Middle Ear Barotrauma

[maudiver216]

I called DAN's medical services today after having done two dives at an average depth about 50 feet. It wasn't until I was out of the water and heading home that I started having discomfort in my right ear in the form of pressure, as well as muffled hearing. I waited a few hours to see if it would clear up on its own, but when it didn't I decided to call DAN. After describing my symptoms, they said that it sounded like I was suffered from middle ear barotrauma caused either on the descent or the ascent. Basically, the tissue in my ear was swollen and that it would take some time to heal. They advised to stay out of the water between two and three weeks. I called my dive buddy who said that he was experiencing similar symptoms.

I think this has happened to me once before but it lasted a few hours (i think) and this time around I feel more discomfort. My question is: is this something that divers commonly go through? Have you suffered from similar symptoms or know someone who has?
Thanks

 

[rsingler]

My question is: is this something that divers commonly go through?

This is a phase that most all of us have gone through. Equalizing is not a natural skill for many of us. It takes practice; lots of it. So while you equalized "early and often", the fact that you have pain suggests that your middle ear has some inflammation from negative pressure barotrauma on descent. Yes, positive pressure barotrauma is possible, and if you ever perforate from clearing your ears too forcefully, you'll know what I mean. But that's much less common.
Yours is negative pressure barotrauma because you now have some muffled hearing. That's residual fluid; either seawater (less likely), or serum that oozed into the middle ear like a blister as the space tried to equalize itself when clearing was slightly inadequate.

Yes, it'll clear by itself. If pain increases or you get a fever, then it's gotten infected before the fluid cleared, and you might need antibiotics. But that's uncommon.

And don't forget otitis externa. If your pain is not when you clear, but when you pull on your ear, you've gotten a mild infection from contaminants in the water that grew in the damp environment of your external ear canal and its wax. That may subside with "swimmers ear" alcohol/glycerine preparations. Rarely, antibiotics are needed.

This is all very common. The pain will stop occurring as you get more dives under your belt and begin to clear without even thinking about it. Remember to clear early, before you even feel pressure.
What might never stop happening is the clicking and occasional muffling for a few days. Even after 30 years, when I come back from a week's tropical dive trip, I'm clicking and even sometimes muffled for a couple of days. It's just a little seawater and snot from the repeated in/out/in/out of tiny bursts of air from clearing hundreds of times over a week's diving.

Not to worry! Next time you'll improve, barring some unusual anatomic abnormality. In the meantime, a trial of decongestant is not inappropriate (out of the water) to see if it helps your current symptoms. I strongly disagree with those divers that use decongestants as an aid during diving.

Open a conversation with @doctormike if you'd like an opinion from a diving ENT specialist. He's one of our local experts, along with @Duke Dive Medicine .

Dive Safe!

Diving Doc

 

[BlueTrin]

This is a phase that most all of us have gone through. Equalizing is not a natural skill for many of us. It takes practice; lots of it. So while you equalized "early and often", the fact that you have pain suggests that your middle ear has some inflammation from negative pressure barotrauma on descent. Yes, positive pressure barotrauma is possible, and if you ever perforate from clearing your ears too forcefully, you'll know what I mean. But that's much less common.
Yours is negative pressure barotrauma because you now have some muffled hearing. That's residual fluid; either seawater (less likely), or serum that oozed into the middle ear like a blister as the space tried to equalize itself when clearing was slightly inadequate.

Yes, it'll clear by itself. If pain increases or you get a fever, then it's gotten infected before the fluid cleared, and you might need antibiotics. But that's uncommon.

And don't forget otitis externa. If your pain is not when you clear, but when you pull on your ear, you've gotten a mild infection from contaminants in the water that grew in the damp environment of your external ear canal and its wax. That may subside with "swimmers ear" alcohol/glycerine preparations. Rarely, antibiotics are needed.

This is all very common. The pain will stop occurring as you get more dives under your belt and begin to clear without even thinking about it. Remember to clear early, before you even feel pressure.
What might never stop happening is the clicking and occasional muffling for a few days. Even after 30 years, when I come back from a week's tropical dive trip, I'm clicking and even sometimes muffled for a couple of days. It's just a little seawater and snot from the repeated in/out/in/out of tiny bursts of air from clearing hundreds of times over a week's diving.

Not to worry! Next time you'll improve, barring some unusual anatomic abnormality. In the meantime, a trial of decongestant is not inappropriate (out of the water) to see if it helps your current symptoms. I strongly disagree with those divers that use decongestants as an aid during diving.

Open a conversation with @doctormike if you'd like an opinion from a diving ENT specialist. He's one of our local experts, along with @Duke Dive Medicine .

Dive Safe!

Diving Doc

Please can you tell why you oppose decongestants ?

 

[rsingler]

Please can you tell why you oppose decongestants ?

Two primary reasons:
Tachyphylaxis, and rebound.

Folks who use decongestants routinely to dive often see progressively less effect, and that is problematic when using shorter acting drugs like pseudoephedrine or phenylephrine. Having stuff wear off in the middle of the afternoon dive, or not have an effect at the second application for the afternoon is potentially dangerous.
Rebound is of concern because congestion is often worse after drug effects wear off with repeated use. If you are depending upon a decongestant to keep your passages open when you already have fluid in them, the extra blockage of rebound congestion can make things much worse.

With negative pressure in the middle ear, it's not simply a matter of having to deal with pain on descent. The potential for vertigo while underwater is what makes this otherwise simple issue life threatening. Perforation of an eardrum and inrush of cold water is a classic cause of disorienting vertigo. Vertigo is not just dizziness, it can be having your whole world start to spin. Which way is up? How do you self-rescue? Fighter pilots know first-hand how bad this can be, when it is induced during pilot training. You don't want to be that diver.

 

[BlueTrin]

Two primary reasons:
Tachyphylaxis, and rebound.

Folks who use decongestants routinely to dive often see progressively less effect, and that is problematic when using shorter acting drugs like pseudoephedrine or phenylephrine. Having stuff wear off in the middle of the afternoon dive, or not have an effect at the second application for the afternoon is potentially dangerous.
Rebound is of concern because congestion is often worse after drug effects wear off with repeated use. If you are depending upon a decongestant to keep your passages open when you already have fluid in them, the extra blockage of rebound congestion can make things much worse.

With negative pressure in the middle ear, it's not simply a matter of having to deal with pain on descent. The potential for vertigo while underwater is what makes this otherwise simple issue life threatening. Perforation of an eardrum and inrush of cold water is a classic cause of disorienting vertigo. Vertigo is not just dizziness, it can be having your whole world start to spin. Which way is up? How do you self-rescue? Fighter pilots know first-hand how bad this can be, when it is induced during pilot training. You don't want to be that diver.

Thanks that’s a great explanation

 

[BRT]

Two primary reasons:
Tachyphylaxis, and rebound.

Folks who use decongestants routinely to dive often see progressively less effect, and that is problematic when using shorter acting drugs like pseudoephedrine or phenylephrine. Having stuff wear off in the middle of the afternoon dive, or not have an effect at the second application for the afternoon is potentially dangerous.
Rebound is of concern because congestion is often worse after drug effects wear off with repeated use. If you are depending upon a decongestant to keep your passages open when you already have fluid in them, the extra blockage of rebound congestion can make things much worse.

With negative pressure in the middle ear, it's not simply a matter of having to deal with pain on descent. The potential for vertigo while underwater is what makes this otherwise simple issue life threatening. Perforation of an eardrum and inrush of cold water is a classic cause of disorienting vertigo. Vertigo is not just dizziness, it can be having your whole world start to spin. Which way is up? How do you self-rescue? Fighter pilots know first-hand how bad this can be, when it is induced during pilot training. You don't want to be that diver.

All this may or may not be true but some of us have many decades of experience diving with pseudoephidrine without problems and have experienced problems if we try to dive without it.

 

[Pedro Burrito]

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A ScubaBoard Staff Message...

Moved from Basic to Diving Medicine

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[MargaritaMike]

Fighter pilots know first-hand how bad this can be, when it is induced during pilot training. You don't want to be that diver.

Hasn't happened while diving, but it wasn't fun during flight training.

Cheers -