equalizing after an external ear infection..

[Kay_K]

I had a pretty bad outer ear infection 3 weeks ago that took a week+ to pass, with antibiotics and painkillers. I was totally deaf on the affected side, couldn't chew and all... After the infection cleared, I went back to diving and immediately noticed that I don't need to equalize with the valsalva anymore... I move my jaw around a bit on descent, but rather as a precaution - I did try to descend without doing anything at all shakehead and my ears felt absolutely fine during the dive and after. My ears just somehow equalize on their own now...

What could this possibly mean and should I be concerned? I'm on a long DM internship on a remote island in east Indonesia - there's a hospital in the village, and an english-speaking local doctor who charges foreigners ridiculous sums.. Fellow DMs and instructors can't offer any really meaningful advice..

 

[Jim Lapenta]

Is your hearing back to 100%? I ask because I just this last week and a half went thru the same thing. My one ear still feels just a tiny bit full but the pain and infection is gone. I am wondering if perhaps there may be just a bit of pressure still on the inside and that is what is compensating for the pressure underwater? IN any case was in the pool last night for the first time since using the meds the doc gave me and experienced the same thing. Less effort required to equalize. At least down to 10 ft anyway. And I am now back to using the white vinegar/alcohol/peroxide rinse afterwards. Neglecting to use it and spending 5 out of 8 days in the water was IMO a big factor in getting the damn infection in the first place.

 

[DocVikingo]

Hi Kay K,

Are you certain this was an infection of the "outer ear" (otitis externa) as opposed to one of the middle ear (otitis media)?

[Basic ear anatomy --> http://www.valleyhealth.com/images/image_popup/w17_earanatomy.jpg

Regards,

DocVikingo

 

[Kay_K]

Hi Jim,

Is your hearing back to 100%?

Yes, it was definitely 100% back and the pain and discomfort were gone when I started diving again. Did 5 days*3 dives a day in a row, and noticed this strange thing... and it's not that equalizing takes less effort - it feels like I don't need to equalize at all anymore! (I do make sure now to move the jaw on descent though, just in case..)

Hi DocVikingo,

Are you certain this was an infection of the "outer ear" (otitis externa) as opposed to one of the middle ear (otitis media)?

Having read many threads on this forum and the articles on DAN, I was under the impression that otitis media can occur only if the eardrum is damaged? Please forgive me my ignorance, I'm very inexperienced..

Btw, I've got the infection again - in another ear this time, and not as bad b/c I recognized it and started taking antibiotics earlier. This is just... beyond frustrating... :depressed: After that first infection I made sure to wash my ears with fresh water after each dive, but apparently that wasn't enough.. Next time it will be with mineral oil and ear beer, many thanks to this forum...

 

[doctormike]

Having read many threads on this forum and the articles on DAN, I was under the impression that otitis media can occur only if the eardrum is damaged? Please forgive me my ignorance, I'm very inexperienced..

Hi, Kay...

Thanks for writing!

This does come up a lot (will write a sticky when I get around to it!)....

Otitis externa (OE, outer ear infection, "swimmer's ear") and Otitis media (OM, middle ear infection, from barotrauma or infection), are two completely different things with different causes, physiology and risks.

OE is a skin inflammation of the canal of the ear that starts in the side of your head and travels down to the eardrum. It can be caused by aggressive instrumentation, diving, sweating or some types of ear drops. In severe cases, with swelling of the canal, it can cause some hearing loss but this is uncommon. Sometimes, accumulated earwax makes it worse, especially if you are packing it in with a q-tip in an attempt to remove it..!

OM is caused by bacterial infection in children (AOM, or acute otitis media), or by pressure injury in divers (OME, or otitis media with effusion). It causes a significant (but usually temporary) hearing loss. The problem in both cases is poor equalization/ventilation of the middle ear cleft (the space behind the eardrum) due to diving or (in children) due to poor function of the Eustachian tube. Diving when you can't equalize make you at risk for an eardrum perforation, or worse.

There are also INNER ear problems (DCI, perilymph fistulas, etc..) that can cause permanent deafness, but that's for another day!

There is a small amount of overlap: OM can cause OE if the eardrum perforates and that infected fluid drains into the ear canal. OE can't really cause OM (although I suppose it is remotely possible to cause some barotrauma if your outer ear was sealed shut from inflammation and that affected the air pressure in the ear canal during descent).

Btw, I've got the infection again - in another ear this time, and not as bad b/c I recognized it and started taking antibiotics earlier. This is just... beyond frustrating... :depressed: After that first infection I made sure to wash my ears with fresh water after each dive, but apparently that wasn't enough.. Next time it will be with mineral oil and ear beer, many thanks to this forum...

I know that it is hard, but there is NO substitute for having someone who knows what he or she is looking at taking a look in your ear. Especially if you have a hearing loss, which means that it might be more than a simple OE that is treated with the topical methods that you are referring to...

Good luck!

Mike

 

[Kay_K]

I know that it is hard, but there is NO substitute for having someone who knows what he or she is looking at taking a look in your ear.

Eh, it's just not possible at the moment, the nearest ENT is in Bali, which is quite a distance away.. I suppose I just have to learn how to manage it until i'm back to civilization..

Especially if you have a hearing loss, which means that it might be more than a simple OE that is treated with the topical methods that you are referring to...

I'd still think it was an external infection on both occasions, bc the canal was extremely swollen and painful to touch, and eardrops wouldn't go in at all. I messed with my ear way too much.. I'm back in the water again now, trying my best to use ear beer straight away after a dive, so I'll see how it goes. However, the way my ears equalize by themselves now after the 1st infection 6 weeks ago, that puzzles me slightly...

Thanks again and keep up your good work!

 

[doctormike]

Eh, it's just not possible at the moment, the nearest ENT is in Bali, which is quite a distance away.. I suppose I just have to learn how to manage it until i'm back to civilization..

Yup, I have had this sort of conversation with many dive professionals working in "island paradises"...

Not a lot of good options. Hopefully, scubaboard can give you some insight until you can be seen...

I'd still think it was an external infection on both occasions, bc the canal was extremely swollen and painful to touch, and eardrops wouldn't go in at all. I messed with my ear way too much.. I'm back in the water again now, trying my best to use ear beer straight away after a dive, so I'll see how it goes. However, the way my ears equalize by themselves now after the 1st infection 6 weeks ago, that puzzles me slightly...

Yes, if the ear is painful to touch, that is much more likely an external ear infection... in some cases, the ear canal gets so swollen that it becomes "airtight", and can affect equaliziation, but that is also very rare.

Hang in there, and keep us posted!

Best,

Mike