Right Ear Has Bled on Two Consecutive Dive Outings

[Protondecay123]

It's the Internet. But sometimes the advice is quite good.

I would dare say the advice of someone who hasn't even been in the physical presence of the patient, ( much less done a physical examination and reviewed pertinent history, labs, etc) would not be something I would place more faith in than the advice of a medical professional who had. Now if it bleeds again, going to someone while it is still acutely bleeding would probably be confirmatory.

 

[tursiops]

I would dare say the advice of someone who hasn't even been in the physical presence of the patient, ( much less done a physical examination and reviewed pertinent history, labs, etc) would not be something I would place more faith in than the advice of a medical professional who had.

I would dare say if the medical professional said something highly implausible (described by the OP as a hypothesis, not a diagnosis), it is worth a second opinion, which is what the responding medical professionals are suggesting.

 

[Protondecay123]

I would dare say if the medical professional said something highly implausible (described by the OP as a hypothesis, not a diagnosis), it is worth a second opinion, which is what the responding medical professionals are suggesting.

I would argue that once the bleeding has stopped and likely healed it doesn't matter if you get 3 opinions. But going while it's acutely bleeding would be confirmatory and you don't need a surgeon to see that. I would just say that a slight amount of hemorrhage associated with what is most likely otitis externa (swimmer's ear) is not uncommon.

 

[tursiops]

I would argue that once the bleeding has stopped and likely healed it doesn't matter if you get 3 opinions. But going while it's acutely bleeding would be confirmatory and you don't need a surgeon to see that.

LOL! Careful, you are almost giving a diagnosis!

 

[Doctorfish]

If I were the OP and I had bleeding from my ear, I would personally go see an ENT specialist. There could have been subtle ear drum or middle ear damage that a basic exam by a PA would not necessarily have picked up.

Why are we getting into an argument here?

 

[TrimixToo]

@doctormike care to comment?

 

[doctormike]

@doctormike care to comment?

Sure!

First of all, make sure that it actually IS blood. I have seen many people confuse extruded earwax with blood because or the reddish brown color.

Excluding very unusual clinical scenarios, there are basically two places that blood from the ear canal can come from, the outer ear or the middle ear. See my page for explanation of these terms if necessary.

Outer ear: Rupture of small blood vessels is actually a possibility - there is a condition called outer ear barotrauma. To get this, you need to prevent the ear canal from equalizing with ambient pressure, with unventilated ear plugs, a tight fitting hood, or rarely significant cerumen (earwax) impaction. Other outer ear sources would be a severe otitis externa (swimmer's ear) or direct trauma (Please, NO Q-TIPS!).

Middle ear: To have bloody drainage from the middle ear, that implies a tympanic membrane perforation associated with middle ear barotrauma. That sounds worse than it is, and while you shouldn't dive with an open perforation, the prognosis for complete healing is good in the absence of other ear disease, so it's possible that this could have been the problem and then it could have resolved by the time of the OP's exam.

In general, the ear is a "black box" to most non-ENT doctors - urgent care or otherwise. I don't mean to sound arrogant, urgent care and ER docs are terrific and have to cover a lot of ground, but the ear (like the eye) is just so specialized and requires such special equipment for a good exam, that it's best to seen an ENT doc for a problem like this. The OP happened to have found a PA with some experience, but I doubt that he was able to do a microscopic exam, and I don't know if a formal audiogram and tympanogram was done (also crucial)

As far as the other point of discussion, I have absolutely no problem with people discussing possible diagnoses here, just like I have no problem with people discussing various accident scenarios in A&I. That's the whole point of having a discussion board. Sometimes, even an experienced medical professional will miss something, and a second opinion can be helpful. No one is "refuting" anything, we are having a discussion. Of course no one here has examined the patient. But why would the OP post in the first place if he didn't want other opinions? As long as no one actually TREATS someone through the Internet, or reassures them and tells them it's OK to dive without an exam, these discussions can be helpful..

 

[gert7to3]

My quip about seeking a referral was not a contradiction of the PA's dx. It was directed at the fact that Buoy_A observed symptoms for a couple of weeks.

 

[Doctorfish]

Hey OP, did you ever get to an ENT specialist and is your ear all better?