Serous Otitis Media -- Causing a lot of ear infections

[Fogest]

I don't do that, and I don't see why any doctor can't explain that to the parents - for middle ear effusion (OME, serous otitis media), antibiotics don't do anything, and have side effects. If they want them anyway, there are plenty of other docs.

Even for acute otitis media (WITH pus), for kids over 6 months of age, it's not necessary to initially treat with antibiotics. 80% of cases of acute otitis media resolve in 48 hours with a placebo (fake, inactive drug), and it seems that initial pain relief is just as good with Motrin or Tylenol as with antibiotics.

So what should be done if I have fluid in my middle ear and I am experiencing pain? Is there nothing that can be done and I should just take some regular over the counter medication like tylenol to ease the pain? Because I did not ever ask for him to give me antibiotics, hell I didn't even say that the pain was that bad, I was managing fine just using regular tylenol. Only reason I am taking them is because I was told to, but if they are not actually going to help, and may cause side effects then I see no reason to continue taking them. At this point my ears have stopped hurting, however that could have just naturally gone away and not have even been the antibiotics.

I do still however have the same dampened kind of hearing going on though.

Do you mean equalizing, or attempting to equalize. I ask because since a little over a year ago, I've been having difficulties equalizing (for no known reason), and if I'm not careful, I easily get into a state, where nothing works anymore despite the fact that I do not feel any pain, stuffiness or pressure whatsoever. I also (attempt to) equalize all the time, and if on my next attempt, I do not feel any feedback, however subtle, in one ear or in the other, it usually means I've already gone too far, and I have to reascend. When my ears are good, I can feel gas moving both ways. When that's no longer the case, it's usually a sign that I rushed it. I can tell something's not right even if I don't feel any pain or pressure, just by the way my ears respond.

I'll be honest, I don't know how I can really be sure here. I usually hear the slight pop noise and get that feeling that I assume is meaning I am equalizing properly. Can I say though if it is working properly? No, not really. I am not experiencing any kinds of pain during the dive or after in my ears so I really can't say if I am equalizing properly or not and if I am having any kind of barotrauma.

This is kind of why it is frustrating. I really feel like I am at the point of not knowing what is wrong. I think I am equalizing properly, but then the facts here seem to be indicating that I may not actually be equalizing properly. But then I have even more conflicting facts because I also have experienced this same kind of dampened hearing effect and discomfort in the ear a few months before I began diving, so I am in a pretty confused position right now.

---

Also as a side note, my doctor never actually advised me to stop diving at all or to take any kind of break. So I am not sure if I should be waiting either to go diving again, or if I'd cause damage by doing more dives. I have dive charters booked for this weekend and the next one, and I'd rather not skip them. I don't mind having to deal with the pain that I am likely to get after, but I do mind if it will be causing damage.

 

[peeweediver]

Forest: Going through exact same thing. Memorial day weekend, I was teaching OW class at our quarry. Pushed too much through equalizing problems to get down to 23 feet because the students had driven an hour and a half to get there. Dumb on my part. A week later pain started. Diagnosed with infection. First round of antibiotics didn't work and on day 8 of antibiotics, my ear drum ruptured. I didn't even feel it, just realized that crap was coming out of my ear. At a Cubs game, no less, while in line for a hot dog. Skipped the hot dog. New round of antibiotics did not seem to work either but when I went back to ENT for third time she said the ear looked much better and ear drum was starting to heal. Now it's 2 weeks later. The whole time I have had pulsating tinitus, muffled hearing with fluid in middle ear and pain. Now the pain is very intermittent, but sharp for 1/2 a second each time. Also, my sinuses seem to be upset, but when I say that I sound like a hypochondriac. I go back to ENT in 4 weeks to evaluate the ear drum, test my hearing and plan next steps. All this with a trip to Cocos Island planned for September 15th paid for and nonrefundable (don't ask about trip insurance or I'll cry). My ENT cannot explain sharp pain and says the fluid may take months to drain. She and DAN docs believe there is plenty of time for ear drum to heal and for me to dive, but in the end, she says, "We won't know until you try". My story is being stupid and pushing too far. I know you are frustrated that you don't know how this happened. No answer for you except when you return to diving descend 10 times slower and equalize from face in water on. From my reading, the first 6 feet set the tone. Eustachian tubes don't recover from stress and don't reopen even after just 6 feet of forcing things.
DoctorMike: if you see this and have any words of wisdom, I'm all ears......

Rob

 

[fmerkel]

For reference on clearing - I volunteer at our local Aquarium and work in the tropical tank that is 7' deep. For safety and communication we use full face masks. The nose dam to facilitate clearing simply does not work for me in spite of lots of work and even customization to try to make one work right. I simply don't bother with it.
Out of the water I can clear easily with the standard yawn/jaw-thrust maneuver. No problem at all. For some reason when I strap that mask on and go into the water that simple technique gets compromised. I cannot clear easily most of the time....but I do try because it sometimes works and is probably doing.....some.....good even if not complete.

No big deal, right? I mean I almost never put my head on the bottom so rarely do I ever actually get more than 4-6 feet deep. During the course of the hour+ dive I probably will have to pop up and down a fair amount so go through more pressure swings in the shallow than a normal dive.
It's not unusual for me to have a bit of minor stuffiness after one of those excursions. I almost never have anything like that from a normal dive that I can use the Valsalva on, regardless of the depth

4-6 (probably 2-3) feet of improper clearing is all it takes to start the cascade of traumatizing the ears. It's kind of like a blister > You can do a LOT of damage in a very short time (like a blood blister), by really screwing up your clearing and ignoring or not noticing the signs. New divers are often so task loaded they don't even notice. This is not uncommon.
Or, more like a regular blister formation you just keep piling on the tiny insults one after another (2-4' of depth change is plenty, especially shallow) until the effusion starts leaking into your ears. You may not even notice it until later.

Diving???? Now??? You would be well advised to not even consider it. Did you ASK the doc?
Note - Asking a non-diving physician questions like that is often entirely useless. Just because they are a physician doesn't mean they know anything about diving.
Yes, you can cause damage, including permanent hearing loss.

Tinnitus & high frequency hearing loss due to inner ear damage

 

[Fogest]

For reference on clearing - I volunteer at our local Aquarium and work in the tropical tank that is 7' deep. For safety and communication we use full face masks. The nose dam to facilitate clearing simply does not work for me in spite of lots of work and even customization to try to make one work right. I simply don't bother with it.
Out of the water I can clear easily with the standard yawn/jaw-thrust maneuver. No problem at all. For some reason when I strap that mask on and go into the water that simple technique gets compromised. I cannot clear easily most of the time....but I do try because it sometimes works and is probably doing.....some.....good even if not complete.

No big deal, right? I mean I almost never put my head on the bottom so rarely do I ever actually get more than 4-6 feet deep. During the course of the hour+ dive I probably will have to pop up and down a fair amount so go through more pressure swings in the shallow than a normal dive.
It's not unusual for me to have a bit of minor stuffiness after one of those excursions. I almost never have anything like that from a normal dive that I can use the Valsalva on, regardless of the depth

4-6 (probably 2-3) feet of improper clearing is all it takes to start the cascade of traumatizing the ears. It's kind of like a blister > You can do a LOT of damage in a very short time (like a blood blister), by really screwing up your clearing and ignoring or not noticing the signs. New divers are often so task loaded they don't even notice. This is not uncommon.
Or, more like a regular blister formation you just keep piling on the tiny insults one after another (2-4' of depth change is plenty, especially shallow) until the effusion starts leaking into your ears. You may not even notice it until later.

Diving???? Now??? You would be well advised to not even consider it. Did you ASK the doc?
Note - Asking a non-diving physician questions like that is often entirely useless. Just because they are a physician doesn't mean they know anything about diving.
Yes, you can cause damage, including permanent hearing loss.

Tinnitus & high frequency hearing loss due to inner ear damage

I understand the task loading, however I am definitely focussing on my breathing and equalization while I descend. I only have to focus on my equalizing on every breath out, checking depth every so often, and popping a little air in my BCD as I descend. I have not found this to be too hard. In future dives I will try to pay even more attention to it to make sure I am equalizing often.

Now in reference to whether I should dive or not, I have already dove many times shortly after having this ear pain and had no problems. So maybe I am risking it and just asking for it. I guess I will talk to one of my experienced dive instructors and call DAN tonight to see if I should be skipping my plans this weekend. It's just both of these dive trips this weekend and the next are planned and paid for and I can't get refunds on them. So I want to go if possible, but I won't sacrifice my ears if they will cause permanent damage. I really don't care about some pain, as long as it is not permanent.

 

[fmerkel]

It's your ears but the permanent damage may happen without much pain incurred at the time.

You can talk to who ever you want, as much as you want, you are not going to get any definitive answers. Maybe you get away with it, maybe you don't. No one will actually know, but with your history the odds are getting stacked against you. You are kind of playing Russian Roulette with your hearing, and no one has any idea how may chambers are loaded...but some are.

 

[kr2y5]

checking depth every so often

Not sure if you meant this, but it sounds like continuous descent takes precedence, and equalization is a kind of supplementary activity. It used to work for me, but not any more. If you are like some of us, you might need to make your progress in descending dependent on your progress with equalization, and to pause your descent, or reascend slightly, if you find that you are not equalizing fast enough. You should be very aware of and in control of your depth, not just check it every once in a while, because ears can be very unforgiving.

 

[fmerkel]

Yup, I go down to ~ 12-15 feet and just stop for a couple minutes. From there I follow the bottom contour down quite slowly. Now in my case it's sinus equalization more than ears. I use the stop to set up my camera and strobes. OTOH, it's amazing how many people I buddy with thank me for such a slow descent. It turns out they have trouble also and often feel pushed by the pace of the group. I could see where this may be a chronic issue with boat diving some locations, which likely is a lot of dive sites. Luckily we have some prime shore diving around here.

I can do green/blue water descents but I really don't like to, doubly so it there is current present. I really have no physiological choice than a controlled descent, and ascent though those don't seem to create problems.....but I don't push it.

 

[Fogest]

I actually have only really done shore dives now and I am always following a gradual shoreline that descends because of that. My descents are usually quite slow, and I do check the depth quite often, I usually actually have my watch right in front of my face the whole way down and the only time I am not looking at it is while I have my fingers on my nose equalizing. If I find I am having troubles equalizing I will turn vertical instead of horizontal and this maneuver puts me a few feet up and allows me to clear easier as I am vertical.

Looking at my dive logs my average descent rate is usually between 19-24 ft/min which does not seem too fast, but maybe it is? At that speed I am even less than the maximum ascent rate.

 

[doctormike]

Forest: Going through exact same thing. Memorial day weekend, I was teaching OW class at our quarry. Pushed too much through equalizing problems to get down to 23 feet because the students had driven an hour and a half to get there. Dumb on my part. A week later pain started. Diagnosed with infection. First round of antibiotics didn't work and on day 8 of antibiotics, my ear drum ruptured. I didn't even feel it, just realized that crap was coming out of my ear. At a Cubs game, no less, while in line for a hot dog. Skipped the hot dog. New round of antibiotics did not seem to work either but when I went back to ENT for third time she said the ear looked much better and ear drum was starting to heal. Now it's 2 weeks later. The whole time I have had pulsating tinitus, muffled hearing with fluid in middle ear and pain. Now the pain is very intermittent, but sharp for 1/2 a second each time. Also, my sinuses seem to be upset, but when I say that I sound like a hypochondriac. I go back to ENT in 4 weeks to evaluate the ear drum, test my hearing and plan next steps. All this with a trip to Cocos Island planned for September 15th paid for and nonrefundable (don't ask about trip insurance or I'll cry). My ENT cannot explain sharp pain and says the fluid may take months to drain. She and DAN docs believe there is plenty of time for ear drum to heal and for me to dive, but in the end, she says, "We won't know until you try". My story is being stupid and pushing too far. I know you are frustrated that you don't know how this happened. No answer for you except when you return to diving descend 10 times slower and equalize from face in water on. From my reading, the first 6 feet set the tone. Eustachian tubes don't recover from stress and don't reopen even after just 6 feet of forcing things.
DoctorMike: if you see this and have any words of wisdom, I'm all ears......

Rob

Hey, Rob...

Nothing that you haven't heard before, probably! Basically, an eardrum perforation due to barotrauma in an ear that was previously health usually heals eventually. Middle ear fluid generally goes away by itself. If you don't have a perforation, Valsalva and Toynbee maneuvers can help. A short course of steroids can help, and for an adult who is really bothered by there middle ear fluid, there is the option of actually doing an office myringotomy (making a small hole in the eardrum to let it out).

Hang in there - hard to be specific over the internet, but it sounds like things are moving along...

Mike

 

[fmerkel]

Did you go diving? How did it work out if you did?