Suspected middle ear barotrauma on trip, do I need to see a doc before flying home?

[fluff_astrid]

Alas, even as an experienced diver, I believe I have suffered a middle ear barotrauma on a dive holiday.

I didn’t recognize it as what it was at first, since I had no issues clearing on land nor any congestion or illness, so it’s different than what I expected. I had trouble clearing one ear on a shallow dive descent, which admittedly was a bit of a quick descent due to current, eventually and with some, but not bad, of pain, I got it to squeak clear (pretty common for this particular ear; even previously checked this with an ENT a few years ago and they saw nothing of note with the ear), I continued with two more dives with it squeaking clear throughout as it usually does, and then realized after the day was done that I had a full feeling in the ear. I gave it a few days, still a full feeling, and although I sort of could clear/pop it, the clearing sensation was what I’d call “dull” or “sticky.” I tried a shallow descent on a line today to see if the situation had improved but, nope, barely managed to get down to 3m and no equalization at all despite some success at the surface. Chatted with DAN, and they agree it seems to be a clear cut case of middle ear barotrauma, with fluid effusion likely.

Now, I honestly don’t care if I can’t dive the rest of this trip — it’s a bummer, but I got a few dives in and can always dive in a month or whenever this clears up. I’m traveling with a non diver so plenty else we can do. And this doesn’t seem to be infected or anything like that, the full feeling is annoying but not in pain, maybe a slight ache, and I doubt there’s a perforation as hearing is not noticeably impacted (I’m sure I’ve lost a bit with the fluid of course). I blew my opposite eardrum as a teenager when I was congested on a flight, and this is nothing like that lol.

My bigger question is, I’m currently traveling abroad and I fly home in about 8 days time. Can I manage a plane flight without needing to see a doctor first, from what I understand there’s not much they could do anyways except tel me to wait and see? If it were easy to see the doctor here I’d do it, but ENTs have a 3 month wait so my only option is the ER or urgent care, and I don’t want to go through that hassle if they might misdiagnose me or just tell me some vague thing about fluid behind my ear. I’d much rather wait to let my trusted doctor look at things when I’m home, and just relax on the rest of my trip without having to visit the ER if unnecessary. And I can do whatever it takes to prep my ears for the plane flight — decongestants, Afrin, whatever.

Thanks!

 

[Duke Dive Medicine]

Alas, even as an experienced diver, I believe I have suffered a middle ear barotrauma on a dive holiday.

I didn’t recognize it as what it was at first, since I had no issues clearing on land nor any congestion or illness, so it’s different than what I expected. I had trouble clearing one ear on a shallow dive descent, which admittedly was a bit of a quick descent due to current, eventually and with some, but not bad, of pain, I got it to squeak clear (pretty common for this particular ear; even previously checked this with an ENT a few years ago and they saw nothing of note with the ear), I continued with two more dives with it squeaking clear throughout as it usually does, and then realized after the day was done that I had a full feeling in the ear. I gave it a few days, still a full feeling, and although I sort of could clear/pop it, the clearing sensation was what I’d call “dull” or “sticky.” I tried a shallow descent on a line today to see if the situation had improved but, nope, barely managed to get down to 3m and no equalization at all despite some success at the surface. Chatted with DAN, and they agree it seems to be a clear cut case of middle ear barotrauma, with fluid effusion likely.

Now, I honestly don’t care if I can’t dive the rest of this trip — it’s a bummer, but I got a few dives in and can always dive in a month or whenever this clears up. I’m traveling with a non diver so plenty else we can do. And this doesn’t seem to be infected or anything like that, the full feeling is annoying but not in pain, maybe a slight ache, and I doubt there’s a perforation as hearing is not noticeably impacted (I’m sure I’ve lost a bit with the fluid of course). I blew my opposite eardrum as a teenager when I was congested on a flight, and this is nothing like that lol.

My bigger question is, I’m currently traveling abroad and I fly home in about 8 days time. Can I manage a plane flight without needing to see a doctor first, from what I understand there’s not much they could do anyways except tel me to wait and see? If it were easy to see the doctor here I’d do it, but ENTs have a 3 month wait so my only option is the ER or urgent care, and I don’t want to go through that hassle if they might misdiagnose me or just tell me some vague thing about fluid behind my ear. I’d much rather wait to let my trusted doctor look at things when I’m home, and just relax on the rest of my trip without having to visit the ER if unnecessary. And I can do whatever it takes to prep my ears for the plane flight — decongestants, Afrin, whatever.

Thanks!

Hi @fluff_astrid ,

It sounds like you already have a pretty good handle on this. As I'm sure you know, flying involves much less pressure change than diving. The difference in pressure between sea level and the cabin pressure of a commercial airliner, which is roughly 8000 feet of altitude, is about the equivalent of 8.5 feet of sea water. If you can equalize on land with minimal effort, you should be fine to fly. Nasal sprays and oral decongestants should be used mindful of their duration of action - if your clearing is borderline to the point where you think you need one of those, you don't want it wearing off mid-flight since the descent from altitude is the most difficult part.

In the meantime, you may opt to gently attempt to clear the ear, which can help get rid of fluid buildup. Do not force a Valsalva (pinch and blow) maneuver, as this can cause serious damage to your inner ear. If it doesn't clear relatively easily, leave it be.

If you consistently have to squeak that ear down when diving, so to speak, it might be best to discuss some pre-medication options for diving with your ENT. At the risk of stating the obvious, if you're that congested you're at higher risk for barotrauma.

Best regards,
DDM

 

[fluff_astrid]

Hi @fluff_astrid ,

It sounds like you already have a pretty good handle on this. As I'm sure you know, flying involves much less pressure change than diving. The difference in pressure between sea level and the cabin pressure of a commercial airliner, which is roughly 8000 feet of altitude, is about the equivalent of 8.5 feet of sea water. If you can equalize on land with minimal effort, you should be fine to fly. Nasal sprays and oral decongestants should be used mindful of their duration of action - if your clearing is borderline to the point where you think you need one of those, you don't want it wearing off mid-flight since the descent from altitude is the most difficult part.

In the meantime, you may opt to gently attempt to clear the ear, which can help get rid of fluid buildup. Do not force a Valsalva (pinch and blow) maneuver, as this can cause serious damage to your inner ear. If it doesn't clear relatively easily, leave it be.

If you consistently have to squeak that ear down when diving, so to speak, it might be best to discuss some pre-medication options for diving with your ENT. At the risk of stating the obvious, if you're that congested you're at higher risk for barotrauma.

Best regards,
DDM

Thanks much DDM. So even if I’m hearing a slightly less satisfying click/pop noise on land (like normal clearing but a bit dull), I can assume that’s “clearing”?

I agree my bigger mistake may have been my using Vasalva on the dives where I was having issues — I was trying to blow a lot, going up and down, so now am limiting myself to the more swallow/jaw movement methods. For some reason those are hard for me to do in the water with a reg in though.

The part about congestion — that’s the thing, I had no signs of congestion before diving. My nose was clear, with nothing to blow. My guess is that it’s because I had flown in from a long haul the day before and my sinuses were probably dried out a bit, and might not have recovered by the time I was diving. Perhaps in the future I need to do some saline sprays the day before.

Thank you again!

 

[fluff_astrid]

Thanks much DDM. So even if I’m hearing a slightly less satisfying click/pop noise on land (like normal clearing but a bit dull), I can assume that’s “clearing”?

I agree my bigger mistake may have been my using Vasalva on the dives where I was having issues — I was trying to blow a lot, going up and down, so now am limiting myself to the more swallow/jaw movement methods. For some reason those are hard for me to do in the water with a reg in though.

The part about congestion — that’s the thing, I had no signs of congestion before diving. My nose was clear, with nothing to blow. My guess is that it’s because I had flown in from a long haul the day before and my sinuses were probably dried out a bit, and might not have recovered by the time I was diving. Perhaps in the future I need to do some saline sprays the day before.

Thank you again!

So as an update, my hotel had a doctor that was able to see me. Apparently there is no fluid in the ear or sign or perforation, no infection, but instead that my eardrum is turned a bit inward. Said it’s a Eustachian tube issue, unclear on how long it will take to resolve/whether it would be risky to fly, and simply prescribed Flonase.

I can’t get an appointment with my ENT at home until early November, so I’m assuming I’m going to have to attempt to fly home with standard Eustachian tube mitigations and hope for the best upon landing…