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Ear barotrauma recovery

Discussion in 'Diving Medicine' started by Chris Ra, Dec 5, 2019.

  1. Chris Ra

    Chris Ra Angel Fish

    # of Dives: 25 - 49
    Location: Germany
    30
    16
    8
    Hello,

    I started diving in 2017 and noticed right away that I had trouble equalizing the pressure in my right ear. I continued diving and finished the PADI OWD course, even having 6-7 dives after that, while ignoring the increasing pain in my right ear. It took a few months afterwards until my ear was completely ok.

    In summer 2019 I decided to fix this problem and had surgery (eustachian tuboplasty with a balloon). The operation was succesful. The problem was that my next diving vacation was 4 weeks after the surgery and I didn't completely recover yet. In this time I was also doing nasal irigations with a salt water solution. Because I thought that I would be alright, I went diving anyway. The first four dives went without any problems. On the fifth, it seems that I still had some water in the nose from the saline rinse and when I went down, I couldn't equalize and started feeling pain in the right ear. Because I was stupid, I continued to descend even when I felt overwhelming pain. I was trying to equalize every second, but it wasnt working and I was too stubborn to give up and ascend. After a minute or so, I managed to equalize once and the exruciating pain I was feeling went away, so that I continued diving. However, after this dive, I felt like my right ear was completely blocked.

    After flying back home, I went to my ENT and he diagnosed a in-ear barotrauma. He believes that I still had water from the nasal irigations left and that this led to the accident. I got oral cortison tablets, which didn't help at all. Then I got two intratympanic injections with cortison. This made it a bit better, but I still feel like having cotton wool in my ear. The audiogram shows a loss of 20-25 db in the low frequency range. One week ago, I started to do inhalations with a cortisone solution and this seems to help a little bit as well. At least I can equalize the pressure on both ears when trying this at home.

    Did you experience something similar? My ENT says that the damage which was done, is irreversible. Is it possible that this is not true and that the healing will just take more than 3 months? What do I have left to try to heal my ear?

    Thank you for your help!
     
  2. Wathdoc

    Wathdoc Angel Fish

    # of Dives: 1,000 - 2,499
    Location: uk
    62
    48
    18
    Please do not think that I am being rude, but you said in your post that you were stupid. You were, and you have suffered for it. Don't repeat by rushing back into it. ENT is not my field but I would strictly follow the ENT advice including time. It might be better by a little but I doubt it will be significant. My friend an A and E surgeon did something similar and he decided hearing was more important than diving.
     
  3. Angelo Farina

    Angelo Farina Marine Scientist

    # of Dives: 1,000 - 2,499
    Location: Parma, ITALY
    595
    859
    93
    My wife suffered a similar history when young, and we started diving (she was 16, I was 17). After the barotrauma she had to stop substantially for one year, making proper cycles of medications and thermal water therapy. I do not know the exact details of the treatments, but it was in the seventies, so they are almost certainly outdated. I remember she did purchase an aerosol machine (at the time very expensive), and in the following years she was always carrying it with us when leaving for marine holidays (despite not needing it anymore).
    However, in the end the origin of the problem revealed not to be be medical, but technical. At beginning she was using the crap Valsalva method of equalization. When she repeated the diving course one year after, and she told the instructor of the problem of previous year, which caused her to suspend the training, he immediately understood the problem and did teach her how to equalize with the Marcante-Odaglia method. This is not well known outside Italy, it has close similarity with the Frenzel method mostly employed by free divers, but is better suited to scuba divers as it does not require to close the mouth, nor stopping breathing. After learning the proper equalization technique, she did not suffer of equalizing problems or barotraumas anymore for all her life...
    So take your time, heal completely, and then, when you will be allowed by your physician to dive again, take the time to learn a proper method of equalization which works for you.
    I know many people who gave up "because they cannot equalize"; while the correct wording would be "because they did not take the time and make the exercises required for learning the technique for proper equalization"...
     
  4. Joneill

    Joneill Loggerhead Turtle

    # of Dives: 100 - 199
    Location: New Jersey, USA
    1,628
    1,436
    113
    I don't think that anyone can definitively answer that question - but inner ear barotrauma can result in permanent impacts to hearing. Only time will tell...

    Inner-Ear Barotrauma (IEBT) | Ears & Diving - DAN Health & Diving
     
  5. Bigbella

    Bigbella Manta Ray

    # of Dives: I'm a Fish!
    Location: San Francisco
    501
    420
    63
    I experienced a ruptured eardrum, back in 2008, which ironically occurred -- not at depth, but on the surface, after a series of dives. The swell had picked up, and I was essentially, slapped upside the head by a body of water. There was no real pain; but I was a bit stunned and vertiginous when I returned to shore. Attempting to get what I thought was water from my left ear, I noticed quarter-sized drops of blood on the sand. I had thought that I had somehow been cut on the hand; had no idea that the ear was at issue at the time. Just felt as though it had been filled with water.

    The ER referred me to a otolaryngologist, who also happened to be a surfer -- this is Kali-forn-ia, after all -- and had seen any number of similar cases. He assured me that the eardrum, as vascularized as it was, would rapidly heal within a few weeks. I was a miserable desk jockey for a month, and considered just how many No. 2 pencils I could suspend from the acoustical tiles in our office (about fifteen).

    The first dive back, was through clenched teeth -- worried about that potential "bomb" in my head -- about six weeks after the accident; and the only long-term issue has been occasional tinnitus in that ear -- something which I had been told to anticipate. Haven't had ear issues since; but I also followed my physician's advice to the letter.

    This is a good, though unintentional advertisement for DAN. They covered everything; and considering that my medical insurance, at the time, carried a deductible which was three times the cost of my car while at university (or, heh, heh, nearly forty-eight years of DAN premiums), it was a no brainer . . .
     
  6. iamrushman

    iamrushman Great White

    # of Dives: 1,000 - 2,499
    Location: ft. lauderdale, florida
    3,267
    908
    113
    it's been said that time heals all wounds...good luck.
     
  7. Duke Dive Medicine

    Duke Dive Medicine Medical Moderator Staff Member

    2,451
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    Hello @Chris Ra ,

    Did you have any other symptoms besides pain and hearing loss? Maybe vertigo (spinning feeling) or tinnitus (ringing in the ears)? I'm wondering what led your doctor to diagnose inner ear barotrauma.

    Best regards,
    DDM
     
  8. Chris Ra

    Chris Ra Angel Fish

    # of Dives: 25 - 49
    Location: Germany
    30
    16
    8
    Hello DDM,

    I did not have vertigo or tinnitus at any time. My ear felt like it was blocked; like I was having a cotton ball in it. It has been 3 months since then and I still have not recovered completely, despite having two cortisone shots in the ear. It has gotten better, but it is frustrating because the ear feels so differently and I experience hearing loss, which is also varies day by day. Sometimes it is worse, sometimes I have the feeling that I am almost healed.

    They only did several audiograms in the past 6-8 to weeks and I was told that it is very likely that it could be an ear barotrauma. I am going next week to an ENT specialized on diving. I wonder what he will say...
     
  9. Silt Life

    Silt Life Angel Fish

    # of Dives: 0 - 24
    Location: Hotlanta
    29
    36
    13
    I had a similar experience last year when I forced eq at about 60fsw. A daily dose at night time of 25mg Meclizine and a couple months cleared up that full ear feeling, but I also didn’t dive again for six months~! All good now with no diminished hearing and I seem to be able to equalize much easier than before.....
     
  10. Duke Dive Medicine

    Duke Dive Medicine Medical Moderator Staff Member

    2,451
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    Hi Chris,

    Thanks for the details. Several areas of the ear can be subject to barotrauma. At this point it's probably moot, but we do differentiate between inner ear barotrauma, middle ear barotrauma, and external ear barotrauma, since the symptoms, complications, and recovery arcs can differ considerably. Here's an article I wrote for DiveAssure a while back that provides some more information.

    Recovery from ear injuries can be slow, and getting back in the water too soon can cause you to re-injure the area and set you back. I think the fact that you seem to be recovering slowly is reassuring; I'll be interested to hear what the diving ENT has to say.

    Best regards,
    DDM
     
    chillyinCanada likes this.

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