Treating Middle Ear Barotrauma At Home??

[Spanocha]

During my second check-out dive, I had trouble equalizing coupled with pain, so I ultimately aborted the dive. After experiencing fullness in my left ear and a slight difficulty hearing, I went to the ER to receive the offical diagnosis of middle ear barotrauma, which I already suspected. As worth noting--I had to be seen by three different doctors. It was as if they did not what to do or what to say.

At any rate, the earliest appointment I can get to the ENT is the 10th, but I have a flight leaving the 13th. Is there any "at-home" therapies I can pursue that may assist the opening of the Eustachian tubes so that the blood in my ear can drain "naturally"?

This sucks on at least 4 different fronts.

 

[TSandM]

You may get some benefit from decongestants like Sudafed, and also from ibuprofen (assuming you have no contraindications to taking either of them).

Few doctors ever see barotrauma, and it looks very much like an middle ear infection, so I'm not terribly surprised that the people who saw you were uncertain. (You may have seen a bunch of different doctors because they said to everybody, "Come look at this -- we don't see this very often!)

Before you dive again, you may get some benefit from watching Dr. Kay's video. It's long, but it's extremely informative about the anatomy and pathophysiology of barotrauma, and about equalizing techniques.

 

[DocVikingo]

Hi Spanocha,

On the non-prescription front the alternatives are limited, but include:

1. Take a decongestant, such as Sudafed Original.

2. Take a nonsteroidal anti-inflammatory such as aspirin, ibuprofen or naproxen.

3. Place a warm compress or heating pad on the affected ear.

4. Sleep with the head raised on a pillow with the affected ear facing upwards.

Of course, monitor closely for signs of infection.

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice.

 

[Spanocha]

Do you think the "behind-the-counter" Sudafed is significantly different (more effective) than the "over-the-counter" Sudafed PE?

Also, I'm trying to turn this negative into a positive by quitting smoking. I have read that smoking can thicken the mucous in and around sinus cvities and Eustachian tubes.

Do you think I'll be able to get in an airplane in two weeks?

I have also read that Sudafed should not be taken for more than 3 days straight as it may trigger a resistance to the drug as well as a higher likelihood of developing complications again.

 

[DocVikingo]

Hi Spanocha,

[NOTE: There are about 17 Sudafed products ----> SUDAFED®, the #1 nasal decongestant for cold, sinus and allergy relief, so it important that discussions such as this one are very specific concerning exactly which product is under consideration.]

As regards the comparative decongestant activity of oral pseudoephedrine v oral phenylephrine, it seems likely that the latter is a marginal substitute for the former. This is largely because phenylephrine is extensively metabolized in the gut and its efficacy as a decongestant has been not well-established to begin with. Most of the persons with whom I have spoken who have tried both felt that the original Sudafed Nasal Decongestant with pseudoephedrine was superior to newer Sudafed PE.

All Sudafed products come with detailed instructions for use. I am not aware of instructions indicating that any of the oral Sudafed products "...should not be taken for more than 3 days straight as it may trigger a resistance to the drug as well as a higher likelihood of developing complications again." It sounds like what is being referred to are sympathomimetic nasal spray products such as Afrin (oxymetazoline) and Otrivine (xylometazoline) where rebound can be an issue (See response #7 in the following thread http://www.scubaboard.com/forums/diving-medicine/231960-ear-drops-help-equalize.html).

Your treating ENT seems to be in the best position to advise on the matter of when flying is safe. Typically, once all signs and symptoms have resolved, and one is able to equalize with ease, flying does not pose a risk.

In the meantime, quitting smoking would be expected to have salubrious effects both on irritation and inflammation of mucus membranes and mucus production and removal. Cessation also is a wise idea from the standpoint of cardiovascular and respiratory health, among others.

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice.

 

[Spanocha]

What's interesting is that I called DAN and I was told that not only will Sudafed regimens not work, but that it is not even worth taking. It is frustrating when every single source you consult has a different expert opinion.

 

[ianw2]

I'm not a physician as other posters in this thread are.

If you have real baurotrauma and the fluid build up in your ear is blocked in by a closed off and highly irritated Eustachian tube, a decongestant is not likely to do a thing for you as far as relieving the pressure in your inner ear. That fluid will eventually be reabsorbed by the surrounding tissue.

Your ENT will be able to prescribe drugs that will help to speed that process as well as stave off any infection that may occur while your body is healing itself.

Commercial airline cabins are pressurized so that that internal air pressure is the equivalent of being at 2,000 to 8,000 feet above sea level, depending upon the airplane manufacturer and model. This change in pressure is significantly less than descending to 33fsw. Even so, you may well experience some discomfort during ascent and descent. With more than a week to go between now and your flight, a significant portion of the fluid in your inner ear should have been reabsorbed, unless there is some infection present, too.

Your best bet is to find a primary physician who is also an experienced diver. My personal primary physician and her PA are both divers with OW/AOW/and Rescue under their collective belts. Both have done extensive reading and study in hyperbaric medicine and diving medicine.

Good luck to you!

Ian

PS - about a million years ago (36 to be precise), my very first dive instructor back in Binghamton, NY, was a physician. She recommended pseudo-ephedrine for use prior to diving for those with difficulty clearing. If I recall, NAUI even recommended the drug, too.

I've tried the "new" PE product. I find it absolutely useless.

 

[TSandM]

As you can imagine, Spanocha, there are no randomized, controlled studies to see if Sudafed aids with the resolution of inner ear barotrauma. (At least I couldn't find any in searching Medline and the Rubicon archives.) As the medication is off patent and OTC, there's little motivation for anybody to do such a study. People HAVE studied using Sudafed to PREVENT barotrauma, and it seems pretty convincing that it works. It's unlikely to be harmful in the normal, healthy patient, and it may help, so I recommend it.

There is no immediately effective treatment for barotrauma, but if the meds shorten the recovery time or lessen the symptoms, they've accomplished something.

 

[DocVikingo]

What's interesting is that I called DAN and I was told that not only will Sudafed regimens not work, but that it is not even worth taking. It is frustrating when every single source you consult has a different expert opinion.

Hi Spanocha,

As was said earlier, "On the non-prescription front the alternatives are limited,...."

It is correct that a Sudafed product is likely to be of minimum benefit. The same is true for the other suggestions. By themselves or in combination they help in some cases and in many others do little or nothing. On the other hand, they will do no harm. Personally, I cannot think of anything else to recommend.

As Ian has said, the fluid will eventually be absorbed. If you can avoid a middle ear infection, the passage of time and avoidance of further trauma to the ear are the best treatments.

Hopefully, your upcoming ENT consultation will prove more informative and beneficial.

In the meantime, you're welcome for the questions we have answered and for the assistance we have tried to provide.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice.

 

[Spanocha]

Thanks, guys. I certainly did not mean to imply that you did not know what you were talking about. I did read a post on this site where the individual with the same malady contacted DAN and DAN told him to try the Sudafed regimen (wherein the DAN representative seemed to scoff at such a notion when I talked to him).

At any rate, I picked up the "real" (original) Sudafed today (pseudo-ephedrine) and I am taking that in combination with simple Ibuprofren. We'll see what happens and I'll add my testament to the boards.