Hematoma in Ears?

[willgr1]

Hi Docs-

So I just returned from a visit to the local medical clinic to get some drops for what I thought was a moderate ear infection, which I can only presume came from my diving activities a few days prior.

Here's the story, did three days of cave diving in FL, ending on Tuesday. First sign of pain on Sat. in the right ear. Sunday, quite a bit of pain in the right ear, slight pain in the left ear. Monday, right ear feels also perfect (very slight pain if you push on it), left ear in quite a bit of pain, and had a discharge of a bloody fluid during the night.

So the Doc takes a look and says my ear drum and areas beyond look great, but there are large bumps in both ears, a black bump in the right ear, and a red on in the left. The doc is calling the Hematomas.

I've never heard of a hematoma in the ear canal from diving, nor could I find any info on this. Thinking a visit to the ENT may be in order in the near future, but was curious if this has been seen often and how it's caused by (and would effect) diving.

 

[TSandM]

Boy, it's hard for me to imagine how you would get bilateral hematomas in the external auditory canal, unless you were using some kind of earplugs. I'd be more suspicious that you have some kind of external otitis that's causing blistering and bleeding, although I have never personally seen such a thing.

 

[doctormike]

Hi Docs-

So I just returned from a visit to the local medical clinic to get some drops for what I thought was a moderate ear infection, which I can only presume came from my diving activities a few days prior.

Here's the story, did three days of cave diving in FL, ending on Tuesday. First sign of pain on Sat. in the right ear. Sunday, quite a bit of pain in the right ear, slight pain in the left ear. Monday, right ear feels also perfect (very slight pain if you push on it), left ear in quite a bit of pain, and had a discharge of a bloody fluid during the night.

So the Doc takes a look and says my ear drum and areas beyond look great, but there are large bumps in both ears, a black bump in the right ear, and a red on in the left. The doc is calling the Hematomas.

I've never heard of a hematoma in the ear canal from diving, nor could I find any info on this. Thinking a visit to the ENT may be in order in the near future, but was curious if this has been seen often and how it's caused by (and would effect) diving.

Hey, Willgr, thanks for writing!

With most ear stuff, the diagnosis can be very difficult for a non-ENT physician. I don't mean to sound arrogant, and I certainly defer to other docs for most medical problems, but the ear is very difficult to accurately diagnose without a lot of experience in otoscopy. Pediatricians are often a lot better than general medical docs and/or adult ER docs, just because ear disease is so common in children and relatively rare in adults. And I'm sure that there are some adult docs who are good with the ear, they are just in the minority IMHO.

Ear canal hematomas are usually the result of external trauma to the ear (such as cleaning out earwax, using a q-tip, etc..). Ear canal osteomas (bony protrusions, or "surfer's ear") can mimic these, especially if they are inflamed or irritated. It would be very unusual for them to be the result of barortauma, since there is no trapped air in the external ear canal.

Tight, unvented earplugs could theoretically cause a relative (to ambient) negative pressure in the canal on descent, but even then, I doubt that you would be able to cause a hematoma, which is a collection of blood under the skin. Severe otitis externa ("swimmer's ear") or impacted cerumen (or other debris) could give the appearance of canal hematomas. On the other hand, middle ear bleeding (hemotympanum) is a common result from diving related barotrauma, but in this case, the blood would be behind the eardrum.

Usually, a true external ear canal hematoma will resolve on its own with time, and should not be associated with any long term hearing or balance issues. Seeing an ENT doc is probably a good idea...

Best,

Mike

 

[breezybrd]

I know this is old, but I am looking for answers the doctors don't seem to have.

I have just returned from a couple of days of shallow river dives (<25') surveying fish in Oregon and I am experiencing exactly what the OP describes, only in my right ear, after I did have issues equalizing at 8 ft or so after being down for 10 minutes. This job is very much yo-yo diving as we go up and down with the river bottom.

I got swimmers ear last year after this trip. So when my ear started to hurt the night we got back I figured it was the same and went to urgent care the next day. The on-call PA said hmmm, we'll treat it for swimmer's ear, but it wasn't presenting typically. That was Friday, and by Sunday I was back at urgent care with much worse ear pain. He gave me a shot of torodol for the pain and referred me to the ENT. Just saw the ENT today, and got really no answer. Maybe a light case of Shingles was the ENT's answer. But my ear drum looks good. I just can't imagine shingles shows up in the ear that I had trouble clearing so close to a dive trip. Anyone else experienced this. Any additional input from the Docs out there?

I found one article of hemorrhage WITHOUT rupture of the tympanic membrane, but it's not really the same thing. Article linked below.

I'll keep looking around to see if I can find anything but would appreciate hearing anyone else's experience.

Hemorrhage within the tympanic membrane without perforation - Journal of Otolaryngology - Head & Neck Surgery

 

[Duke Dive Medicine]

I know this is old, but I am looking for answers the doctors don't seem to have.

I have just returned from a couple of days of shallow river dives (<25') surveying fish in Oregon and I am experiencing exactly what the OP describes, only in my right ear, after I did have issues equalizing at 8 ft or so after being down for 10 minutes. This job is very much yo-yo diving as we go up and down with the river bottom.

I got swimmers ear last year after this trip. So when my ear started to hurt the night we got back I figured it was the same and went to urgent care the next day. The on-call PA said hmmm, we'll treat it for swimmer's ear, but it wasn't presenting typically. That was Friday, and by Sunday I was back at urgent care with much worse ear pain. He gave me a shot of torodol for the pain and referred me to the ENT. Just saw the ENT today, and got really no answer. Maybe a light case of Shingles was the ENT's answer. But my ear drum looks good. I just can't imagine shingles shows up in the ear that I had trouble clearing so close to a dive trip. Anyone else experienced this. Any additional input from the Docs out there?

I found one article of hemorrhage WITHOUT rupture of the tympanic membrane, but it's not really the same thing. Article linked below.

I'll keep looking around to see if I can find anything but would appreciate hearing anyone else's experience.

Hemorrhage within the tympanic membrane without perforation - Journal of Otolaryngology - Head & Neck Surgery

Just for clarity, did the PA who examined you say that there were hematomas in the external ear canal?
Best regards,
DDM