Ear Squeeze
Question
My husband and I had just returned from a four-day dive trip. We had made four dives per day, all multilevel, in Saipan. After the second day of diving, my husband had problems clearing and complained of pain in his ears. He also said he felt as if he had two pillows over his ears and complained of trouble with his balance and a constant buzzing sound. He saw an ear, nose and throat specialist after flying home. The doctor found an excess of mucus behind the eardrum that had begun to harden. He made a small incision in my husband's eardrum to help remove the mucus (which had turned black). He expressed amazement that my husband had experienced no problem flying and said my husband should not dive for the next six months and then not dive so deep in the future.
Can you find out ahead of time if you are one of the few people with mucus problems? Can my husband really dive again? What is so deep? (We did an 80-foot-maximum dive.)
Can you find out ahead of time if you are one of the few people with mucus problems? Can my husband really dive again? What is so deep? (We did an 80-foot-maximum dive.)
Answer
Your husband’s symptoms are consistent with middle-ear barotrauma, which is associated with the inability to equalize the middle-ear air space when diving. This is usually due to some type of eustachian tube dysfunction and most commonly caused by a problem like a recent cold, allergies or any type of irritation which inflames the mucus membrane and causes both swelling and mucus discharge. The pain, muffled hearing, or buzzing sounds, as well as the difficulty with balance, can all be caused by pressure – and in this case, a fluid buildup in the middle-ear air space.
In this particular case, it seems the barotrauma was sufficient to cause bleeding into the middle ear - which is why the mucus appeared black. The constant pressure exerted on the tiny bony structures and delicate internal membranes of the inner ear is what produced your husband's symptoms. It sounds as though he had a fairly serious barotrauma and was fortunate not to have ruptured his eardrum or one of the internal membranes of the ear - which could result in a decreased, or permanent loss of hearing. The small incision in the eardrum – called a myringotomy – may help drain the ear of excess mucus and provide an opening to ambient air, which can help dry out the middle ear. If the ear was full of blood and other tissue fluids during the flight, an increase in symptoms would not have necessarily occurred, since the lowered pressure in the aircraft cabin would have been transmitted through the fluid-filled middle ear chamber.
The ability to clear mucus from the nasal passages is important, but will not necessarily prevent middle-ear, or sinus barotrauma. The safest approach to preventing middle-ear, or sinus barotraumas, is to avoid any discomfort in these air spaces. Once you have gone beyond discomfort to experiencing pain, you may have already drawn fluid into these spaces. This can have immediate consequences, like blocking the passage of air back out of the air space. Depending on the severity of the injury, six months is not too long to wait before diving again. In fact, such injuries may keep a diver from diving again altogether if the Eustachian tube or the structures of the middle ear have been damaged permanently. Since only time will tell, another complete examination is advisable for your husband, and it should probably include a hearing test.
In this particular case, it seems the barotrauma was sufficient to cause bleeding into the middle ear - which is why the mucus appeared black. The constant pressure exerted on the tiny bony structures and delicate internal membranes of the inner ear is what produced your husband's symptoms. It sounds as though he had a fairly serious barotrauma and was fortunate not to have ruptured his eardrum or one of the internal membranes of the ear - which could result in a decreased, or permanent loss of hearing. The small incision in the eardrum – called a myringotomy – may help drain the ear of excess mucus and provide an opening to ambient air, which can help dry out the middle ear. If the ear was full of blood and other tissue fluids during the flight, an increase in symptoms would not have necessarily occurred, since the lowered pressure in the aircraft cabin would have been transmitted through the fluid-filled middle ear chamber.
The ability to clear mucus from the nasal passages is important, but will not necessarily prevent middle-ear, or sinus barotrauma. The safest approach to preventing middle-ear, or sinus barotraumas, is to avoid any discomfort in these air spaces. Once you have gone beyond discomfort to experiencing pain, you may have already drawn fluid into these spaces. This can have immediate consequences, like blocking the passage of air back out of the air space. Depending on the severity of the injury, six months is not too long to wait before diving again. In fact, such injuries may keep a diver from diving again altogether if the Eustachian tube or the structures of the middle ear have been damaged permanently. Since only time will tell, another complete examination is advisable for your husband, and it should probably include a hearing test.
Posted in Dive Safety FAQ
Categories
2020
January
February
Group Fitness at the PoolHow to Rescue a Distressed diver at the SurfaceHow to manage Near-DrowningNo Sit-ups no problem How to manage MalariaHow to manage Oxygen Deficiency (Hypoxia)What to do when confronted by a sharkHow to manage Scombroid PoisoningHow to perform a Deep Diver RescueHow to perform One-rescuer CPRHow to perform a Neurological Assessment
March
DAN’s Quick Guide to Properly Disinfecting Dive GearCOVID-19 : Prevention Recommendations for our Diving CommunityGermophobia? - Just give it a reasonable thoughtScuba Equipment care – Rinsing and cleaning diving equipmentCOVID-19 and DAN MembershipFurther limitations imposed on travels and considerations on diving activitiesDAN Membership COVID-19 FAQsLancet COVID-19 South African Testing SitesCOVID-19 No Panic Help GuideGetting Decompression Sickness while FreedivingDown in the DumpsCardiovascular Disease and DivingDelayed Off-GassingDiving after Dental surgeryDiving with Multiple MedicationsPygmy Seahorses: Life AquaticAfrica DustCOVID-19 Myth BustersScuba Units Are Not Suitable Substitutes for VentilatorsDisinfection of Scuba Equipment and COVID-19Physioball Stability Exercises
April
COVID-19 AdvisoryScuba Equipment Care - Drying & Storing Your GearTransporting Diving Lights & BatteriesHow to Pivot Your Message During a CrisisTourism Relief FundCOVID-19 Business Support ReviewDiving After COVID-19: What We Know TodayEUBS-ECHM Position Statement on Diving ActivitiesPart 2: COVID-19 Business Support ReviewPress Release
May
Diving in the Era of COVID-19Dive Operations and COVID-19: Prepping for ReturnCOVID-19 & Diving Activities: 10 Safety RecommendationsCOVID-19: Surface Survival TimesThe Philippines at its FinestThe Logistics of ExplorationThe Art of the Underwater SelfieShooter: Douglas SeifertFAQs Answered: Disinfecting Scuba EquipmentStock your First-Aid KitResearch and OutreachCovid-19 ResearchOut of the BlueEffects of Aspirin on DivingThe New Pointy end of DivingDiving and Hepatitis CCaissons, Compressed-Air work and Deep TunnellingPreparing to Dive in the New NormalNew Health Declaration Form Sample Addressing C-19 IssuesDiving After COVID 19: What Divers Need to Know
June
Travel Smarter: PRE-TRIP VACCINATIONSAttention-Deficit/Hyperactivity Disorder and DivingCOVID-19: Updated First Aid Training Recommendations From DANDiving with a Purpose in National Marine SanctuariesStay Positive Through the PandemicFor the Dive Operator: How to Protect Your Staff & ClientsStudying Deep reefs and Deep diversAsking the Right QuestionsLung squeeze under cold diving conditions
July
Dive DeprivationVolunteer Fish Surveys: Engage DiversDAN Member Profile: Mehgan Heaney-GrierTravel Smarter: Don’t Cancel, Reschedule InsteadDive Boat Fire SafetyRay of HopePartner ExercisesDiving at AltitudeAluminium ExposureHip FracturesAcoustic NeuromaGuidelines for Lifelong Medical Fitness to DiveNew Dive Medical Forms
August
Women in Diving: Lauren Arthur, Conservationist & Natural History Story TellerWomen in Diving: Dr Sara Andreotti White Shark ResearcherTiming ExerciseWomen in Diving: The Salty Wanderer, Charlie WarlandWomen in Diving: Beth Neale, Aqua soul of freedivingWomen in Diving: Diving and spearfishing Diva, Jean HattinghWomen in Diving: Zandile Ndhlovu, The Black Mermaid
September
October
Freediving For ScienceStep Exercises with CardioFluorescence Imaging help Identify Coral BleachingChildren and DivingThe Watchman device and divingScuba Diving and Factor V Leiden gene mutationNitrogen Narcosis at shallow depthsOil and Particulates: Safe levels in Breathing Air at depthDive Principles for Coping with COVID-19The Importance of a Predive Safety CheckTalya Davidoff: the 'Plattelandse Meisie' Freediver
2019
February
April
May
DAN Press ReleaseYour Dive Computer: Tips and tricks - PART 1Your Dive Computer: Tips and tricks - PART 2Aural HygieneDCS AheadHow Divers Can Help with coral conservationRed Tide and shellfish poisoningDiving after Kidney DonationDiving with hypertrophic cardiomyopathyEmergency Underwater Oxygen Recompression
June
July
September
October
November
Exercise drills with DowelsHeart-rate TrainingCultivating ConservationTRavel Smarter : Evaluating an unfamiliar Dive operatorChallenging the Frontiers of Decompression ResearchTravel Smarter: Plan for Medical EmergenciesWhen should I call my Doctor?DAN Student Medical Expense CoverageAdvice, Support and a LifelineWetsuits and heat stressDiving after Chiropractic adjustments
2018
April
Flying after pool diving FAQLung squeeze while freediving FAQDiving after Bariatric surgery FAQMarine injuries FAQVasovagal Syncope unpredictable FAQIncident report procedure FAQDiving after knee surgery FAQDiving when in RemissionDive with orbital Implant FAQInert gas washout FAQOxygen ears FAQPost Decompression sicknessChildren and diving. The real concerns.Diving after SurgeryPhysiology of Decompresssion sickness FAQDiving and regular exerciseGordon Hiles - I am an Underwater Cameraman and Film MakerScuba Air QualityBreath-hold diving. Part 3: The Science Bit!Compensation Legislation and the Recreational DiverCape Town DivingFive pro tips for capturing better images in cold waterThe Boat Left Without You: Now What?
May
When things go wrongEmergency Planning: Why Do We Need It?Breath-hold diving: Running on reserve -Part 5 Learning to RebreatheSweet Dreams: When Can I Resume Diving Post Anaesthesia?Investing in the future of reefsTo lie or not to lie?THE STORY OF A RASH AFTER A DIVEFirst Aid KitsTaravana: Fact or Falacy?
June
Oxygen Unit MaintenanceKnow Your Oxygen-Delivery Masks 1Know Your Oxygen-Delivery Masks 2Emergency Oxygen unitsInjuries due to exposure - HypothermiaInjuries due to exposure - Altitude sicknessInjuries due to Exposure - Dehydration and other concernsHow to plan for your dive tripThe Future of Dive MedicinePlastic is Killing our ocean
September
Return to DivingDiagnoses: Pulmonary blebSide effects of Rectogesic ointmentDiving with ChemotherapyReplacing dive computers and BCDsCustomize Your First-Aid KitPlan for medical emergenciesHow the dive Reflex protects the brain and heartDry suits and skin BendsAltitude sickness and DCSScuba Diving and Life Expectancy
2017
March
April
Incident Insight: TriageA Field Guide to Minor MishapsSnorkels: Pros & ConsTime & RecoveryMedication & Drug UseDiving with CancerNitrox FAQCOPD FAQHyperbaric Chamber FAQJet Lag FAQHydration FAQAnticoagulant Medication FAQFluid in the Ear FAQEye Surgery FAQElderly Divers FAQNitrogen FAQHealth Concerns FAQMotion Sickness FAQMicronuclei FAQ
June
August
2016
February
March
Breath-Hold Diving & ScubaReturn to Diving After DCITiming Exercise & DivingHot Tubs After DivingSubcutaneous EmphysemaIn-Water RecompressionDiving at AltitudeFlying After DivingDiving After FlyingThe Risks of Diabetes & DivingFlu-like Symptoms Following a DiveHand & Foot EdemaFrontal HeadachesBladder DiscomfortLatex AllergiesRemember to BreatheProper Position for Emergency CareAches & PainsCell Phones While DrivingSurfers Ear Ear Ventilation TubesDealing with Ear ProblemsDiving with Existing Ear InjuriesPerforated Ear DrumENT SurgeryUnpluggedCochlear ImplantsPortuguese Man-of-WarJellyfish StingsLionfish, Scorpionfish & Stonefish EnvenomationsStingray Envenomation Coral Cuts, Scrapes and RashesSpeeding & Driving Behaviour
June
Newsflash! Low Pressure Hose DeteriorationItching & rash go away & come back!7 Things we did not know about the oceanMigraine HeadacheAttention Deficit Disorder Cerebral Vascular AccidentEpilepsyCerebral PalsyHistory of SeizuresMultiple Sclerosis Head TraumaBreast Cancer & Fitness to Dive IssuesLocal Allergic ReactionsSea LiceHow ocean pollution affects humans Dive Fatality & Lobster Mini-Season StatisticsPregnancy & DivingReturn to Diving After Giving BirthBreast Implants & DivingMenstruation During Diving ActivitiesOral Birth ControlBreast FeedingPremenstrual SyndromeOsteoporosisThe Aftermath of Diving IncidentsCompensation Legislation & the Recreational DiverNoise-Induced Hearing LossLegal MattersThe Nature of Liability & DivingDAN Legal NetworkWaivers, Children & Solo DivingHealthy, but overweight!Taking Medication while Scuba DivingGetting Fit for the Dive SeasonBone Considerations in Young DiversAsthma and Scuba DivingHepatitisDiving with HyperglycemiaShoulder PainDiving After Spinal Back Surgery
August
Hazard Identification & Risk AssessmentCaring For Your People Caring For Your FacilitiesCaring For Your BusinessScuba Air Quality Part 1Scuba Air Quality Part 2Chamber Maintenance Part 1Chamber Maintenance Part 2The Aging Diver Propeller SafetyRelease The PressureDon't Get LostMore Water, Less Bubbles13 Ways to Run Out of Air & How Not To7 Mistakes Divers Make & How To Avoid ThemSafety Is In The AirHow Good Is Your Emergency Plan
2015
January
March
No Comments