Ear Trauma at 15 metres = Never Dive Again

[ianr33]

You're in a tough situation because at your level of experience you're already task-loaded, especially in current like you were in, and it can be easy to lose track of whether you're clearing your ears or not. It's possible that your injury was related to improper equalization technique,

That's a really good point.

The only time I ever had significant ear issues was several years ago in the Gulf of Mexico. Pulling down a mooring line in ripping current, I only cleared my ears AFTER they started hurting from the pressure change. TOO LATE! Antibiotics cleared it up in a couple of weeks,but to this day my left ear is harder to clear than the right.
Point is that clearing needs to be automatic. Easy to forget to do it when too much is going on.

I hope you recover and get to dive again.

 

[OkByMe]

I know I'm going to get jumped on... So here goes.

1968-69, Vietnam along the DMZ. I got satchel charged while in the fire direction control bunker on the radio at Fire-base Russell. This burned me pretty good, punch a few holes in me, seared my lungs and corneas - BIG yellow spots in the center of my vision (I was looking right at it when it came through the door, whups!) from the super-heated gas and blew out both my eardrums. The pressure caused some fluid leakage from the left ear, and blood in the eyes, nose and mouth. I was dizzy as hell, ears ringing like a bell. It was hours and hours before I got Evacuated. Sounds pretty dismal...

I have been diving since 1967, with of course, a good long break from 68 to 76. The Navy and the VA gave it a few attempts and probably did more harm than good. In 76 I found the Shea clinic in Memphis, Tn, and a surgeon who dives as well. Over the course of time, my eyeballs healed up no problem, although the opto guys will probably tell me I shouldn't be diving. My lungs got better and spirometer shows normal function, but my SAC sucks, I'm an air hog, and the lung guys would probably tell me I shouldn't be diving.

The problem has been the ears. 38 operations making eardrums (5 on the right and the rest left) from veins in my hands, cartilage from the lobe. I needed a prosthesis in the left ear because so many years without an eardrum eroded the tendons in the connecting bones, so I have a straight shot from the drum to the window. Tinnitus up the yahoo, and just as I start to get used to it, the frequencies start changing. Incipient vertigo without warning and nothing other than some congestion seeks to trigger it. I have learned to trust my eyes rather than my ears over the years. Grimm, Grimm, Grimm.

On occasion, I develop a very small pinhole in my left eardrum, but I know how to mitigate it and still dive. I put a few drops of a viscous sterile otic solution in both ears and use Doc's pro-plugs (VENTED) in both ears. I make sure to keep a positive pressure up in the middle ear, and hold in the left plug while clearing the right ear. I can go straight down and no water enters my left ear, no problems clearing. Of course I keep on having the tympanoplasty, but after a while, it thins out and presto!, pinhole. I might add that the pinholes has never developed as a result of trauma, ether diving or just running the lawnmower.

In 2010, I made 36 dives with a pinhole. Caymans.. on the wall 100-120ft. Keys.. Spiegal grove, Duane, Vandenburg, 100+. Cosumel, Costa Maya, Rotan - Honduras. No infection, tenderness, nothing. The only thing of all that was a dive on the Spiegal Grove... So many great big Bull Sharks, I had such a grip on my mouthpiece it made my jaws and teeth hurt. I had another surgery last year and have not been diving since, but you guessed it, pinhole!!!! I'm planning Los Cabos in October and I'm NOT going to let the pinhole slow me down.

I have been on a few freshwater dives to the 2nd. thermocline at 40' or so to check the ear, me and my gear. 58 degrees about.. Sometimes the cold water can cause vertigo, but the plugs keep the ear warm. 3 weeks and no problems. If you are ever going to get water in the middle ear and have an infection, you are going to get it in a clear freshwater lake like Greers Ferry or Ouachita in Arkansas. I know that I kept the ear clear by using my methodology. I am not suggesting you do that, but only saying that there are some workarounds that my work for some situations and it may not be as GRIMM as you think it is.

I am now in a "Ducked" position.

 

[Duke Dive Medicine]

Was going to say something about ducking satchel charges instead of internet barbs, but nahh...

All kidding aside, thank you for your service. Nobody's going to jump too hard on a wounded veteran. Also, I don't think anyone here is going to be able convince you to stop diving. I won't even try. I'm sure you've been told that you risk severe infection, further hearing degradation, worsening tinnitus, etc. It sounds as if you've made a realistic assessment of the risks, are willing to accept them, and are doing your best to mitigate them.

Your point is well taken in that people with what would appear to be show-stopping disabilities can continue to dive. Last week we had Jim Elliott, the founder of Diveheart, give a grand rounds presentation in our conference room. As part of that presentation, he showed photos of a ventilator-dependent patient making a pool dive. We all gasped a bit at that, but it was done, and done with the risks clearly identified and mitigated as much as possible.

Thanks so much for sharing your story, and again, my most sincere thanks for your service.

Best regards,
DDM

 

[gert7to3]

To OkByMe,
Glad you made it back to the world. Unbelievable that we are three wars along.

I had scarlet fever when I was six and that caused subsequent ear infections which resulted in the loss of most of my right eardrum. This meant I did not get a SE Asia tour complements of Uncle Sam. I have had two tympanoplasties in the right ear. The second one is still going strong 21years.

I found that when I was diving and getting my ears wet I had trouble with the tympanoplasty. On 2 occasions this resulted in small pinhole leaks. I tried a Doc's Pro Plug and that helped. It will keep your ear dry down to about 20 ft/ 7 m, then limits water exchange. However, the best solution I found was the Pro Ear mask made by IST. The mask has earcups with hoses attached to the eye chamber of the mask. When you equalize your mask, you equalize the earcups and you dive with dry ears. I think that it is easier to equalize dry ears, you don't get a delicate tympanoplasty wet, you don't get outer ear canal irritation and in cold water you blow warm air against your ears.

The mask looks like a dive gimmick, but it works.

Swimming Ear Protection Diving Masks ProEar 2000

Also, how's your air conduction hearing? I now have a BAHA bone conduction hearing aid. It's a bit pricey, but it helps a lot in noisy environments. It's designed for people who have poor air condition of sound through their ear drum, but an otherwise good cochlea.

I have no economic interest in the Pro Ear mask product or the BAHA hearing aid.

---------- Post Merged at 12:16 AM ---------- Previous Post was at 12:12 AM ----------

I meant to site poor air conduction of sound in that last paragraph.

 

[OkByMe]

To OkByMe,
Glad you made it back to the world. Unbelievable that we are three wars along.

I had scarlet fever when I was six and that caused subsequent ear infections which resulted in the loss of most of my right eardrum. This meant I did not get a SE Asia tour complements of Uncle Sam. I have had two tympanoplasties in the right ear. The second one is still going strong 21years.

I found that when I was diving and getting my ears wet I had trouble with the tympanoplasty. On 2 occasions this resulted in small pinhole leaks. I tried a Doc's Pro Plug and that helped. It will keep your ear dry down to about 20 ft/ 7 m, then limits water exchange. However, the best solution I found was the Pro Ear mask made by IST. The mask has earcups with hoses attached to the eye chamber of the mask. When you equalize your mask, you equalize the earcups and you dive with dry ears. I think that it is easier to equalize dry ears, you don't get a delicate tympanoplasty wet, you don't get outer ear canal irritation and in cold water you blow warm air against your ears.

The mask looks like a dive gimmick, but it works.

Swimming Ear Protection Diving Masks ProEar 2000

Also, how's your air conduction hearing? I now have a BAHA bone conduction hearing aid. It's a bit pricey, but it helps a lot in noisy environments. It's designed for people who have poor air condition of sound through their ear drum, but an otherwise good cochlea.

I have no economic interest in the Pro Ear mask product or the BAHA hearing aid.

---------- Post Merged at 12:16 AM ---------- Previous Post was at 12:12 AM ----------

I meant to site poor air conduction of sound in that last paragraph.

Pinholes are the pit for sure. I have not tried the Proear yet, but I'm thinking about it. I have to have prescription eyeballs too, so that will bump the cost up too. My backup mask is pretty old and a little different than my current prescription, so I can buy the Proear w/P and use my current for backup... BUT we are divers, right we can just about justify anything. My Doc' looks at me strangely when I've asked if he could make the eardrum a little thicker...So it would holdup better,,, he just looks at me and says it is his job to restore my hearing as best he can, not to put a pressure hatch over my ear canal. If you can find some Lotrimin, that stuff is very viscous and stays inside, between the drum and plug. I swear, dives to 100 and I can come up and pull the plug and still drain the solution out. The surface tension does not allow it get displaced.

I can't hear the HF over 2200HZ anyway without blasting it up to 100+ db and than all I hear is "clicks" and "snaps". The right ear is much better and with it working I have good speech discrimination.

But enough about me. I was just trying to give the OP some hope that things may not be as bleak as he thought. Maybe the Proear would be a route for him as well. All I know is that the vented plugs makes it almost as good as "back in the day" where I could just head to the bottom clearing all the way. Other divers without the issues we have, had also said it is a lot easier to clear without pausing.

 

[gert7to3]

The Pro Ear mask's earcup tubes are attached with little threaded valves, held on by a plastic nut. They can be easily disconnected from the Pro Ear mask skirt. Then the earcups and headband can be attached to another mask, such as your old prescription mask. All you need to do is punch a couple of .125 " / 4 mm dia. holes in the mask skirt. Definitely use a hole punch, not a drill. The hole should be really snug to seal against the valve stem. You can seal any hole in a mask skirt by putting a plastic nut and screw through it. You will want to position the valve well away from the edge of your mask skirt, where it contacts and seals against your skin.

 

[Duke Dive Medicine]

Gert, all of the posts I've seen about the Pro-Ear mask have been very complimentary. I personally do not have any experience using it and I'd like to get your, and other divers', input as to how practical it is and how well it protects the ears from water intrusion. If we see a diver in clinic with a situation like yours or OkByMe's, it would be great to provide a confident recommendation for a product that could help them minimize the risk of water intrusion. This may be deserving of a new thread but since this one's headed in this direction anyway, can you provide more detail on how well the mask works to keep out water? Is it easily dislodged? Can you swim through surf without the ear cups leaking? Does it stay put with head movement? The website has a photo of it underneath a hood... have you used it this way and if so, is it comfortable to wear throughout the dive?

It would be great to hear from other divers who use the Pro-Ear as well.

Thanks very much,
DDM

 

[gert7to3]

I have done more than 100 dives using the Pro Ear Mask and it does indeed let one dive with completely dry ears.

The only times I've had any leaks it was because I got the edge of the outer skirt over the edge of my hood, or the outer skirt curled under itself, or I didn't get my ear fully inside the inner earcup. You clear the earcups just like a regular mask.

My diving is split between Lake Michigan off Chicago and Bonaire for the most part. The mask has never been prone to dislodgment during boat entries or the comparatively mild shore entries on Bonaire. I have not been diving in anything I would really call a strong current or in heavy surf. However, there have been a few boat returns where I was looking down at the deck of the boat and I was still in the water. Actually dislodging this mask is probably more difficult because you have three structures on the mask going around three protrusions on your head. Of course if there was a dislodgement you would have three times the stuff to put back in order. You really need bare hands to feel if everything is right.

I tried the Pro Ear hood, but didn't like it. It has an inner layer with cut outs over your ears and an outer layer that goes over everything. The hood skirt is too short and the whole thing is stiff and cumbersome. I simply made cut outs in my hooded vest. The neoprene overlaps the outer skirt of the earcup. You look really goofy in the hood with your ears sticking out. However, with the mask in place you look alright and it behaves like any other mask. There is no pulling or squeeze. I do not find it tiring and my ears feel better dry. This especially true on the surface where waves may slapping your head, especially snorkeling or on surface swims.

I have used the mask many times in cold water, as low as 41 F. The mask felt as fine as anything is going to at those temperatures.

Build quality of the mask is good. The lenses are somewhat small and this limits your field of view. However I converted my prescription mask and just use the Pro Ear Mask earcups and head strap. The connectors through the mask skirt are slightly fragile. You can break things if you pull too hard on the mask. The plastic on the outer part of the earcups, which holds the headband, developed fatigue cracks on my first mask after six years. The company seems to have gone over to a better quality plastic on their more recent production masks. The ring which crimps the tube to the connector can split and the tube will pop off. I reinforce this area with small zip ties and a wrap of silicone Rescue Tape tape. I keep some zip ties in my BC and I have re-attached an earcup tube while hanging off the back of a boat. Each tube has a valve which lets air travel only one way out to the earcups. If a tube dislodged at the earcup end, your mask would not flood.

Speaking of zip ties, I have also used a couple to re-attach my fin strap, in mid water, when one of my strap buckles broke. Don't leave the surface without zip ties.

I have showed the mask to my otolaryngologist and he was impressed. Though he still wonders why I need to go diving. I have also had a BAHA procedure and the mask skirt seals fine over the post sticking out my head.

For any diving or snorkeling patient who absolutely had to keep their ears dry, I would recommend the Pro Ear Mask and Doc's Pro Plugs together. Otherwise, if it's ok for an occasional minor flood to occur, just the Pro Ear Mask would be fine.

Thanks for your service as a medical moderator.

 

[OkByMe]

Thank You. A very convincing presentation.. I'm going to get one with prescription, if I like the mask size and lens, and give it a shot. If not, I'll try adapting my mask. I'm wondering if an adjustable or elastic cumber-bund would assist in securing the ear cups with a without lot of pressure. Much like I wear when water skiing to make sure the plugs don't get slapped loose with a fall. I wear a bump cap/helmet when diving and a helmet when snow skiing with the plugs along, with a snug sweatband over me ears doing both.

 

[tracydr]

Does anybody else hear crickets? I have constant tinnitus but I describe it as the sound of crickets.