Middle ear barotrauma - recovery time

[DES63]

Hi All,
Recently diagnosed with mild middle ear barotrauma (MEBT) but ear drum is fine. In Bonaire a couple of weeks ago - I dived at least once a day - no issues with equalization. 24 hours after last dive, I woke up with clogged ear and hearing about 50% of normal. Went to an ENT on return home - he says I have middle ear fluid consistent with MEBT. Two weeks later - I’ve done a course of prednisone and antibiotics and am using Sudafed and nasal steroids now but it doesn’t feel like it’s improved much. No diving till it’s resolved which could take weeks to months and of course I have a bunch of boat trips booked over next few weeks.

In the absence of diving, I have now read every article ever written on MEBT and am now considering a change of career to professional gum chewer (doing this to keep eustacian tubes open). I’d be really interested to know others experiences in recovery time for similar mild MEBT - thanks!

 

[living4experiences]

Did your doctor tell you the origin of the fluid and what happens to it? Does your body resorb it or does it drain out of your ear? When I was getting certified years ago, on my last certification dive, I got a reverse block but didn't know that at the time. I had a searing pain in my ear during ascent, and when I got out of the water and back to the hotel room, there was some blood and I was completely deaf in that ear.

Upon returning home, I was lucky to find an ENT doctor in my area that was a scuba diver. He said I had burst the lining of my eardrum, the deafness was not permanent, and I could not fly or dive until it was healed. He told me that the blood and internal scabbing (my nonmedical term) would be resorbed by my body, and my hearing would slowly return. This was six weeks before my first-ever dive trip. Only time and my body's ability to heal was all I could count on. I saw him three days before the flight, and I was so relieved when he said I was cleared to fly and dive.

He recommended that going forward, I should use Doc's ProPlugs, Nasacort 2-3 days before diving and continue using during the dive trip, and take Sudafed (psuedoephedrine). I've used these methods on every dive since and never had another problem. Nasacort is nonaddictive and doesn't have the rebound effect like Afrin.

Not to minimize what you're going through, but if you have fluid and not blood, you may be doing okay in the healing process. It's hard to be patient while your body is healing and this can make you anxious. I felt the same way.

Do you have a DAN membership or have you read any of the barotrauma articles from DAN? They are very helpful.

 

[scubaozy]

You do not have to chew a gum, instead you could do Toynbee maneuver gently. In mild cases the ear will clear in couple of days. If fluid stays long, like in your case, it will turn into an infection, this explains why ENT prescribed the anti biotics, they are to heal the infection and the rest of the medicine is to decongest so that all that fluid can drain. For any type of infection I had, I was given often 1wk of antibiotics and normally they should start improving the infection within 3-5 days. I would contact the ENT if it did not improve after a week of antibiotics treatment, unless ENT advised otherwise. Otitis media can be tricky, you are trying to heal an infection in warm humid closed area. If it was me, I would stay in touch with my ENT.
MEBT term also covers ruptured TM, so, a lot of recovery times you are reading in articles like 6-12wks are covering that as well. If your ears do not have infection or fluid in and your ET and sinuses are fully functional, your TM is not ruptured, there is not need to wait weeks.

 

[Duke Dive Medicine]

Hi All,
Recently diagnosed with mild middle ear barotrauma (MEBT) but ear drum is fine. In Bonaire a couple of weeks ago - I dived at least once a day - no issues with equalization. 24 hours after last dive, I woke up with clogged ear and hearing about 50% of normal. Went to an ENT on return home - he says I have middle ear fluid consistent with MEBT. Two weeks later - I’ve done a course of prednisone and antibiotics and am using Sudafed and nasal steroids now but it doesn’t feel like it’s improved much. No diving till it’s resolved which could take weeks to months and of course I have a bunch of boat trips booked over next few weeks.

In the absence of diving, I have now read every article ever written on MEBT and am now considering a change of career to professional gum chewer (doing this to keep eustacian tubes open). I’d be really interested to know others experiences in recovery time for similar mild MEBT - thanks!

Inflammation in that area is notoriously slow to resolve. Unfortunately if the area is subject to repeat trauma by continuing to dive, it's going to take even longer.

Can you expand on what you said about not having any equalization issues? I'm curious how you ended up with fluid in the middle ear without having problems equalizing.

Best regards,
DDM

 

[DES63]

Thanks all for responses!

 

[DES63]

Inflammation in that area is notoriously slow to resolve. Unfortunately if the area is subject to repeat trauma by continuing to dive, it's going to take even longer.

Can you expand on what you said about not having any equalization issues? I'm curious how you ended up with fluid in the middle ear without having problems equalizing.

Best regards,
DDM

I did 8 dives in Bonaire - no problems with ears or equalizing. I did the last dive on the morning before departure day and it was fun and uneventful. No issues with ears and everything was fine the entire day. However, the next morning, I woke up with clogged ear but flying back to the US was no problem.

I did have a similar problem about 7 years ago doing daily dives in Grand Cayman. Since then, most of my diving has been in quarry or NE boat trips where I do a couple of dives a day, with a week or more between diving days. I normally take a 12 hr sudafed and or Afrin as a precaution but if I forget, there has been no issue. I’m wondering if current situation is a result of cumulative daily dives. ENT again tomorrow - noted your comment re inflammation so have added ibuprofen to my Sudafed/nasocort regimen.

 

[Duke Dive Medicine]

I did 8 dives in Bonaire - no problems with ears or equalizing. I did the last dive on the morning before departure day and it was fun and uneventful. No issues with ears and everything was fine the entire day. However, the next morning, I woke up with clogged ear but flying back to the US was no problem.

I did have a similar problem about 7 years ago doing daily dives in Grand Cayman. Since then, most of my diving has been in quarry or NE boat trips where I do a couple of dives a day, with a week or more between diving days. I normally take a 12 hr sudafed and or Afrin as a precaution but if I forget, there has been no issue. I’m wondering if current situation is a result of cumulative daily dives. ENT again tomorrow - noted your comment re inflammation so have added ibuprofen to my Sudafed/nasocort regimen.

You could be getting water intrusion into the middle ear via the Eustachian tube. Just so it's asked, are you equalizing early and often, and before you feel the need to? During the dives, did you have any point where you felt pressure in the middle ear that resolved with equalization?

Best regards,
DDM

 

[DES63]

You could be getting water intrusion into the middle ear via the Eustachian tube. Just so it's asked, are you equalizing early and often, and before you feel the need to? During the dives, did you have any point where you felt pressure in the middle ear that resolved with equalization?

Best regards,
DDM

Not really - ears felt fine. I must admit that I think I was getting complacent with equalizing ie only doing so when I felt pressure. I was also not good about taking Claritin on vacation but did not really experience allergies in Bonaire.

ENT says right ear fine, left ear still has some mucus but should be fine in a week or two. Another round of antibiotics as precautionary measure. Feels pretty good - I’m planning to be back on the boat a week from now, armed with Sudafed, Afrin and a rediscovered awareness of the importance of equalizing early and often.

For future reference for anyone else experiencing similar issues (middle ear fluid without blood, no eardrum damage), mine (hopefully) will be resolved in 3-4 weeks. Still not sure why onset was 24 hours after last dive - doesn’t seem consistent with MEBT but I’m not an expert.

Again, thanks all for input. In the big picture, this is a minor problem, but I missed a trip to the St Lawrence and a couple of boat trips so still annoying.

 

[Duke Dive Medicine]

Not really - ears felt fine. I must admit that I think I was getting complacent with equalizing ie only doing so when I felt pressure. I was also not good about taking Claritin on vacation but did not really experience allergies in Bonaire.

ENT says right ear fine, left ear still has some mucus but should be fine in a week or two. Another round of antibiotics as precautionary measure. Feels pretty good - I’m planning to be back on the boat a week from now, armed with Sudafed, Afrin and a rediscovered awareness of the importance of equalizing early and often.

For future reference for anyone else experiencing similar issues (middle ear fluid without blood, no eardrum damage), mine (hopefully) will be resolved in 3-4 weeks. Still not sure why onset was 24 hours after last dive - doesn’t seem consistent with MEBT but I’m not an expert.

Again, thanks all for input. In the big picture, this is a minor problem, but I missed a trip to the St Lawrence and a couple of boat trips so still annoying.

Good info. Mucus is more suggestive of middle ear infection vs barotrauma. Sounds like you're getting the appropriate care.

Best regards,
DDM