Ear infections, congestion and Nasonex

[oreocookie]

I just got back from a week in Utila where I had to miss the last 3 dives after my ear decided it didn't want to cooperate anymore. It would equalize but it just didn't feel right, so I stayed shallower fearing a possible reverse block on the accent. After the dive it felt blocked and I couldn't get any air into or out of my ear for 2 days, then it started to hurt but at least it would equalize enough for my flights home. I saw a doctor this morning and got drops for swimmer's ear and some oral antibiotics for a possible deeper infection (the area of my neck where I imagine the Eustachian tube is is a bit swollen and sore at times). She also gave me Nasonex to cut down on congestion which she says can make infections more likely.

I asked about prevention for my upcoming trip to Bonaire and she said I could use swimmer's ear drops and the Nasonex or an antihistamine to cut down on the congestion (not that I feel very congested, but she said I was). So I'm wondering: is this safe and/or useful and does congestion really have anything to do with ear infections?

[lowviz]

I just got back from a week in Utila where I had to miss the last 3 dives after my ear decided it didn't want to cooperate anymore. ....//........

I realize that I am not speaking directly to your question, but this sounds a lot like an issue I had on a fairly recent "16 dive, 6 day" adventure. Don't beat your ears up. Equalize before you feel the need to. If you wait until it hurts, you will reach a point where your ears just don't want to play anymore.

[doctormike]

I just got back from a week in Utila where I had to miss the last 3 dives after my ear decided it didn't want to cooperate anymore. It would equalize but it just didn't feel right, so I stayed shallower fearing a possible reverse block on the accent. After the dive it felt blocked and I couldn't get any air into or out of my ear for 2 days, then it started to hurt but at least it would equalize enough for my flights home. I saw a doctor this morning and got drops for swimmer's ear and some oral antibiotics for a possible deeper infection (the area of my neck where I imagine the Eustachian tube is is a bit swollen and sore at times). She also gave me Nasonex to cut down on congestion which she says can make infections more likely.

I asked about prevention for my upcoming trip to Bonaire and she said I could use swimmer's ear drops and the Nasonex or an antihistamine to cut down on the congestion (not that I feel very congested, but she said I was). So I'm wondering: is this safe and/or useful and does congestion really have anything to do with ear infections?

Hey, Oreo...! Sorry you are feeling badly..

Lots of threads about this here (gotta make a sticky some day), but here are a few quick comments. I can't really tell you anything specific over the Internet.

Middle ear problems (caused in diving by problems with equalizing due to impaired Eustachian tube function) are often confused with outer ear problems (swimmer's ear, which is a skin problem in a space that is hard to dry, like athletes foot or diaper rash). They have absolutely nothing to do with each other, and are treated by completely different methods, but without a good exam by someone experienced in ear problems, they can be hard to distinguish. I suppose that it is possible that you got both swimmer's ear AND a middle ear infection, but that would not be common.

Here is a rule of thumb. If the symptoms were related to descent/ascent, then it is much more likely to be a middle ear problem. If your ear hurts when you wiggle it on the surface, it is more likely to be an outer ear problem.

You would not fee your ET in your neck - it is a tiny cartilage tube in the base of the skull. But dysfunction can cause barotrauma with diving.

Nasal steroids are used for nasal congestion related to allergies. There is no evidence that they have any effect on the ET, but they are commonly prescribed for this reason.

See an ENT doctor (if you haven't already). And watch this video.

[ccannon707]

For me, after years of no problems, I had 2 trips in a row to Cozumel marred by trips to the local hospital for ear issues... 1 an infection and then ear inflammation. I researched and found lots of info on the issue and ear drops that others use - including Navy divers who make their own "home brew". I found a product at Whole Foods that works for me: NutriBiotic All Natural Ear Drops. They contain vegetable glycerin, alcohol, grapefruit seed extract and tea tree oil (both antibacterial). I use them every night when I am on a dive trip and haven't had an issue since.

And I agree with lowviz, equalize early and often.

[Bubbletrubble]

Yes, "congestion" can contribute to the development of a middle ear infection, among other things.
Your doctor's recommendations are appropriate for keeping your ears healthy for a dive vacation.

Proper use of the swimmer's ear drops will help you avoid an external ear infection. Feel free to purchase an OTC formulation or mix your own. Most homebrew recipes consist of a certain percentage of alcohol (aids with drying) and vinegar (low pH kills off the microbes - can be bacteria or fungi). Take care not to use a homebrew with harsh chemicals in it or else you could be doing more harm than good. A quick search of ScubaBoard should yield numerous threads containing various homebrew recipes.

Nasonex (active ingredient: mometasone, which is a corticosteroid) and/or an appropriate antihistamine can prevent the inflammation of the lining of the upper respiratory tract (specifically in the nasal passages and nasopharynx) associated with allergies. It makes sense to keep that area clear of any inflammation since the air space is contiguous with the middle ear and the sinuses. Ensuring patency of the Eustachian tubes is crucial for ear equalization. It would seem logical that anything which blocks up or restricts the opening of the Eustachian tubes can contribute to a middle ear infection.
For more info on this, here's a link to a relevant webpage on the McKinley Health Center at the University of Illinois.

[doctormike]

It would seem logical that anything which blocks up or restricts the opening of the Eustachian tubes can contribute to a middle ear infection.

Yes, it would. However there is no evidence that allergy medicine (especially allergy medicine like a topical nasal steroid which is sprayed in the nose, far away from the Eustachian Tube) has any effect on middle ear ventilation.

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/5/1412#SEC14

Good for preventing sinus ventilation problems, though..!

[TSandM]

I believe Dr. Kay's video covers it, but HERE is an essay I wrote, trying to help divers understand the difference between external ear infections, which are treated with drops, and middle ear barotrauma, which is not.

[oreocookie]

Thanks for the responses so far. I had no trouble equalizing (or any weird feeling in my ear) before that dive, and I don't think I wait too long before equalizing either. A "tickle" of pressure tells me to equalize, not pain or even discomfort (if I try any earlier than that, nothing happens). The doc mentioned that she couldn't get a good view of the eardrum because of swelling, but figured there might be something going on there based on pain below my ear (right behind my jaw) and a low grade fever. Lynne, your essay mentions fever for inner ear infections, but is that also a possibility for swimmer's ear?

One way or another, I'm going ahead with the pills and drops I've been given and I'll seen how it is in a couple of days.

[DandyDon]

My favorite ear drops to prevent Swimmers Ear infections are a mix of 1 spoon of 100 proof Vodka & 1 spoon of white vinegar, poured into any bottle with an ear applicator/dropper. Medical alcohol at 50% suffices too, but don't mix up a years supply as I understand that the vinegar breaks down after a month - which is why it's not in store brands. I mix up some for every trip, use after every dive & shower of a dive trip - or you can use the Navy approach of 3 minutes on each side once a day.

I did not get ear infections for decades of swimming in pools, lakes, and the sea - and I think I've read the water source doesn't matter much, but then I started getting them until I became diligent about the preventative drops. I've had ears so painful that I was on the verge of tears so I'm pretty good about the prophylactic drops now. Once you get an ear infection tho, it's too late for that mix.

For treatment, your doc may have given you drops with an antibiotic and hydrocortisone? You should always seek professional medical advice of course, but I also don't go on a dive trip without a bottle of that too - just in case.

[TSandM]

If there was visible swelling of the external canal, then you at least had a component of external otitis. Fever is rare with that; fever is rare with otitis media, unless it accompanies a viral illness.