Ear injury

[dskflyr]

Barotruama, Meniere's disease, and tinnitus.

Hi all,
I'm an ENT Physician Assistant with some aerospace med experience. Ear pain after diving is usually due to inability to valsalva and can cause a mild hemorrhage in the middle ear. It does NOT usually cause any permanent hearing loss. It will usually resolve w/o treatment within a few weeks. Obviously, you shouldn't fly if you can't clear your ears. Sometimes decongestants or steroids may hasten resolution. I advise my patients, both divers and flyers to carry Afrin or it's generic equivalent in case they have some congestion or eustachian tube dysfunction while doing either activity. I tell divers to use it prior to diving (it's hard to snort underwater.) This is a very common problem and usually doesn't have a longterm impact on passing a class A. If the AME can see your eardrum move when you valsalva they're happy.
Meniere's is a much different animal. Having ringing in the ears (tinnitus) is only part of the problem. Meniere's is dx with three symptoms: 1. tinnitus (usually loud but not always.) 2. Vertigo- lasting hours to days. A few hours is more common. 3. Hearing loss- usually in the mid range and assymetric between ears. Needless to say Meniere's is a bad bad thing for a pilot or diver.
Tinnitus by itself is usually associated with hearing loss- sort of a "phantom limb" pain after an amputation. Those are very good ideas on masking above. If it's intermittent then I would not sweat it. It is a good reminder to wear hearing protection while on the flightline or doing hobbies that involve hazardous noise.
I would encourage you to see your ENT if you have problems or guestions as the above is just info only.

 

[migio]

Thanks for the insight.Im going to see an ENT asap.I just cant right now because of lack of med insurance.I thought i was covered but im not.

 

[Gorilla]

Thanks VERY much dskflyer. it is always good to hear from a professional on a topic near and dear to pilots... ear issues.

Like many of the guys, I'm a SCUBA diver too, and especially when you're new, there's a tendency to press it. You want to appear that you can hack it, and you don't want to cause trouble for your dive buddies and the other members of the boat. it's like being a brand new pilot. The judgement isn't there yet.

Nothing sucks worse than this - and this happened to me - a long-awaited week of diving the Caymans, and on the first dive, I pressed the issue and forced a painful equalization which cause pain and ringing. Fortunately it kept me out of the water for only 2 days, but it could have easily wrecked the whole week.

2 Sudafed 1/2 hour prior to descent can turn a nightmare into a pleasure as far as the ears go. Unless my ears are absolutely clear and I can easily valsalva prior to descent, I take the pills as a preventative. Afrin doesn't seem to help my ears, only my nose and sinuses in the forehead.

Of course if you are blocked, the only solution is to ascend, NOT to blow even harder! Get NITROX trained, it may be a total placebo effect, but I really think NITROX is overall better for the body and ears.

 

[JediNein]

Meniere's is a much different animal. Having ringing in the ears (tinnitus) is only part of the problem. Meniere's is dx with three symptoms: 1. tinnitus (usually loud but not always.) 2. Vertigo- lasting hours to days. A few hours is more common. 3. Hearing loss- usually in the mid range and assymetric between ears. Needless to say Meniere's is a bad bad thing for a pilot or diver.

Meniere's is not really bad, it's disqualifying for a medical. Don't worry, the vertigo is so bad you won't want to fly, drive, or do anything else other than lie on the floor with your back against the wall so you won't fall off the world. For folks that have severe cases, nothing stops the vertigo except heavy drugs. Interestingly, a treatment, including the severe cases, with long term effect is to be put under, like before a surgery.

Before getting the label of meniere's, check with a doc that knows the disease. If you have it, the doc will know the latest treatments, even the odd one listed above. If you've got it, there is no need to suffer when so many easy and effective treatments are available. If you don't have it, then whatever is causing the vertigo needs to be addressed. It could be something as stupid as a low grade sinus or ear infection. Two weeks on antibiotics and you're done! Why lose a career over bacteria?

FlY SAFE!
Jedi Nein

 

[dskflyr]

Meniere's Treatment

I have more than a few patients that handle their Meniere's well. Usually, a low salt diet and a mild diuretic are very effective. During an exacerbation Valium is helpful. The key is an accurate diagnosis. I see quite a few people that have been misdiagnosed. Vertigo should be evaluated by an ENT specialist. It's hard to get a "label" off your medical records even if it's wrong. Although most people function fine with treatment, I believe it is a career ender for a pilot/ commercial diver.

Meniere's is not really bad, it's disqualifying for a medical. Don't worry, the vertigo is so bad you won't want to fly, drive, or do anything else other than lie on the floor with your back against the wall so you won't fall off the world. For folks that have severe cases, nothing stops the vertigo except heavy drugs. Interestingly, a treatment, including the severe cases, with long term effect is to be put under, like before a surgery.

Before getting the label of meniere's, check with a doc that knows the disease. If you have it, the doc will know the latest treatments, even the odd one listed above. If you've got it, there is no need to suffer when so many easy and effective treatments are available. If you don't have it, then whatever is causing the vertigo needs to be addressed. It could be something as stupid as a low grade sinus or ear infection. Two weeks on antibiotics and you're done! Why lose a career over bacteria?

FlY SAFE!
Jedi Nein