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Ear Squeeze

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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.) 

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. 
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