Ear Damage

Question
Hi, went divng yesterday and on my second dive i had trouble keeping my ears equalized. When arriving back on the boat i had an intense pain in my ears and head, like i had two big weights hanging off my ear drums. The pain has subsided but my ears still feel like they haven't equalized properly and will hurt if i blow my nose. I fly home in four days, should this be a problem and should i see a doctor when i get home - could there be permanent damage there. I do have a bit of a cold at the moment and have been diving for 7 years. Thanks

Answer
The symptoms you are describing seem to be those related to a classic barotrauma injury. Diving when congested will place a diver at greater risk for pressure injuries concerning the ears, sinuses and lungs. Injuries to the ears and the sinuses are most common, but lung over-expansion injuries due to congestion are possible much the same way that smokers are at increased risk of barotrauma to the lungs due to anomalies created by the destruction of soft tissue and the build-up of impurities associated with the habit. For divers who dive with "head colds" congestion can make equalization more difficult during both descents and ascents. A "squeeze" or discomfort during the descent that causes pain is an indication that tissue damage is being done. Likewise, pain during ascent or a "reverse squeeze" is also an indication of an injury. Any decongestant medication that one is taking can wear off while underwater and cause problems with further descent into a dive as well as reverse squeezes. Reverse squeezes are more commonly associated with medication diminishing in effect during a dive. During a reverse squeeze, pressure has difficulty being released as air spaces are expanding. The diver will often feel pain or pressure and then great relief as the pressure is released. Reverse squeezes are less likely to cause severe injuries or permanent damage than squeezes suffered during a descent. During a descent, the pressure increase can be quite substantial if a diver is descending rapidly. Very slow controlled descents (often not taught in recreational diving)help protect against barotrauma and narcosis as well as allow buddy teams to maintain good communication and awareness. When ascending, slow controlled ascents will decrease risk of reverse squeezes and DCI while allowing buddies to maintain communication and awareness. You may wish to call your primary care provider before departure because he or she may be concerned with further injury or aggravated injury due to flying. Your physician may prescribe anti-inflammatory drugs to help decrease swelling of injured tissues or decongestants for your flight as well as other medications. He or she might also have you visit a local physician or ears, nose and throat specialist prior to travel. There is no way for me, as a diving instructor, to even begin to speculate whether or not your injuries might be permanent. But, I can offer you the encouragement that I had suffered a similar injury years ago when diving while congested and it hurt to blow my nose as well. I healed without any observed permanent damage or hearing loss. The most important thing you can do right now is to contact your physician and explain your condition and let your physician know that DAN physicians are available for consultation if your doctor has any questions.