Question about ear pressure AFTER diving

[Emilyrc]

Hey guys-
I woke up this morning and my ears were a little uncomfortable, and I tried popping them gently throughout the day. No dice. The discomfort has gotten worse, to a point where I was watching Bones and Sweets was talking on the phone. They cut away to Bones (on the other end of the line) and you know how there's the TV phone-voice distortion? Yeah.. I couldn't understand what he said, and it had a high pitched sound to it. My husband understood it just fine with no high-pitched sound.

So after my inflator issue yesterday on the last dive, I didn't have any ear issues. I had enough mind to equalize the best I could. Has anyone ever been fine after a dive, then the next day have gradually increasing pressure? No matter what I do, I can't relieve it. If it's quiet, I hear a tinnitus-type of ringing. :angry:

[Dusty2]

Strange! I have residule pressure sometimes but wicking up the water in my outer ear with a Q tip usually clears it. I guess it could be baro trauma but I would be concerned. Usually symptoms of trauma start at once and fade rather than getting worse.

You will probably get some good advice from the more medically astute members soon. But if this is still a factor tomorrow I would seek medical help. It sounds like swelling in the inner ear to me.

I would call DAN if you have their insurance, or even if you don't. They have on duty professionals that are well versed in diving related ear injury.

[Emilyrc]

Thanks Dusty. I've tried the q-tip on the outer canal this morning, before I was awake enough to realize it was an inner ear pressure feeling. Since I posted the last one, I can turn my head in different directions and it will get worse, then get back to where it was when I move my head back. I've never had ear problems.. Except for a recent Otitis Externa a couple months ago. I'm going to wait until tomorrow and see how it is, then call the ENT if it's not better. I'm curious to see if anybody else had experienced the same thing.

Like my mom has always said... I'm special. If anything strange is going to happen to anybody, it will be me.

I really enjoyed looking through your pictures you posted on my intro thread! I can show friends and family what I saw, instead of just telling them.

[WylerBear]

Might be a good idea to give DAN a call.

[Emilyrc]

Thanks Wylerbear, I sent off an email to DAN, hope to hear from them soon. This is really annoying.

[LCF]

As with many injuries, the swelling from barotrauma can increase over the first 24 hours. It really isn't unusual to go to bed after diving, and wake up in the morning with significantly worse symptoms. What you are describing sounds like very classic barotrauma, although the tinnitus is concerning. You can have tinnitus based on muffling of ambient sounds (the background firing of the cochlear nerves becomes much more obvious when there is no ambient sound to compete with it) but you can also get it from damaged hearing, if you have trauma to the inner ear -- which is far less common, but much more serious than ordinary barotrauma, the kind you get from being late or incomplete in equalizing.

If the muffled hearing and tinnitus persist more than 48 to 72 hours, or if you have any problems with balance or vertigo, I'd definitely consult with a diving-savvy physician. Dr. Ed Kay is a family practitioner, not an ENT doc, but he has a specific interest and expertise in diving-related ear problems, and might be someone to contact.

[fmerkel]

Agree with LCF.
For self treatment I'd take an immediate dose of Afrin, and a couple of pseudofed (as long as you don't have personal contradictions). Then get some papaya enzyme (digestive section of vitamin store) and suck a couple every hour. If it doesn't start clearing up in 4-8 hours at this point I'd see someone.

Barotrauma is an injury. Like any injury tissues get inflamed/swell and can leak fluid. The fluid accumulated causes the muffled hearing. Initially this fluid is sterile (like a blister) but is open to the outer environment (throat via the Eustachian canal), will get contaminated and is an excellent medium for growing an infection when the normal drainage and clearance mechanism is compromised. So you can get an inner ear infection on top of the barotrauma. If the problem continues to worsen that may be what is happening. The meds suggested above are an attempt to reduce swelling and open the Eustachian canal back up to facilitate draining. Once an infection starts you need medical help.

[Nwbrewer]

Not a doctor, not saying this is sound medical advice.

I occasionally do something dumb, like dive bombing 15' or so onto crab without clearing my ears. I've gotten to the point here I know during the dive that I've done a little something not good to my ears, and treat with Ibuprofen to relieve any inflammation asap to relieve any swelling, otherwise I'm going to wake up the next morning with symptoms like you describe.

Let us know what DAN says!

Jake

[fmerkel]

Not sure Ibuprofen has much of an anti-inflammatory effect on a couple doses. It generally takes several days of full dosing to achieve that effect. What you are probably getting is simple analgesic effect and your body is luckily taking care of a minor insult. IMO it's best not to do that. I believe like any injury it will heal but the insults are cumulative over time. Seems to me I hear more divers going 'eh?' than non-divers of similar age category. Maybe I'm just paranoid.

[Nwbrewer]

Not sure Ibuprofen has much of an anti-inflammatory effect on a couple doses. It generally takes several days of full dosing to achieve that effect. What you are probably getting is simple analgesic effect and your body is luckily taking care of a minor insult. IMO it's best not to do that. I believe like any injury it will heal but the insults are cumulative over time. Seems to me I hear more divers going 'eh?' than non-divers of similar age category. Maybe I'm just paranoid.

It may be, but it seems to work for me. I don't screw up very often, I'm talking about maybe once a year.

[Emilyrc]

Agree with LCF.
For self treatment I'd take an immediate dose of Afrin, and a couple of pseudofed (as long as you don't have personal contradictions). Then get some papaya enzyme (digestive section of vitamin store) and suck a couple every hour. If it doesn't start clearing up in 4-8 hours at this point I'd see someone.

I have some eardrops and Zycam (?) from the otitis externa. The doc gave me ear drops in case I had some middle ear fluid that he couldn't see at the time. I wonder if those will work?

The pressure is better in my left ear, but not significantly better. If I tilt my head to the left, it gets worse. Right ear is the same. No tinnitus today, but my lower end (bass/tenor) hearing sucks. Hearing the letter S sounds like AM radio with the treble all the way up and the bass all the way down.

Still nothing from DAN yet. I blame the newbies like myself.

[Nwbrewer]

Still nothing from DAN yet. I blame the newbies like myself.

Call and speak with a medic.

[Sounder]

As with many injuries, the swelling from barotrauma can increase over the first 24 hours. It really isn't unusual to go to bed after diving, and wake up in the morning with significantly worse symptoms. What you are describing sounds like very classic barotrauma, although the tinnitus is concerning. You can have tinnitus based on muffling of ambient sounds (the background firing of the cochlear nerves becomes much more obvious when there is no ambient sound to compete with it) but you can also get it from damaged hearing, if you have trauma to the inner ear -- which is far less common, but much more serious than ordinary barotrauma, the kind you get from being late or incomplete in equalizing.

If the muffled hearing and tinnitus persist more than 48 to 72 hours, or if you have any problems with balance or vertigo, I'd definitely consult with a diving-savvy physician. Dr. Ed Kay is a family practitioner, not an ENT doc, but he has a specific interest and expertise in diving-related ear problems, and might be someone to contact.

Geez, you act like you're some kind of doctor or something.

[LCF]

Ear drops are not effective against barotrauma at all -- the eardrum is a pretty effective barrier. Drops are for otitis externa, which is an infection of the outer ear canal caused by skin breaking down because it's wet, and allowing bacteria to get a foothold.

fmerkel's recommendation for antiinflammatories and decongestants is a very reasonable one. Chewing gum may help as well (movement opens and closes the Eustachian tube). BTW, I have an informal recommendation from the dive group at Duke for using ibuprofen after diving on multiple day trips, to avoid the cumulative edema from repetitive minor stress, so taking some after a dive where you suspect you might have done some damage is not a bad idea. Antiinflammatory dosages are high, however -- in the range of 800 mg three times a day for a typical adult -- and there are a number of contraindications to these medications. They should not be taken in high dosage for long periods of time, either.

BTW, HERE is a little essay (with some good responses, too) that I wrote a while back, to try to help divers keep the different kinds of ear problem and treatments straight.

[doug7377]

I have had issue somthing equalize my ears and somthing i think i have equalized and had no pain tell the next day and find out that one ear did not fully equalized. Dan going to tell you to call a ENT. and i would say the same. better to be safe but you could try laying on the ear that hurt and see if that help. hop that help.

[fmerkel]

Good essay LCF. Most divers should read it.

There are numerous ways to clear. If you have trouble with clearing watch Dr. Kay's video and read his Middle Ear Barotrauma essay. This is MUCH longer than LCF's but worth it if you have trouble.
http://faculty.washington.edu/ekay/

To facilitate clearing:
Look UP-really stretch the front of the neck. Looking down pinches the Eustachian tubes closed. Many divers look down to see where they are going on descent and this compromises clearing.
Jut the lower jaw out and down...HARD. Wiggle the jaw around and pay attention to the effect. There will be an optimal position for your anatomy. Helps stretch the Eustachian tubes.
Tilt the problem ear toward the ceiling. Further Helps stretch the Eustachian tubes.
Now....gently try a Valsalva.

[Emilyrc]

DAN told me to contact ENT, just like Doug said. It seems to be relieving itself slowly with the Zycam and constant equalization techniques. Once again, you guys are fantastic. If it does not clear completely by, say, 2pm, I will make an appointment with ENT.

I like those articles. I agree that everybody should read them. Great information!

I'll try not to be such a pain in the butt, I promise.

[doug7377]

have to love DAN fast at geting back to you but they always say the same Call a docter

[fmerkel]

have to love DAN fast at geting back to you but they always say the same Call a docter

That's due to the difficult nature of figuring out what's going on with a person over the phone (hard) or email (terrible). A lot of people can't tell whether the problem is outside or inside the eardrum themselves, which is pretty easy in person.
The litigious nature of the culture doesn't help much.

[WylerBear]

Just FYI, always call DAN. Don't wait for e-mail. They answer 24 hours a day. And barotrauma is nothing to mess with.

[doug7377]

call your docter frist and then call Dan but Dan well help you find a docter that know about diving

[WylerBear]

call your docter frist and then call Dan but Dan well help you find a docter that know about diving

I'd always call DAN first for a scuba-related injury. They have the resources and experience to point me in the right direction. As much as I like my doctor, she thinks I'm crazy for diving at all.

[LCF]

To be honest with you, the vast majority of doctors have learned little or nothing about scuba diving and barotrauma in their training. When I watched Dr. Kay's video the first time, I looked at his photos of eardrums with barotrauma and thought to myself, "Man, I'd be prescribing antibiotics for an ear that looked like that!" So it is really worth while seeing a physician who has some experience with divers, or an interest in diving-related problems.

The majority of barotrauma will resolve with conservative treatment. Persistent hearing loss, suspicion of perforation, or any degree of balance loss or vertigo should prompt urgent consultation with a physician, and symptoms that don't improve over several days of conservative therapy should, as well.

Prevention is worth a pound of cure, too!

[fmerkel]

So, we who play 'Dr.' on the internet want to know the outcome and pathways taken to get there. We gotta know this stuff to ascertain accuracy and effectiveness.

[Emilyrc]

It was pretty much gone yesterday. Used Zycam, anti-inflammatories, and my doc recommended antibiotics, I suspect she wasn't too sure what she was looking at. Couldn't get into any ENT in my area for 2 weeks. I don't plan on diving this weekend, just in case. Anybody need some shore support?