Do vented ear plugs work? The topic comes up often.+

[DocVikingo]

Compliments of UndercurrentOct '09 issue:

"Stoppering the Problem: Do Ear Plugs Work Underwater?

The question of divers using vented ear plugs to ease equalization and keep water out of their ears is often raised on divers' online message boards. These soft polymer plugs form a tight seal and have a very small hole, or vent, running through them to allow for equalization of the ear. Many responders indicate that the plugs reduce the frequency of external ear canal infections and ease clearing of the ears.

Doc's Proplugs (Doc's Proplugs: The Doctor's Choice for Ear Protection) is the primary purveyor of vented ear plugs. It claims that when fitted properly the plugs reduce "ear squeeze caused by inability to equalize between the outer and middle ear” and help "prevent outer ear and inner ear infection, vertigo and thermal reaction. ” Its Web site includes a list of undated and unverifiable testimonials.

Only the most minimal medical research has been conducted on these ear plugs. A self-published, undated piece by the "Sardinian Institute of Underwater and Hyperbaric Medicine" evaluated two professional divers with histories of perforated eardrums "who in the summer made constantly 3 dives per day. ” After observing one diver for 17 months and the other for three months, no problems with inflammation of the middle ear were noted.

Another study found that in patients involved in various watersports, the use of earplugs substantially reduced surfer's ear/exostosis (benign bony growth in the external ear canal caused by exposure to cold, wet and windy conditions).

If a vented ear plug did lessen the flow of water into the external auditory canal, the expectation is that outer ear infections (swimmer's ear) would be reduced. As regards the claim of prevention of "inner ear infection," this isn't believable. Water does not enter the middle ear space from the outer ear unless the eardrum is ruptured. It doesn't enter the the inner ear unless both the eardrum and either the oval or round window are ruptured. And someone with any of these eardrum problems shouldn't be diving.

Decreased water flow also would be expected to reduce temperature-related abnormalities, such as caloric vertigo and surfer's ear.

The claim of easing equalization is difficult to support, as there is no reasonable mechanism of which I am aware to explain how this might occur. Doc's Proplugs' Web site states, "Due to surface tension, the vented plug also reduces abrupt pressure changes from reaching the sensitive eardrum which contributes to easier equalization.” I find this assertion not compelling.

I was unable to find any published reports of harm to the ear from such plugs. Provided the vent in the plug remains unobstructed, these devices appear to pose little danger to the ear. However, if a vent should become clogged, especially upon descent, equalization could become impeded and the eardrum damaged.

As for using such plugs to protect a ruptured eardrum, remember that these devices still do admit a small amount of water. Plus, the diver runs the risk of losing the plug altogether, thus allowing water to freely enter the middle ear space and resulting in pain, disorienting vertigo and possible middle ear infection.

The bottom line? If you're experiencing external ear infections or worried about surfer's ear, vented plugs may be worth the small investment. However, divers with a history of middle-ear congestion or infection are unlikely to benefit from these plugs, and they should refrain from diving until seen by an ear, nose and throat specialist. For those with continuing difficulty in equalizing, experiment with various clearing techniques before trying vented ear plugs. — Doc Vikingo"

Regards,

DocVikingo

[doctormike]

Superb discussion, thanks, doc!

One thing that I see as a common thread in this forum is a LOT of confusion about the anatomy, physiology and physics of the ear. This is understandable, it is not a simple system, and it spans an area of the body that goes from the skin of the face to the back of the nose and all the way into the brain!

People often conflate outer ear problems with middle ear problems, use the term "inner ear" when they mean "middle ear", etc... Also, there is a tendency for some enthusiastic members to strongly recommend a device or approach that has worked for them without a lot of regard as to whether or not the post question is really about the same situation.

I'm not saying this to be condescending or arrogant - after all, that is why we have this forum, to educate people! And remember, any and all sincere questions are always welcome. But it is important to break things down to the facts, understand the disease process, and to take any and all claims made on behalf of commercial products with a grain of salt...

Best,

Mike

[Thalassamania]

If external ear canal infection is the problem, this is not a new issue.

Good discussion of the issue: Effect of Diving and Diving Hoods on the Bacterial Flora of the External Ear Canal and Skin

DAN recommends half and half white vinegar and rubbing alcohol.

Back during the Tektite program, in 1969, there was a lot of problem with middle ear infections, a protocol of a few drops of mineral oil in each ear prior to diving and a post dive wash was developed.

While Vinegar/alcohol is good, what we used for earwash on Tektite was equal parts of 15% Tannic Acid (15 gm. diluted to 100 ml), 15% Acetic Acid (15 ml diluted to 100 ml) and 50% isopropyl or ethanol (50 ml diluted to 100 ml) in a wash bottle. On Tektite we used ethanol because we had a bunch in the lab for pickling specimens. If you leave a wash bottle full of solution in the sun (e.g., on the dash of your car) it feels so good after the dive.

If you have access to any High School or College chemistry lab you can make it. Or you can likely get a pharmacist to make it up (get you doc to write it out as a prescription) or just get the stuff you need from any Chemical Supply company

1) Tannic acid (crystals), weight out 15 grams, transfer to a 100 ml volumetric flask and fill with water.

2) Acetic acid (liquid) put 50 ml or so of water into a 100 ml volumetric flask, slowly add 15 ml of glacial acetic acid then dilute to 100 ml with water.

3) Dilute an appropriate volume of alcohol with water so that you get 100 ml of a 50% alcohol solution.

Combine equal parts of the three solutions (in this case 100 ml each to make 300 ml of Tektite Solution).

Mineral oil in the ears before the dive, and Tektite Solution after. I've done this since '69 and never had any problems with my external acoustic meatus. No need for earplugs.

[DocVikingo]

Personally, I'm for keeping the alcohol in any such mix at a relatively low level, like around 1/3. This is because alcohol dissolves earwax (cerumen), which is there for a very good reason, and can be excessively drying. This can leave the ear canal even more prone to infection. And this is particularly the case when using such drops over multiple dives a day over multiple days. Of course the use of mineral oil or lanolin before each dive may mitigate this concern, but very few divers I know of do this.

Regards,

DocVikingo

[Thalassamania]

The non-compliance of a patient is always a concern, but we had to be compliant and it worked well.

[DandyDon]

Glad someone linked this. I'd missed it I guess.

[Wayne at DiveSeekers]

I swear by Doc's Pro Plugs and have been using them for several years now. As an active Instructor/Diver, I am in the water all the time. Before using Pro Plugs I found that I was always having ear problems and would always have to have prescription ear drops in stock and with me all the time. The worst would be when I would Travel. I would do 3 to 5 dives a day and half way thru the week my ears would start flaring up and then the plane ride home was brutal. Since finding Pro Plugs, No More Ear Problems!! We always stock them now and everyone who uses them swears by them.

Make sure you get fitted properly.

[n733lk]

I swear by Doc's Pro Plugs and have been using them for several years now. Since finding Pro Plugs, No More Ear Problems!! We always stock them now and everyone who uses them swears by them.

Make sure you get fitted properly.

Wayne, do they also help with Equalization problems as advertised?

Thanks!

[Hallmac]

Personally, I'm for keeping the alcohol in any such mix at a relatively low level, like around 1/3.

how about the 1/3 alcohol, 1/3 white vinegar, and 1/3 Hydrogen peroxide formulas.

alcohol to dry
peroxide to kill bacteria
vinegar to lubricate and prevent cracking

Fluff or acceptable?

[HowardE]

Wayne, do they also help with Equalization problems as advertised?

Thanks!

They do for me. (When I'm diving with my head getting wet)