Ear & Balance

Ear pain after diving? You may have sustained an ear barotrauma!

February 1, 2020
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I recently saw a patient, Ms A who suffered from blocked ears and ear pain after taking her first diving lesson. It occurred during her dive. She was worried that she might have sustained a permanent injury to her ears. She denied any ear discharge, giddiness, headaches or nasal symptoms. She did give a history of having ear discomforts during flights.

 

On clinical examination, there was a collection of blood in both her middle ears, just behind her ear drums. This resulted in a conductive hearing loss which was confirmed on a hearing test (audiometry). I explained to Ms A that she sustained a barotrauma to her middle ear and reassured her that the blood behind her ear drum (known medically as hemotympanum) will resolve on its own with time.

 

 

Picture of Ms A’s right ear drum with blood behind it (reddish hue)

 

 

Picture of Ms A’s left ear drum with blood behind it

 

 

Picture of a normal left ear canal and ear drum

 

 

Upon review in the clinic about a month later, Ms A was happy that her symptoms have resolved and her hearing is now back to normal. A clinical examination showed complete resolution of the blood in her middle ear. She was advised to take precautions to avoid such situation in the future.

 

 

What is ear barotrauma?

 

It is a condition in which one experiences ear symptoms (usually discomfort, blockage, pain or giddiness) as a result of exposure to changes in pressure in the environment (usually from a change in altitude)

 

 

What causes ear barotrauma?

 

The Eustachian tube is a bony-cartilaginous tube that connects the middle ear to the back of the nose (area known as nasopharynx). It helps to equalize the pressure the pressure in the middle ear and that of the outside environment. Maneuvers to actively open the Eustachian tube includes Valsalva maneuver (trying to “pop” your ear by blowing out against a pinched your nose and closed mouth), yawning, chewing and crying.

 

 

 

 

In ear barotrauma, the Eustachian tube fails to cope with the change in pressure. When this occurs, there is a difference in pressure across the ear drum (look at the figure below). The pressure difference can be large enough to cause blood vessels and ear drum to rupture.

 

 

Figure taken from “Koriwchak MJ, Werkhaven JA. Middle ear barotrauma in scuba divers. Journal of Wilderness Medicine, 5, 389-398 (1994)”

 

 

Who are at risk of ear barotrauma?

 

There are 3 main groups of people who might be at risk of ear barotrauma:

 

  1. People with Eustachian tube dysfunction
    People who has problems equalizing their ears during flight or in areas of high altitude (E.g. in a tall building or mountains) are more likely to sustain ear barotrauma. It is likely that their Eustachian tubes are not functioning as efficiently as they should.
  2. People with problems with their nose
    As one of the Eustachian tube opening is in the nose, if nasal allergies, colds or sinus infection, you may be more likely to sustain an ear barotrauma.
  3. Young children and babies
    Eustachian tubes in children and babies are smaller, less matured and positioned in a way such that they are not as effective as adult Eustachian tubes. Babies and young children in a plane often cry during take off or landing as this helps open their Eustachian tubes to cope with the change in pressure.

 

What can I do to prevent ear barotrauma?

 

People at risk of ear barotrauma should avoid exposing themselves to situations that result in a sudden change in atmospheric pressure (E.g. diving, taking frequent airplane flights). If these situations are unavoidable, some precautions that may help include during the change in pressure:

 

  1. Yawning
  2. Chewing
  3. Taking decongestants or antihistamines half an hour to 1 hour before flight / diving
  4. Treat underlying nose problems
  5. Ventilation tubes placed in the ear drums for people who fly frequently

 

 

What is the treatment for ear barotrauma?

 

Fortunately, majority of ear barotrauma does not need any treatment and recovers fully on its own. During this period, patients should avoid exposing themselves to significant pressure changes in the environment such as diving or taking a flight.

 

When Should You See An ENT Specialist In Singapore?

  • Any Ear, Nose or Throat symptoms that you are troubled with or concerned of
  • Persistent blocked nose with mouth breathing or snoring

Dr Gan Eng Cern

Dr Gan Eng Cern is a fellowship trained Consultant Ear, Nose & Throat (ENT) Surgeon. He completed his ENT training in Singapore and obtained his subspecialty training in Rhinology and Endoscopic Skull Base Surgery at the world renowned St Paul’s Sinus Centre, University of British Columbia, Vancouver, Canada. He was also a Senior Clinical Lecturer at Yong Loo Lin School of Medicine at the National University of Singapore. Dr Gan was an avid researcher with numerous publications in reputable international ENT journals. He was also an invited speaker and surgical dissection teacher in many ENT conferences and courses.

Awards

  • 2020 – Reader’s Choice Gold Award for Best ENT Specialist
    (Expat Living Singapore)
  • 2016 – Best Educator Award (Eastern Health Alliance)
  • 2016 – “Wow” Award (Patient Compliment)
  • 2014 – Eastern Health Alliance Caring Award – Silver
  • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College
    of Surgeons, Academy of Medicine Singapore for best scientific surgical
    paper)
  • 2012 – Human Manpower Development Award (Ministry of Health,
    Singapore)
  • 2007 – Singhealth Best Doctor Award

Qualifications

  • MBBS - Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
  • MRCS (Edin) - Member of the Royal College of Surgeons Edinburgh, United Kingdom
  • MMed (ORL) - Master of Medicine in ENT (National University of Singapore)
  • FAMS - Fellow of the Academy of Medicine Singapore

Why Choose Dr Gan Eng Cern

1

Reliable & Reputable ENT Expert

Experienced and patient ENT Specialist who has your best interests at heart. We aim to provide you with accessible and specialized care for any ENT condition in a comfortable setting.

2

Friendly & Helpful Clinic Staff

Our friendly staff will assist you to the best of our ability and we are happy to accept most insurance providers and assist with E-filing with relevant insurance providers or Medisave.

3

Advanced ENT Equipment & Fully Equipped Facility

Our ENT Specialist, Dr Gan Eng Cern, will be able to diagnose and offer personalised treatments for your specific ENT condition. You can expect a high level of ENT care in a spacious setting with in-house minor surgical, endoscopy, allergy testing and microscopy services.

4

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There are various financial options available for you to ensure that you are able to receive the most optimal treatment and care. Our ENT clinic staff will be able to assist you with your medical insurance claims and work with your chosen healthcare organization to minimize the hassle and paperwork required. In some cases, you may be able to utilise the funds in your Medisave account to defray part of the costs of your treatment. As our clinic is accredited by the Medisave board, we are able to process your claims from your Medisave for certain clinic procedures.

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