Question: My 14 year old son tends to have somewhat excessive eat wax buildup and uses q-tips to clean out his ears when it makes them itchy. Last night he was doing this when he heard/felt something go 'pop' inside his ear, and there was pain -- not excruciating pain, but definitely pain nonetheless. He withdrew the q-tip and the tip of the cotton was covered in blood. It wasn't flowing from the ear or anything; the blood only got on the q-tip. He said that he continued to feel some pain, as well as hearing things a little weirdly through that ear (though he could definitely still hear through it).

We are currently located on an island in the Caribbean with somewhat primitive medical care. We took my son to the local health clinic, where he was seen by nurses in consultation by telephone with a general practitioner doctor (there was no ENT available). The nurse looked in my son's ear and told us that he had NOT ruptured his eardrum, which was our first assumption about what had happened... they could see the eardrum and it was intact. They didn't know what he could have hurt instead, though they did see the pooled and drying blood in the ear canal.

The nurses told us that it would heal by itself; just not to let him get water in it, or put anything else into the ear even to clean out the dried blood. They authorized me to give him ibuprofen if it hurt, and sent us back to where we're staying.

The problem is that we're supposed to fly home to the United States on Tuesday morning. I asked the nurses whether it was safe for him to fly, given the altitude changes and how that sometimes affects inner ears, but they could not give me an answer, nor could the doctor on the phone, since none of us knew exactly what he has damaged in there. I have read that if it *were* a ruptured eardrum, it would be fine to fly with it... but they tell us that it isn't, and we don't know what it is instead.

As of this morning, he says there is no pain anymore, even without ibuprofen, but he tells me that it sounds a little funny to himself when he talks. Not when other people talk to him; outside sounds still sounds normal. Only when he talks himself, and he hears it from inside his own ENT system. He does not currently have a fever, and there is no sign of ongoing bleeding.

I have a few questions about this scenario:

1) What *could* he have ruptured or damaged, if it isn't the eardrum?

2) Was the nurses' advice and prognosis correct? Is there anything you would add?

3) Is it safe for us to take him on a trip starting early Tuesday morning which involves multiple airplanes going long distances -- a total of about two days in the air or in airports? (My definition of "safe" for this purpose = he won't cause it further damage and he won't be in excruciating agony.)

4) If it would not be advisable for us to fly with him so soon, how long should we wait before attempting it? We could probably delay by a week or so with little trouble, but we do need to get home eventually.

5) If it *is* safe for him to fly, is there anything special we should do to protect the ear from infection or the like, while we're traveling? (We will already be wearing all CDC-recommended PPE, such as N95 masks and goggles, with gloves and disinfectant wipes for when we have to touch high-contact surfaces.)

6) Is there anything else about this injury that you think we need to know now? We will get it checked out in the United States once we have flown home and finished our quarantine period, but that's almost two weeks from now and there's the flight to be decided about in between.

Thank you!