perforated eardrum; surgery and diving

[diveberry]

After an severe external ear infection there is a hole in my eardrum of about 20%. I’m waiting for surgery to reconstruct the eardrum. My ENT is not into diving so I have a few unanswered questions;

• is it normal to wait a 4-5 months before to do the myringoplasty? My ENT says that it will not heal on it’s own so why wait so long..
• Is diving with a combination of a custom made earplug and a pro ear mask an option? I have a perforated eardrum so I should be able to equalize the earcanel…
• What are the risks of getting an infection in case a little bit of saltwater enters the middle ear?

As most of you I’m addicted to diving and very unhappy with the idea of not diving for a year.

 

[iamrushman]

welcome....what's the history of you ear trouble... did you hurt it diving or by some other means?

 

[doctormike]

After an severe external ear infection there is a hole in my eardrum of about 20%. I’m waiting for surgery to reconstruct the eardrum. My ENT is not into diving so I have a few unanswered questions;

• is it normal to wait a 4-5 months before to do the myringoplasty? My ENT says that it will not heal on it’s own so why wait so long..

A recent perforation in a patient with no previous ear problems has a good chance of healing spontaneously. That is typically why myringoplasty is not done immediately.

• Is diving with a combination of a custom made earplug and a pro ear mask an option? I have a perforated eardrum so I should be able to equalize the earcanel…

I don't think that you will get an ENT doctor to "clear" you to do this, since these devices often fail, and it would be better not to expose an ear with a perforation to water under pressure, especially in the case of sudden leakage at depth.

• What are the risks of getting an infection in case a little bit of saltwater enters the middle ear?

Well, you can get a middle ear infection, but other risks are related to the transmission of the pressure to the inner ear with the possibility of a leakage of fluid with permanent hearing loss (PLF), especially with sudden exposure. Remember, you can generate a much larger pressure differential in this way than you can with an intact eardrum. Normally, you don't keep descending if you can't equalize, so the middle ear pressure is never very far from ambient. But if you have no eardrum protecting your stapes footplate (the connection between the middle and inner ear), and your protective device suddenly fails at depth, you could be exposed to a much larger pressure shift.

Also, there are the problems of sudden vertigo at depth, and the impact on your ability to safely complete a dive, etc.. Not to mention the fact that it may complicate any surgery that you need in the future if you get chronic drainage from the perforation.

 

[diveberry]

welcome....what's the history of you ear trouble... did you hurt it diving or by some other means?

Thnx. The only history I had was a mild reoccurring external ear infection which I have already a few years. Lots if itching and some white fluid sometimes.

---------- Post added January 16th, 2014 at 02:20 PM ----------

A recent perforation in a patient with no previous ear problems has a good chance of healing spontaneously. That is typically why myringoplasty is not done immediately.

I understand, but since the ENT sounded pretty sure of his opinion that it will not heal on its own, I was confused.

I don't think that you will get an ENT doctor to "clear" you to do this, since these devices often fail, and it would be better not to expose an ear with a perforation to water under pressure, especially in the case of sudden leakage at depth.



Well, you can get a middle ear infection, but other risks are related to the transmission of the pressure to the inner ear with the possibility of a leakage of fluid with permanent hearing loss (PLF), especially with sudden exposure. Remember, you can generate a much larger pressure differential in this way than you can with an intact eardrum. Normally, you don't keep descending if you can't equalize, so the middle ear pressure is never very far from ambient. But if you have no eardrum protecting your stapes footplate (the connection between the middle and inner ear), and your protective device suddenly fails at depth, you could be exposed to a much larger pressure shift.

Also, there are the problems of sudden vertigo at depth, and the impact on your ability to safely complete a dive, etc.. Not to mention the fact that it may complicate any surgery that you need in the future if you get chronic drainage from the perforation.

Ok, diving is out of the question, hopefully it heals on its own. Thanks for the fast and extensive reply.

 

[doctormike]

Ok, diving is out of the question, hopefully it heals on its own. Thanks for the fast and extensive reply.

Sure. Something about your description of the history sounds a bit off to me, though. There are four ways of getting an eardrum perforation:

1) External trauma - poking a hole in it with a bobby pin or something (believe me, this happens!).

2) Barotrauma - usually a diving injury (surfacing through a reverse block), rarely from flying these days with modern pressurized aircraft.

3) Middle ear infection - common in children, the pressure builds up from pus behind the eardrum and bursts through. Usually heals in a few days.

4) Iatrogenic - a pressure equalizing tube is placed in a young child and the hole doesn't close after the tube comes out.


An outer ear infection ("swimmer's ear") doesn't really cause a perforation. However, if you had chronic drainage from a pre-existing eardrum perforation, that would give you a chronic outer ear infection.

Here is my sticky on this stuff, it might be helpful: http://www.rothschilddesign.com/ear_scuba/

Good luck!

M

 

[diveberry]

Sure. Something about your description of the history sounds a bit off to me, though. There are four ways of getting an eardrum perforation:

An outer ear infection ("swimmer's ear") doesn't really cause a perforation. However, if you had chronic drainage from a pre-existing eardrum perforation, that would give you a chronic outer ear infection.

Here is my sticky on this stuff, it might be helpful: http://www.rothschilddesign.com/ear_scuba/

Good luck!

M

It seems to happen:
Cambridge Journals Online - The Journal of Laryngology & Otology - Abstract - Outcome of 22 cases of perforated tympanic membrane caused by otomycosis

The ENT cant really tell what happened, I think I would have known if I had a perforation already, did a lot of dives last year. But the ENT did see a lot of scare tissue on the eardrum, so who knows. The CT-scan didn't show any problems on the hearing bones.

 

[iamrushman]

well keep us informed....good luck and get well ASAP.

 

[Ste Wart]

After an severe external ear infection there is a hole in my eardrum of about 20%. I’m waiting for surgery to reconstruct the eardrum. My ENT is not into diving so I have a few unanswered questions;

• is it normal to wait a 4-5 months before to do the myringoplasty? My ENT says that it will not heal on it’s own so why wait so long..
• Is diving with a combination of a custom made earplug and a pro ear mask an option? I have a perforated eardrum so I should be able to equalize the earcanel…
• What are the risks of getting an infection in case a little bit of saltwater enters the middle ear?

As most of you I’m addicted to diving and very unhappy with the idea of not diving for a year.

I waited 3 months for my Tympanoplasty; a similar operation, but that was the standard waiting list time for my area in the UK, nothing to do with the Surgeon.
I've had it done and now I have 2 months before I can be assessed if I can dive again. Not a great feeling, but I'm hopeful I will get a 'fit to dive' certificate soon.

 

[diveberry]

well keep us informed....good luck and get well ASAP.

Thnx, I will. Next week I have an appointment with the ENT and a hearing test. Hopefully he can explain why I have to wait so long, or even better tell me the news that it is heeling on its own.

 

[diveberry]

Went to the ENT yesterday and I have to wait for 3 months to give it a chance to heal on its own. If not, he will perform a fat plug myringoplasty. If the perforation is closed either by itself or by surgery, I can try in the pool to equalize and if that goes well, I am allowed to dive again.