Sometimes, after many dives, get piercing ear pain in the 20-30ft range

[DazedAndConfuzed]

Based on what you've written in this thread, my impression is that your quick descents to depths greater than 30 fsw (ostensibly performed to avoid ear pain) are actually leading to some middle ear barotrauma. This only has to occur once and, from that point on (while on vacation), you will experience ear pain upon descent and "ear squishiness"/muffled hearing while topside.

Some people just require more time to equalize their ears during descent. Descend slowly and under control. If it takes 30 seconds to descend 1 foot, then that's the preferred descent rate for you. Discuss all of this with your buddy ahead of time so that he/she knows what to expect once you're in the water.

FWIW, muffled hearing is one common symptom that's associated with middle ear barotrauma.

Differential diagnosis of middle ear barotrauma vs. otitis externa (outer ear infection) is not always so straightforward. When in doubt, schedule an appointment with a health care professional. A simple ear exam with an otoscope would probably reveal whether any damage has been done to your eardrum. Depending on the diagnosis, the physician should be able to give you treatment options. For mild cases of middle ear barotrauma featuring "squishiness" in the ear, decongestants can be helpful.

In both trips that I had the issue, it occured on one of the dives and usually kept on happening on the rest of the dives, so maybe it is what you described.

I assume there are multiple chambers in the ear/head to equalize given that I was blowing all I can blow to equalize to the point of my ear popping the other way and it still had no effect on that pain.

My muffled hearing only occured 4 days after I returned, along with the flu like symptom.

I am hesitant to go to the doctor bcuz the last time I went for vertigo, they went all out on the testing, found nothing and couldn't do anything for me besides load me up with meclazine, then tried to keep me coming back as some sort of permanent patient for almost a year until the assistant forgot to try to get me a followup appt. When I felt a little off balance from this incidence, I just dosed up on meclazine 2x day.

Be careful. 5 dives a day on vacation can really take a toll on more than just your ears. Slow down those descents and ascents, stay hydrated, get sleep, eat as healthily as possible or as one can on vacation and try to stay more shallow. That's a lot of (literally) pressure on your body and it will take a toll. I'm not saying you were bent but I doubt it was a viral infection. I like to dive dive dive on vacation too so I understand.

Dive, hydrate, rest and eat during SI plus sleep..that seemed to have been the whole trip cuz was so narc'd up even with nitrox. My ascend rate was slow, don't have the computer with depth compensated ascend rate graph. Only time I might have ascended in a hurry was when I was really low on air in a night dive and my buddy went off with the guide to see a VW bug sized turtle, and even then it took something like a couple of minutes to go from 60ft to 25ft, then a couple minutes of swim at 25ft-20ft to the boat and a couple more minutes of safety stop.

I assume it is viral because I had flu like symptoms plus what felt like onset of vertigo, which I had a few years ago and 99% of the time it is viral thus non-diagnosable (although my cat had what is described as vertigo, but never fully recovered from it).

Are you new to diving? Or do yo dive once in awhile? Or you dive a few days or so every once in awhile. These dive profiles can have an affect. Your system needs to relax more on those dives where the pain starts. This usually occurs within the 10m/33ft 2ATA range. As pressure is high in this range. As you ascend past this depth it gets better.

Change the dive profile to have a greater SI between dives and descend slow, equalize, etc. If you get too sensitive abort the dive. As the swelling can ruin your diving day. Avoid medication unless prescribed by a diving physician.Rest a day to dive another day

Have fun and enjoy.

I've dived over 10 years, mostly vac diving 1-2x a year putting 10-20 dives per trip. It was only in the last couple of trips that I experience this. SI were usually around 1.5 hr to 2hr between dives. mostly square profile and 70min BT. dived nitrox to say in NDL.

You mention ascend past this range. My pain usually disappears as I descend past the 10m/33ft range. Do you mean go shallower than 10m/33ft?

 

[Bubbletrubble]

I assume there are multiple chambers in the ear/head to equalize given that I was blowing all I can blow to equalize to the point of my ear popping the other way and it still had no effect on that pain.

"Blowing all you can blow" might actually do more harm than good. Over-pressurizing the middle ear space can actually cause damage.
A diver's ear equalization techniques are aimed at equalizing the pressures on either side of the eardrum.
Sinus spaces can't be equalized in the same way. The best you can do is keep the openings to the sinus spaces patent. You can do this by avoiding inflammation of the linings of those sinus spaces. This means taking any allergy meds (if you have allergies) and/or decongestants. A saline nasal rinse can also be helpful.

My muffled hearing only occured 4 days after I returned, along with the flu like symptom.

In my experience, muffled hearing due to middle ear barotrauma usually manifests the day following the incident. The 4 day delay in onset increases the likelihood that the muffled hearing was caused by something else, possibly of infectious etiology. If you were traveling by commercial airline, you were almost certainly exposed to a whole host of communicable pathogens.

I am hesitant to go to the doctor bcuz the last time I went for vertigo, they went all out on the testing, found nothing and couldn't do anything for me besides load me up with meclazine, then tried to keep me coming back as some sort of permanent patient for almost a year until the assistant forgot to try to get me a followup appt. When I felt a little off balance from this incidence, I just dosed up on meclazine 2x day.

You're lumping the muffled hearing and vertigo together. It's possible that the vertigo has a separate cause.
One of the first questions a physician will ask is whether you were taking any other medications in the period leading up to the onset of vertigo.
Have you been using scopolamine (patch or pill) as an anti-seasickness treatment during your dive vacations?
A withdrawal condition featuring persistent vertigo has been identified in people dosing with scopolamine. A few cases have been reported by divers on liveaboard trips. A meclizine tapering protocol has been helpful in at least one published case report.

That being said, it's certainly possible that the vertigo and muffled hearing were both caused by some sort of viral infection.

I can understand your reluctance to see another physician given your past experience. That must have been pretty frustrating.

 

[DazedAndConfuzed]

"Blowing all you can blow" might actually do more harm than good. Over-pressurizing the middle ear space can actually cause damage.
A diver's ear equalization techniques are aimed at equalizing the pressures on either side of the eardrum.
Sinus spaces can't be equalized in the same way. The best you can do is keep the openings to the sinus spaces patent. You can do this by avoiding inflammation of the linings of those sinus spaces. This means taking any allergy meds (if you have allergies) and/or decongestants. A saline nasal rinse can also be helpful.

In my experience, muffled hearing due to middle ear barotrauma usually manifests the day following the incident. The 4 day delay in onset increases the likelihood that the muffled hearing was caused by something else, possibly of infectious etiology. If you were traveling by commercial airline, you were almost certainly exposed to a whole host of communicable pathogens.

You're lumping the muffled hearing and vertigo together. It's possible that the vertigo has a separate cause.
One of the first questions a physician will ask is whether you were taking any other medications in the period leading up to the onset of vertigo.
Have you been using scopolamine (patch or pill) as an anti-seasickness treatment during your dive vacations?
A withdrawal condition featuring persistent vertigo has been identified in people dosing with scopolamine. A few cases have been reported by divers on liveaboard trips. A meclizine tapering protocol has been helpful in at least one published case report.

I can understand your reluctance to see another physician given your past experience. That must have been pretty frustrating.

I didn't keep blowing and blowing. I tried to blow to equalize and when I felt overpressure in my ear I knew it was equalization in the sinus path to the ear.

I mentioned muffled sound with bubbly/gurgly sound when forcing air into sinus along with vertigo sensation because it happened around the same time. Not during the trip, but 4+ days after coming back. They both went away around 10 days later.

I did take 25mg meclizine once a day during the trip as a precaution, but that was not enough to counter the feeling like I am still at sea feeling once I got home given the liveaboard was rocking 7x24. Maybe I should have tapered off on that? I had a few bouts of head feeling like spinning in the following 2nd week I came back, mostly from smelling the dry erase cleaner's fumes. Normally it would just be an annoyance, but those few times my head felt like it was ready to float away. That's why I got back on the meclizine for the next 4 days or so.

I originally got referred to a neurologist because of a pinched spinal nerve and just wanted a cortizone shot. Then soon after, I had bout of vertigo, and after coming back from hospital, she went about a whole battery of test for nerve conductivity, ear balance nerve sensitivity....followup tests. She even wanted to send me to physical therapy in her office to strengthen my ear balance nerves (too bad it got turned down by the insurance). All I wanted was a cortizone shot once in a while until the herniated disk goes away. I know what type of situations to avoid that might cause an onset of vertigo and what to do (not go to ER with their $8000 MRI bill, but just keep my eyes closed, drink plenty of fluid to rehydrate from all the puking, and take meclizine).

 

[Bubbletrubble]

I did take 25mg meclizine once a day during the trip as a precaution, but that was not enough to counter the feeling like I am still at sea feeling once I got home given the liveaboard was rocking 7x24. Maybe I should have tapered off on that? I had a few bouts of head feeling like spinning in the following 2nd week I came back, mostly from smelling the dry erase cleaner's fumes. Normally it would just be an annoyance, but those few times my head felt like it was ready to float away. That's why I got back on the meclizine for the next 4 days or so.

Is it possible you were suffering from a condition known as mal de debarquement?
Here's a Wikipedia link to the topic.
Here's a link to an essay written by a physician about potential causes and treatment for the disorder.

Since you were taking meclizine during the liveaboard and immediately ceased taking the drug after the liveaboard, I suppose meclizine withdrawal should be on the differential as well. If that was the issue, then re-starting the meclizine and doing a taper would be a reasonable approach.

I originally got referred to a neurologist because of a pinched spinal nerve and just wanted a cortizone shot. Then soon after, I had bout of vertigo, and after coming back from hospital, she went about a whole battery of test for nerve conductivity, ear balance nerve sensitivity....followup tests. She even wanted to send me to physical therapy in her office to strengthen my ear balance nerves (too bad it got turned down by the insurance). All I wanted was a cortizone shot once in a while until the herniated disk goes away. I know what type of situations to avoid that might cause an onset of vertigo and what to do (not go to ER with their $8000 MRI bill, but just keep my eyes closed, drink plenty of fluid to rehydrate from all the puking, and take meclizine).

I have heard that the right kind of physical therapy can be very helpful for some types of vertigo. Too bad that your insurance wouldn't cover it if that's the treatment your neurologist recommended.

 

[DazedAndConfuzed]

Is it possible you were suffering from a condition known as mal de debarquement?
Here's a Wikipedia link to the topic.
Here's a link to an essay written by a physician about potential causes and treatment for the disorder.

Since you were taking meclizine during the liveaboard and immediately ceased taking the drug after the liveaboard, I suppose meclizine withdrawal should be on the differential as well. If that was the issue, then re-starting the meclizine and doing a taper would be a reasonable approach.

I have heard that the right kind of physical therapy can be very helpful for some types of vertigo. Too bad that your insurance wouldn't cover it if that's the treatment your neurologist recommended.

Me and my wife both felt the PCSD (post cruise symptoms disorder, (the rocking feeling, not the 20LB weight gain) this time but it went away on its own in less than a week. Strangely, we both felt it the first time we used one of those giant cruise ship, she actually got sick during the trip. I just had that rocking feeling for a week or so (thought it would be permanent). Never had it after that until this time. I guess I should taper off the meclizine nex time, or do the procedure that rolls the little balls in my ear back to its position.

I have long recovered from my vertigo when they tried to get me to PT. I moved on and though I didn't feel like I need it, but who knows. The vertigo went away, but not the herniated disk. I wanted them to treat that by reducing the swelling with cortizone, but they kept going back to the vertigo (they did treat my herniated disk, but with all these electro conductivity and needle poke test along my whole arm).

 

[scubadobadoo]

Have you been using scopolamine (patch or pill) as an anti-seasickness treatment during your dive vacations?
A withdrawal condition featuring persistent vertigo has been identified in people dosing with scopolamine. A few cases have been reported by divers on liveaboard trips. A meclizine tapering protocol has been helpful in at least one published case report.

I used a scope patch for a week and had vertigo and sea sickness as described above when I took the patch off. Boy did it do the job while I was wearing it, but once off, all hell broke lose. :depressed:

 

[scubadobadoo]

I have heard that the right kind of physical therapy can be very helpful for some types of vertigo. Too bad that your insurance wouldn't cover it if that's the treatment your neurologist recommended.

My mother told me about this type of treatment for her vertigo. She now swears by it and I tried not to laugh at her assuming it was some silliness. Kinda like letting fish bite you in a pool to eat eczema off your body. :shocked2: After some research, it seems this "newer" treatment for vertigo is actually legit and very helpful to many people.

 

[DazedAndConfuzed]

I was given the quickie treatment of getting te little balls back into its proper place. Didn't do the PT so don't know what it encompasses.