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Unrecognized Ear Barotrauma

A novice diver continues diving despite ear pain. Since my very first dive a year and a half ago, I've always had trouble equalizing my left ear. I can equalize it only by swallowing. During my 25-dive history, equalization never worked by squeezing my nose and blowing it.

(Is your knowledge about equalization up to date? Take a quiz at http://www.alertdiver.com/Ears_Quiz.)

On my recent trip to Cozumel, I was participating in the first dive of a planned seven-dive series over four days. The water temperature was 80°-89°F, and visibility was 50 feet. During the descent, I had difficulty equalizing, and between 20 and 30 feet I felt pain in my left ear for a few seconds to a minute. I halted my descent and told the divemaster about my problem. I ascended a bit and equalized my ear pressure by swallowing. When my ear felt normal, I continued my descent.

At about 50 feet I experienced the same problem again. I stopped, ascended and tried to equalize. Suddenly I heard a loud "explosion" in my left ear followed by strong pain, dizziness and nausea lasting for about one minute. Symptoms disappeared almost as suddenly as they appeared, and I completed my dive without problems.

After completing one more dive and returning to shore I started feeling very dizzy; this lasted until the next day. For three days I also had blurred vision when reading. I experienced mild pain in that left ear occasionally during the following days. It felt like I was very drunk.

Immediately after the first dive I told my divemaster about the equalizing problem and the symptoms I experienced, but no one suggested that I abstain from diving for a while. I continued diving as scheduled without any other problems. However, the mild pain in my left ear remained until the end of the trip.

I decided to consult a doctor to be sure I could fly back home. He found middle-ear barotrauma and a bacterial infection of my left ear. There was no discharge from the ear. I received one shot of corticosteroid, antibiotics for five days, Advil for pain, nasal decongestant in tablets and nasal spray.

When I was back home I saw a doctor skilled in dive medicine 16 days after that explosion event. She said some blood was still visible behind the eardrum but the otitis had healed. That ear remained sensitive.

Six weeks later I saw the doctor again, and she declared that my ear was completely healed — no more barotrauma. She checked my ears, did a couple of tests and told me that I could dive again.

Since then I have dived 14 times in cold water at depths between 25 and 65 feet, and I had no trouble with that ear more than before the incident. I still have some difficulties equalizing that ear, but that has always been the case.Problems with pressure equalization in the middle ear are very common in diving and may result in barotrauma, which is the most common diving injury. To learn more about it, see "The Diver's Complete Guide to the Ear."

Symptoms of barotrauma vary. Rarely does a diver experience a loud noise as this diver described, but more common is a pain in the ear and dizziness. Divers should be aware of symptoms of barotrauma and should not ignore them. If there is any discomfort in the ears, divers should abstain from diving. If mild ear pain or hearing difficulty continues after flying or diving for days, divers should see a doctor.

Severe barotrauma may require urgent care. If a diver experiences dizziness and a feeling of spinning immediately after flying or diving, he/she needs to see a doctor immediately because there is a small chance that an emergency ear surgery may be needed.

In case of severe ear pain, bleeding or drainage of fluid from the ears, which may represent a ruptured eardrum, divers should see a doctor at the first opportunity within several days.

— Dr. Petar J. Denoble


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