Serous Otitis Media -- Causing a lot of ear infections

[Fogest]

Lots of misconceptions about ears and diving. Here is my sticky about all of this, I hope that it is helpful.

Ear disease is very frequently misdiagnosed by doctors who are not ENT docs or pediatricians. Your doctor may be great, I don't mean to sound snotty (hah!). However there should be no confusion between middle ear barotrauma leading to serous otitis media (for which antibiotics should never be used), acute otitis media with pus in the middle ear (which is extremely uncommon in adults, even in divers), and otitis externa ("swimmer's ear", which may require microscopic cleaning of the ear in addition to drops).

Read the sticky and feel free to ask specific questions.

So if I read and understood the middle ear section correctly, there is very little that I can do when I get this fluid in my ear, but just wait for it to go away. And when I get this fluid I am very likely going to also get an ear infection that starts shortly after the fluid appeared?

By the sounds of it, due to the location of this there is not much I can do about the ear infection either, especially since I can't really be using antibiotics to treat it every time.

My issue though is that I feel like I had this problem before I even started diving. I have been to the talker abut 5-6 months ago for a problem where my hearing in one ear was not the best. Also I still experience issues where whenever I lay down I experience a discomfort in my one ear. It seems like the same symptons of having this fluid in my ear, however I was experiencing this in the winter time, so I wasn't even doing anything in the water at all.

When I am descending I am equalizing every breath I do out and typically descending slow. I hear the distinct popping sound, and anytime I feel too much pressure building I slow down the descent and go up a little so that I can equalize properly. I never have experienced any pain in my ears while diving, or had any pain after the dive.

The only weird thing I do have, which I am sure if it is normal, is that as I am ascending I usually having a popping noise in my ears. I am not sure if this is abnormal though as this is the same kind of popping I'd get when ascending in an airplane, or entering one of those big pressurized inflatable domes some places have.

So at this point I am just really confused what the problem really is. Should I be asking my doctor to refer me to an ENT then? While I know diving has made my ears get infected every time after diving, I am not sure if that is the full root cause since I have had these kind of fluid in ears symptoms that you described long before diving

Also can this cause any damage if I continue diving and keep experiencing this kind of pain after?

 

[doctormike]

It's really hard to be specific over the Internet, since I don't know just what is going on with your ears. This is one of the reasons why ear disease can be so confusing, because different conditions can have similar symptoms, even though the treatment is vey different.

True ear infections (otitis media, pus behind the eardrum requiring antibiotics) is VERY unusual in adults, even with diving related barotrauma. A good diagnosis is the most important thing. I don't know any ENT doctors in Ontario, but if you call DAN they may be able to give you a local referral. Or you could just find a local ENT doc from your regular medical doc.

 

[Fogest]

It's really hard to be specific over the Internet, since I don't know just what is going on with your ears. This is one of the reasons why ear disease can be so confusing, because different conditions can have similar symptoms, even though the treatment is vey different.

True ear infections (otitis media, pus behind the eardrum requiring antibiotics) is VERY unusual in adults, even with diving related barotrauma. A good diagnosis is the most important thing. I don't know any ENT doctors in Ontario, but if you call DAN they may be able to give you a local referral. Or you could just find a local ENT doc from your regular medical doc.

According to my doctor there was indeed a fluid behind my ear drum in the middle ear, but I am unsure of how sure he actually was of that or if his instruments can even allow him to tell that properly. So I will definitely seek a referral to an ENT from my doctor or from DAN.

Thanks for the help!

 

[doctormike]

Right, fluid in the middle ear (serous otitis media) is very common after diving. INFECTED fluid, aka pus (acute otitis media, requiring antibiotics) is rare.

 

[Imla]

Have you considered the possibility that you might be equalizing slightly to late? You will hear the pop, and you will equalize, but that the force exerted by the pressure might cause repeated cases of minor trauma and induce an inflamed state in your ear?? Ie, not enough for you to feel direct pain when equalizing while diving, but enough to cause minor damage repeatedly, and for this to cause swelling and buildup of fluid in the middle ear.
When you are cleared to dive again, try to "pre-equalize" with less force, and try to be in front of any pressure changes. Less force exerted by water and less force exerted by you might result in less irritation in the ear.

 

[Fogest]

Have you considered the possibility that you might be equalizing slightly to late? You will hear the pop, and you will equalize, but that the force exerted by the pressure might cause repeated cases of minor trauma and induce an inflamed state in your ear?? Ie, not enough for you to feel direct pain when equalizing while diving, but enough to cause minor damage repeatedly, and for this to cause swelling and buildup of fluid in the middle ear.
When you are cleared to dive again, try to "pre-equalize" with less force, and try to be in front of any pressure changes. Less force exerted by water and less force exerted by you might result in less irritation in the ear.

I actually have been in the habit of just equalizing on every breath out, especially during the first 30 ft. So this is what has me wondering if it is actually a problem or not.

Right, fluid in the middle ear (serous otitis media) is very common after diving. INFECTED fluid, aka pus (acute otitis media, requiring antibiotics) is rare.

Yeah, my doctor did say I had serous otitis media, however by his words he prescribed me the antibiotics for the ear infection I have. So I am not sure if that means the fluid was infected, and pus or not, or what may be the case.

 

[doctormike]

Yeah, my doctor did say I had serous otitis media, however by his words he prescribed me the antibiotics for the ear infection I have. So I am not sure if that means the fluid was infected, and pus or not, or what may be the case.

Serous otitis media - by definition - means no infection in the middle ear. So it's either one or the other. I am not aware of much recent evidence to support the use of antibiotics for SOM.

 

[fmerkel]

The routine use of antibiotics for middle ear problems is still common in spite of recommendation against the practice for years. Most cases are children with anxious/upset parents that EXPECT something done and NOW!
It's easier to prescribe them than try to educate a parent who probably won't understand it and may not believe it anyway.
It's a lot like what you are going through right now.

 

[doctormike]

The routine use of antibiotics for middle ear problems is still common in spite of recommendation against the practice for years. Most cases are children with anxious/upset parents that EXPECT something done and NOW!
It's easier to prescribe them than try to educate a parent who probably won't understand it and may not believe it anyway.
It's a lot like what you are going through right now.

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.

 

[kr2y5]

I actually have been in the habit of just equalizing on every breath out, especially during the first 30 ft. So this is what has me wondering if it is actually a problem or not.

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.