Right ear clogged, popping and tinnitus

[caue Feres]

Hello scubaboard community,
A month ago I went snorkeling, it was not really pleasant, although I didn't think I had any issue equalizing. I think I didn't very deep, probably 3, 4 meters maximum.
At the same day when I got in the hotel, I realized that i had developed this tinnitus in my right ear. Also felt my ear clogged, with some pressure and kind of heavy.
I didn't fell any pain and didn't come off any liquid.
Next day I did two dives and everything went well. But the tinnitus continued.
After one month I still listening the tinnitus, maybe it is a little bit better than the day after.
I Went in the ent doctor, he said that everything looks fine, no problem in the eardrum and gave me anti-inflammatory for 7 days.
Also did the audiometry, had some hearing loss 6kHz - 30db / 8kHz - 40db
I can hear my ear popping through out the day.

I would please like to ask the DDM @Duke Dive Medicine what could have happened and if Do you believe this tinnitus will be go away?

I would also like to ask if I Can practice sports normally like jogging, cycling and swimming in the pool?

Thank you so much for your help.

 

[Duke Dive Medicine]

Hello scubaboard community,
A month ago I went snorkeling, it was not really pleasant, although I didn't think I had any issue equalizing. I think I didn't very deep, probably 3, 4 meters maximum.
At the same day when I got in the hotel, I realized that i had developed this tinnitus in my right ear. Also felt my ear clogged, with some pressure and kind of heavy.
I didn't fell any pain and didn't come off any liquid.
Next day I did two dives and everything went well. But the tinnitus continued.
After one month I still listening the tinnitus, maybe it is a little bit better than the day after.
I Went in the ent doctor, he said that everything looks fine, no problem in the eardrum and gave me anti-inflammatory for 7 days.
Also did the audiometry, had some hearing loss 6kHz - 30db / 8kHz - 40db
I can hear my ear popping through out the day.

I would please like to ask the DDM @Duke Dive Medicine what could have happened and if Do you believe this tinnitus will be go away?

I would also like to ask if I Can practice sports normally like jogging, cycling and swimming in the pool?

Thank you so much for your help.

Hello @caue Feres ,

I'm sorry this happened to you. Without a baseline audiogram (and for clarity, I'm not the expert on audiograms on SB, @doctormike is), there's no way to tell whether this event led to your mild high-frequency hearing loss or whether it was present already. Given your description though, it would be reasonable to conclude that it is new.

Your symptoms are consistent with ear barotrauma. It could be in the middle ear; you didn't mention whether the ENT saw fluid behind the eardrum. If he/she did, this could explain the hearing loss and tinnitus. If there isn't any fluid behind your eardrum, then I would lean more toward inner ear barotrauma. I'm not sure what can be done about it this far out and would defer to the ENT physician who saw you as far as treatment options. Did the ENT mention inner ear barotrauma as a possibility? This would help inform any activity recommendations.

Best regards,
DDM

 

[caue Feres]

Hello @caue Feres ,

I'm sorry this happened to you. Without a baseline audiogram (and for clarity, I'm not the expert on audiograms on SB, @doctormike is), there's no way to tell whether this event led to your mild high-frequency hearing loss or whether it was present already. Given your description though, it would be reasonable to conclude that it is new.

Your symptoms are consistent with ear barotrauma. It could be in the middle ear; you didn't mention whether the ENT saw fluid behind the eardrum. If he/she did, this could explain the hearing loss and tinnitus. If there isn't any fluid behind your eardrum, then I would lean more toward inner ear barotrauma. I'm not sure what can be done about it this far out and would defer to the ENT physician who saw you as far as treatment options. Did the ENT mention inner ear barotrauma as a possibility? This would help inform any activity recommendations.

Best regards,
DDM

Hi @Duke Dive Medicine
Thank you so much for the answer
The ENT doctor said that probably it is a barotrauma, but didn't mentioned inner or middle ear barotrauma.

Are there specific differences between them that you could point out, please?

The fact that I can hear some popping inside the ear change anything in the analysis?

She could see fluid behind the eardrum, these fluid had diminished in my second appointment, but still there.

In this case, can I swimming in the pool? I imagine that I should not dive again.

She also did a nasofibroscopy to make sure everything it was alright and the result was good in that sense.

The hearing loss was minimum, doctor said she would not worried about that.

My main concern is the tinnitus, which I hope will go away in the future as I've seen happening with others.

Heard about ginkgo biloba, that could help with tinnitus, do you have any thoughts?

Thank you again for your help.

Best regards,

 

[doctormike]

Hi,

The critical piece of information here is the audiogram, which will determine what sort of hearing loss you have. You can post it or DM it to me if you want me to take a look. Without knowing that, it's hard to say much about your situation.

Tinnitus is a very difficult thing to treat. No one really knows what causes it, and there is no treatment that has been shown to help definitively. You might want to check out ata.org for some patient to patient advice. But if it is associated with a hearing loss, it may improve when the hearing loss improves.

Here is some information that may help you understand the different types of hearing loss.

Best,

Mike

 

[caue Feres]

Hi @doctormike,
The link you sent is very informative, thank you.

Please, find attached my audiometry test, it is in Portuguese, but the left graphic in red is regarding my right ear.

Thank you.
Best regards,

 

[doctormike]

Thanks! It does look like your hearing loss isn't too bad, but of course, the question is why you have it and are you at risk for it worsening. The problem is (and I'm doing some guesswork, since I don't read Portuguese!), is that I don't see a bone line, so I can't tell for sure if your hearing loss is conductive (middle ear) or sensorineural (inner ear). However, I'm guessing that it is a SNHL, because your tympanograms are normal. Theoretically there are middle ear issues that will be present with a normal tympanogram, but that would be pretty uncommon in this situation.

So the question is that if you have a new onset SNHL, is that from barotrauma, or from the more common reason which is a "sudden SNHL", which is thought to be the result of an inflammatory - possibly autoimmune - process. Yes, it would be a coincidene for you to get an inflammatory SSNHL at the same time you were diving. However, you were snorkeling, not diving, and you didn't report an immediate change with a dive injury, but it happened some time later. That doesn't mean it couldn't be barotrauma, but less likely. And with snorkeling, it's not likely to be inner ear DCS (although there are actually a few reported cases of this with extreme competitive free diving)>

So hard to say much about tinnitus - like I said, no one really knows much about that, but it does sometimes wax and wane. Look at that link I sent you. As far as management of either barotrauma or SSNHL, you are a little far out from the injury for things like steroids or recompression.

 

[Duke Dive Medicine]

Hi @Duke Dive Medicine
Thank you so much for the answer
The ENT doctor said that probably it is a barotrauma, but didn't mentioned inner or middle ear barotrauma.

Are there specific differences between them that you could point out, please?

The fact that I can hear some popping inside the ear change anything in the analysis?

She could see fluid behind the eardrum, these fluid had diminished in my second appointment, but still there.

In this case, can I swimming in the pool? I imagine that I should not dive again.

She also did a nasofibroscopy to make sure everything it was alright and the result was good in that sense.

The hearing loss was minimum, doctor said she would not worried about that.

My main concern is the tinnitus, which I hope will go away in the future as I've seen happening with others.

Heard about ginkgo biloba, that could help with tinnitus, do you have any thoughts?

Thank you again for your help.

Best regards,

@doctormike gave you some good info and I defer to him on treatment for tinnitus. Re gingko biloba; as with any herbal remedy (and some are really effective), look for peer-reviewed research and let your doctor know you're using one because they can interact with some medications. Re the difference between middle and inner ear barotrauma, middle ear barotrauma is generally benign, inner ear barotrauma that affects the vestibular apparatus can be more serious. Here's a ScubaBoard Knowledge Base article on barotrauma that explains it in more detail. If the tinnitus is continuing to improve, then there's reason to be optimistic.

Fluid in the middle ear at this point likely indicates that there's still inflammation there. Ear inflammation can take several weeks to resolve, so you may continue to see improvement over time.

Best regards,
DDM

 

[doctormike]

Fluid in the middle ear at this point likely indicates that there's still inflammation there.

It looks like there were type A tympanograms on that audiogram, which means that there isn't much fluid in the middle ear...

 

[NW Dive Dawg]

I personally swear by the use of "Swim Ear" drops after every day of diving. It's basically just isopropyl alcohol that mixes with water and then promotes 100% evaporation. Just say'n....

 

[doctormike]

I personally swear by the use of "Swim Ear" drops after every day of diving. It's basically just isopropyl alcohol that mixes with water and then promotes 100% evaporation. Just say'n....

Right, but that's an outer ear phenomenon, so that wouldn't have anything to do with this apparent sensorineural hearing loss.