Diving Modification For Weakened Ear Drum

[Supermoto]

If you have Eustachian tube dysfunction like the OP does then an earplug would create an enclosed gas-filled space in the affected ear and subject it to barotrauma.

Best regards,
DDM

Hi, thanks for the reply. There is no Eustachian tube dysfunction, the only problem is the TM. Some background: My left TM was significantly damaged while having a custom ear-mold made when the dam failed allowing the mold to adhere to my TM. It was not handled properly (just ripped out) and my TM has not been able to fully heal. A Tympanoplasty was unsuccessful. There is still a tiny pinhole that refuses to heal.
So with a perfectly functioning ear/sinus with a pinhole in the TM what is the harm in a sealed earplug in that ear while diving?

 

[MB NZ]

Hi, thanks for the reply. There is no Eustachian tube dysfunction, the only problem is the TM. Some background: My left TM was significantly damaged while having a custom ear-mold made when the dam failed allowing the mold to adhere to my TM. It was not handled properly (just ripped out) and my TM has not been able to fully heal. A Tympanoplasty was unsuccessful. There is still a tiny pinhole that refuses to heal.
So with a perfectly functioning ear/sinus with a pinhole in the TM what is the harm in a sealed earplug in that ear while diving?

When I had my ongoing tympanic membrane perforations, I often wondered what harm an ear plug could do. I guess, if you couldn't equalise there would be a risk of the ear plug being pushed further in to the ear and doing more damage. It's just a theoretical question, I would not recommend that anyone dives with a perforated ear drum. It would be interesting to hear an opinion from Duke Diving Medicine.

 

[Richard Dayan]

Hi, thanks for the reply. There is no Eustachian tube dysfunction, the only problem is the TM. Some background: My left TM was significantly damaged while having a custom ear-mold made when the dam failed allowing the mold to adhere to my TM. It was not handled properly (just ripped out) and my TM has not been able to fully heal. A Tympanoplasty was unsuccessful. There is still a tiny pinhole that refuses to heal.
So with a perfectly functioning ear/sinus with a pinhole in the TM what is the harm in a sealed earplug in that ear while diving?

I will make this real simple.

I use OKEN ear plugs.

just get them, problem solved.

 

[Duke Dive Medicine]

Hi, thanks for the reply. There is no Eustachian tube dysfunction, the only problem is the TM. Some background: My left TM was significantly damaged while having a custom ear-mold made when the dam failed allowing the mold to adhere to my TM. It was not handled properly (just ripped out) and my TM has not been able to fully heal. A Tympanoplasty was unsuccessful. There is still a tiny pinhole that refuses to heal.
So with a perfectly functioning ear/sinus with a pinhole in the TM what is the harm in a sealed earplug in that ear while diving?

Oh man. That hurts just reading it. I'm surprised nothing but the TM was damaged.

Putting an earplug in the ear would effectively seal off the space just as if you had a TM, only more lateral (toward the outside). The risk of barotrauma would be the same as anyone with a tympanic membrane, but I don't think you'd get the the same feedback with pressure changes or an impending barotrauma as you would if you had an intact TM. The risk (esp. to your flight status) of putting an earplug in may outweigh the risk of using the Pro-Ear mask without the ear plug. I would check with an ENT. Your go-to flight surgeon might have a recommendation, or you could call the hyperbaric unit at UCLA.

Tagging @doctormike , our resident ENT.

Best regards,
DDM

 

[Supermoto]

Oh man. That hurts just reading it. I'm surprised nothing but the TM was damaged.

Putting an earplug in the ear would effectively seal off the space just as if you had a TM, only more lateral (toward the outside). The risk of barotrauma would be the same as anyone with a tympanic membrane, but I don't think you'd get the the same feedback with pressure changes or an impending barotrauma as you would if you had an intact TM. The risk (esp. to your flight status) of putting an earplug in may outweigh the risk of using the Pro-Ear mask without the ear plug. I would check with an ENT. Your go-to flight surgeon might have a recommendation, or you could call the hyperbaric unit at UCLA.

Tagging @doctormike , our resident ENT.

Best regards,
DDM

Yeah, there's actually much more to the story but not a fun experience. You'd be surprised how low the FAA medical standards are when it comes to TM serviceability or even hearing so not much help there.

Good point about the ear plug essentially acting like a TM. That might cause problems especially descending, without the feedback of discomfort.

While I am not interested in another invasive tympanoplasty, I'd be interested if there is another option (myringoplasty?) that doesn't require accessing my middle ear. My ENT at USC thinks another tympanoplasty is the only option, the last one destroyed about 75% of my hearing and replaced it with a screaming tinnitus that is only "temporary", 3 years later and the volume has not decreased. I haven't had good luck with allowing people access to my left ear.

I know that no professional would ever recommend diving without an intact TM. I'm willing to take a bit of risk to enjoy diving, I'm just trying to minimize the risk. I'm prepared to keep dives shallow and short to allow surfacing at any time if I detect a bit of water in my pro-ears in order to risk water in my middle ear and subsequent infection.

 

[Angelo Farina]

If this can be of help, one of the best free divers of history, the Greek sponge hunter named Haggi Statti, had both tympanic membranes permanently perforated, and he did dive simply allowing water to enter.
Here is his history:

 

[Duke Dive Medicine]

If this can be of help, one of the best free divers of history, the Greek sponge hunter named Haggi Statti, had both tympanic membranes permanently perforated, and he did dive simply allowing water to enter.
Here is his history:

Angelo, great story, though this gentleman was probably the exception rather than the rule, and if he tolerated back pain resignedly he likely tolerated chronic middle ear infections resignedly too. He wouldn't have felt the pain and pressure normally associated with those.

 

[Duke Dive Medicine]

Yeah, there's actually much more to the story but not a fun experience. You'd be surprised how low the FAA medical standards are when it comes to TM serviceability or even hearing so not much help there.

Good point about the ear plug essentially acting like a TM. That might cause problems especially descending, without the feedback of discomfort.

While I am not interested in another invasive tympanoplasty, I'd be interested if there is another option (myringoplasty?) that doesn't require accessing my middle ear. My ENT at USC thinks another tympanoplasty is the only option, the last one destroyed about 75% of my hearing and replaced it with a screaming tinnitus that is only "temporary", 3 years later and the volume has not decreased. I haven't had good luck with allowing people access to my left ear.

I know that no professional would ever recommend diving without an intact TM. I'm willing to take a bit of risk to enjoy diving, I'm just trying to minimize the risk. I'm prepared to keep dives shallow and short to allow surfacing at any time if I detect a bit of water in my pro-ears in order to risk water in my middle ear and subsequent infection.

DM sent.

 

[MB NZ]

Re: water getting in to the middle ear. It's happened to me many times and it's not a pleasant experience. Plus, as mentioned, there is a high risk of infection. Something I have also experienced, not nice and very hard to get rid of with antibiotics.

I may have mentioned on this thread already, I dived for sometime with a perforation using a Pro-Ear mask. In retrospect, that was a really stupid decision.

 

[Supermoto]

Re: water getting in to the middle ear. It's happened to me many times and it's not a pleasant experience. Plus, as mentioned, there is a high risk of infection. Something I have also experienced, not nice and very hard to get rid of with antibiotics.

I may have mentioned on this thread already, I dived for sometime with a perforation using a Pro-Ear mask. In retrospect, that was a really stupid decision.

Yes I got water in my middle ear and it was not fun. It got infected and I was remote (living on a sailboat) with no medical care so it was just my wife (nurse) and some antibiotics to get me through. Luckily no permanent damage.

I am good at managing risk, I just want to educate myself to reduce risk to an acceptable level. Like I said, probably just shallow dives and pro-ears with Doc's Pro Plugs to catch splashes of water if they get in the ear-cup while I surface immediately. I don't dive with paid tours and groups, just my wife and friends so no pressure to go deep or continue with the dive if some water gets in my ear cup. The Pro-ears are pretty reliable if used properly.