What is wrong with me?

[DiveTheGalapagos]

It always begins with blowing mucous into my inner ear / eustachian tube. I seem to have mucous forming allergies I'm unaware of. Nearly 2 years ago was my first accident and that kept me from diving for a couple of months. All fine until July. This was my fault and a very stupid thing to do.

I was with some weak divers on a trip. Rather than leave them with one dive guide, I brought up the rear especially to cuidar (care for...sounds better than babysit) for one man I had to rescue on Day 1. Towards the end, developed a cold. Rather than do the smart thing, my fear for their well-being rendered mute my better sense. I blew my nose and poured liquid Afrin in which gave me about an hour reprieve...did 4 dives like that over 2 days. Yes, I should be and am being punished. Haven't been able to dive since then. Left ear only 'pops' about half relative to right ear. Learned last week, lots of (either) infection or mucous in my sinuses. It's a question mark because the antiobiotics made no difference.

I have now stumped 4 ENTs, but not before spending a small fortune on many tests. Cat scan is the same as radiografia? Where you go in a cylindrical chamber for head scans. 2nd of those today and still nothing. So antiobiotics, along with the Latin version of Nasonex and Sudafed (pseudoephedrine) has made no impact it seems. Had some type of injection today to hopefully help dry it. Doctors literally don't know what to do, at least down here. We're assuming it's a clogged Eustachian tube. If the white we can see with the light / camera up my nose isn't infection and is mucous, is there not an instrument that can flush the Eustachian tube? Same instrument in ear says ear is all fine.

Supposed to be on a liveaboard this week. Supposed to make up for that on one Monday. Dieing to get back in the water. Sigh. Any ideas?

 

[Cruisin Home]

If your sinuses are not draining then something has to be done.
2 treatment paths:
1) mechanical/surgical: Surgeon tries to open the "ostia" (holes into each sinus) via ballon or mechanically.

2) Treatment with steroids: steroidal treatment "shrinks" the membrane and ultimately open the ostia for drain.

I would try and opt for option 2 first. Ask your physician. Good luck

PS: get the report of the CT scan if you can and send to me.

 

[TSandM]

I don't think there is enough information here to give you any good advice. I do know that they can do some testing to see if your Eustachian tube is functioning normally. A CT scan is most useful for diagnosing bony abnormalities, and may show fluid and thickening of the lining in the sinuses if there is sinus disease. If you have stumped 4 otolaryngologists, who have had the advantage of taking a good history, doing a good exam, and performing their own diagnostic tests, I don't think you are going to get a lot of assistance over the internet. Sorry!

 

[Cruisin Home]

TS&M,
I concieve, design, build and deliver complex medical imaging systems all over the world and have come to appreciate that we enjoy a quality of medicine here in the USA that is unsurpassed. For instance the field of ENT was propeled forward circa year 2000 by the advent of multislice CT thus enabling for the first time very thin slices and high reconstructed resolution. This is huge in ENT where small bony anatomy such as around the sinuses and orbit are sub millimeter in thickness, yet if they are compromised can lead to life threatening bacterial infections of the meninges. Chances are the CT scanner this man was scanned on is what we would consider an old single slice machine and he likely had 5mm slice thickness. That's like the Stone-age to us!

while I agree that internet medicine is difficult, particularly this forum where you rarely get the entire presentation, you can still guide some folks as to where they should try next. Steroidal treatment of refractory sinusitis has become somewhat of a standard here in USA but may not have penetrated rest of world. Some dangers involved also with the therapy. Also not for prolonged usage, particularly if there is a "mechanical" problem involved in blockage/drain.

But I still help at least one person per month over this exact hurldle here in the suburbs of Boston! Medicine is not equal: not in the world, not in a country, city, or even in the same hospital.

sorry for the rant, I usally enjoy and agree with your great posts, but this one is associated with a personal crusade of mine to advocate for patients challenged with getting a correct diagnosis and ultimately timely treatment. The failure in this process cost my brother his life! As such I try and help patients everyday.

 

[DiveTheGalapagos]

It's been awhile since that original post and I can now add 2 more ENT docs (+1 more CT) to the stumped list. Due to the problem in July-Aug, I didn't dive. I could have cleared then, but thought it better not to dive. I've now had to forego 3 trips, so have not dived since July. About a week ago, my left ear just 'went out', the worst it's ever been by far. Feels completely blocked, loud tinnitis increasing in volume with deep breaths, coughs, etc and hearing loss. I have no dizziness, but am really uncomfortable. Antibiotics didn't clear up the visible white inside so am assuming it's mucus and not infection.

A few days of pseudofedrine and a Mometasone furoate spray later, there is some popping. So I'm now wondering if it's possible this is all due to my allergy to gluten being the source of the mucus (yes-I was on a binge and ate wheat for about a month). After nearly five months with no diving, hard to believe it has anything to do with diving. The first time I ever had a problem was a couple years back and that was related to equalizing with mucus I didn't even know I had as no obvious congestion was present.

Just wondering if either of you has run into anything like this? Could a gluten allergy possibly be at the bottom of this? I'm now getting so frustrated and with the worsening, would help get on a plane to the US if I wasn't scared to try to fly when I can't pop my left ear. Could living at 9000 ft be a factor?

And ps..Cruisin...I'm on the mainland, not Galapagos, so the equipment is pretty modern. The hospital, labs and affiliated doctors I utilize list this: ... 1.5 Tesla MRI, 64 slice computerized tomography...which means nothing to me but may to you.

 

[DocVikingo]

So I'm now wondering if it's possible this is all due to my allergy to gluten being the source of the mucus (yes-I was on a binge and ate wheat for about a month).

1.5 Tesla MRI, 64 slice computerized tomography...which means nothing to me but may to you.

Hi DivetheGalapagos,

Given a known history of gluten intolerance, it certainly seems worthwhile to pass on offending wheat and wheat-related products to see what happens.

The unit described, while not the most powerful or sophisticated CT scanner available, is modern, widely-used and appears appropriate to the diagnostic work up.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.