizing in a pool during a shallow dive, and to ensure that your technique is OK. I don't know if you can do that before you leave, though... feel free to PM me if you want a local referral for an ENT doc, I might know someone in your area...

Best,

Mike

PS: The proplugs (vented!) are OK for preventing swimmer's ear, but are really not designed to deal with barotrauma.

 

[udtfire]

doc mike that was a great post and very kind of you to share that knowledge

 

[LWB]

Yeah, I think I have a good grasp on it. My better half's sister is an audiologist and she gives me more information and technical terms than I care to hear.

I guess I should give you just a little history. Ear infections have not been all that uncommon following a diving trip. Usually I get prescribed the "Power Pack"...you know, take 2 pills today, and then one for the next three days...or something like that. Also, wax build up is a problem all of the time for me. In fact, the doctor said she couldn't even see my ear drum in the ear that I wasn't having any problems with. She did say there was build up on the ear drum of the bad ear. However, she said she could see enough to rule out a perforation. She told me to use Debrox after about 3 weeks and when all the other symptoms had gone away. Anyway, I think that #1 is probably what happened. My guess is the pain was from the pressure from the fluid. Since you said there was no treatment for the build up of this fluid, then it would make sense that it took some time for that symptom to go away. My guess is I did not have an infection, but who knows. The doctor did say that my throat was very red. She told me to use pseudofed and nasal sprays, but I have read in other threads here that they don't help....and they didn't.

Unfortunately I did not go see an ENT. I tried, but either people don't like to work in West Palm Beach or all the elderly people around there have the docs booked up. I couldn't wait for the two or three weeks to seek treatment. I was worried about my hearing and I was hoping something might help with the pain. Whatever the case, I hope it never happens again. On a side not, as I said before, I am a pilot. I fly pressurized and unpressurized aircraft and I never have any problems clearing my ears while flying. I realize that we are talking a lot more pressure when it comes to water, but again I'm just giving you a little history.

Thanks for the response, much appreciated.

 

[doctormike]

Yeah, I think I have a good grasp on it. My better half's sister is an audiologist and she gives me more information and technical terms than I care to hear.

Can she get you in for an audiogram before you go? She could also check the pressure behind your ears (that's the tympanometry part of the test).

In fact, the doctor said she couldn't even see my ear drum in the ear that I wasn't having any problems with. She did say there was build up on the ear drum of the bad ear. However, she said she could see enough to rule out a perforation.

Yes, without cleaning out the earwax using a microscope and a curette, it can be very hard to give any specific diagnosis - that's really part of the evaluation...

She told me to use Debrox after about 3 weeks and when all the other symptoms had gone away. Anyway, I think that #1 is probably what happened. My guess is the pain was from the pressure from the fluid. Since you said there was no treatment for the build up of this fluid, then it would make sense that it took some time for that symptom to go away. My guess is I did not have an infection, but who knows. The doctor did say that my throat was very red. She told me to use pseudofed and nasal sprays, but I have read in other threads here that they don't help....and they didn't.

Again, the devil is in the details!

On a side not, as I said before, I am a pilot. I fly pressurized and unpressurized aircraft and I never have any problems clearing my ears while flying. I realize that we are talking a lot more pressure when it comes to water, but again I'm just giving you a little history.

Yup, that's exactly right..! Even if you were flying the space shuttle with windows open, you can't swing more than one atmosphere... a few feet of water will beat up your ear more than a big chunk of airspace...

Thanks for the response, much appreciated.

doc mike that was a great post and very kind of you to share that knowledge

No problem, always happy to help as best as I can... I'm jealous of your trip, have a great time in Roatan... I was there a few years ago, it's beautiful!



Mike

 

[LWB]

Good news, no ear problems! I forgot my Docs Pro Plugs, but no signs of trouble after 18 dives in 6 days. I was very diligent about equalizing as I wasn't taking any chances. I didn't have a chance to get hooked up to the audiogram, but maybe I'll see about doing that in the future. Hopefully the last problem was just a fluke.

 

[doctormike]

Good news, no ear problems! I forgot my Docs Pro Plugs, but no signs of trouble after 18 dives in 6 days. I was very diligent about equalizing as I wasn't taking any chances. I didn't have a chance to get hooked up to the audiogram, but maybe I'll see about doing that in the future. Hopefully the last problem was just a fluke.

Great, glad you had such a good trip..! I'll have to settle for the Jersey shore, but it's still nice..!