Ear concerns before taking lessons

[mizzie]

Ok, obviously I will get a go ahead from a doctor before I actually start lessons, but I was just wondering what scuba divers have to say about this.

The story is, I had ear surgery when I was nine to remove some of the bones in one ear. It's a long story, but the result is a near total hearing loss in that ear (other ear is fine, it doesn't create a problem). Now, I did take an extreme crash course in scuba and went on a few dives when I was 12 (another long story, deepest dive was 60 feet) and had no issues with clearing my ears. Clearing them is also not a problem when I fly. In fact, I've found that the ear I had surgery on is actually a lot easier to clear. Probably since it is more open.

So, when they ask about any ear issues, is that mainly because of clearing problems? My concern is that I'll go to the doc and they will hear "ear surgery" and not let me take lessons. If clearing has never been a problem, is it likely that I'll get the go ahead to take lessons?

 

[spectrum]

When they as about any health issues it is because you, the instructor and I are not doctors and a doctor's interpretation should be sought. There can be lots of other issues beyond ear clearing ability, in fact that may be one of the more minor. Be sure to see a dive savvy doctor, find one through DAN if need be.

Pete

 

[knotical]

I periodically post this link:
http://www.wrstc.com/downloads/10 - Medical Guidelines.pdf
Used by several of the major scuba certifying agencies, it is a medical questionnaire and set of guidelines for the examining physician. With it, you can often answer many of your own questions.

In your case, look under Otolaryngological at the end of the fifth page.
You're absolutely right; you'll definitely want to be assessed by a physician. But since you had no problems three years after your surgery, my nickel says you still won't.

best wishes

 

[rk288]

I agree, find a Doctor who is an experienced diver. DAN may be able to help but in addition to DAN I found an excellent diving doctor by talking to my local NAUI Course Director thru the LDS.

 

[mizzie]

Sorry if I wasn't clear. I do, fully, plan on seeing a doctor and getting permission from him/her before diving. I thought I would call my LDS to see if there is one in the area that is recommended for diving concerns. I will be doing that regardless of the answers in this thread.

What I mostly wanted to know is if ears are an issue only because of clearing or if there are other concerns. And, if there are other factors, what those are. I'm already putting a lot of time and effort into this (going through the books and materials required before taking lessons, etc) and I guess I am looking for reassurance that I might be able to actually dive at the end of it. My worry is that ear surgery automatically equals no diving.

 

[Wingwalker84]

Mizzie, I would say that you should be fine. Even if the Doc does want to go into detail due to the ear surgery, I don't think that it should be a problem, but then again I am no doctor. Seeing as in how you were planning on visiting a doctor on the matter, go ahead with no worries. To my understanding clearing your ears has less to do with the bones in your ears than it does with the ability to be able to open and close your Eustachian tube manually to equalize the pressure in you middle ear with you throat. Some people have a very had time doing this.

 

[DevonDiver]

I don't think that it should be a problem, but then again I am no doctor.

All due respect to Wingwalker84, but the highlighted aspect should be noted.

There are a few medical doctors on this forum, who can provide good advice. Definitely listen to those. The rest of us....well, we just speculate....and that's not something to chance your health and well-being on

For sure you need to consult a doctor before signing on to a scuba course. The dive school would ask you to do this anyway (I hope!!) once you had completed the medical screening form with the initial paperwork.

If you are uncertain of whether a 'regular' (non-diving) doctor would understand the issues involved with diving, then you should be sure to obtain the 'Medical Guidelines' for doctors, that will be produced by whichever scuba agency is providing your training course. Those guidelines will explain to the doctor exactly what they need to assess when considering your fitness to dive. However, you may still be refered to an ENT specialist for consult.

If you need a second-opinion, then ask your scuba center (or google the web) to find a dedicated Diving Doctor. Diving medicine is a specialist field...and any doctor engaged in that will have a much clearer understanding.

Here are some documents for reference:

The PADI Guidelines for Doctors states:

[FONT=Verdana, sans-serif]OTOLARYNGOLOGICAL[/FONT]

[FONT=Verdana, sans-serif]Equalization of pressure must take place during ascent and descent between ambient water pressure and the external auditory canal, middle ear and paranasal sinuses. Failure of this to occur results at least in pain and in the worst case rupture of the occluded space with disabling and possible lethal consequences.[/FONT]
[FONT=Verdana, sans-serif]The inner ear is fluid filled and therefore noncompressible. The flexible interfaces between the middle and inner ear, the round and oval windows, are however subject to pressure changes. Previously ruptured but healed round or oval window membranes are at increased risk of rupture due to failure to equalize pressure or due to marked overpressurization during vigorous or explosive Valsalva manoeuvres. The larynx and pharynx must be free of an obstruction to airflow. The laryngeal and epiglottic structure must function normally to prevent aspiration. Mandibular and maxillary function must be capable of allowing the patient to hold a scuba mouth piece. Individuals who have had mid-face fractures may be prone to barotrauma and rupture of the air filled cavities involved.[/FONT]

[FONT=Verdana, sans-serif]Relative Contraindications:[/FONT]
• [FONT=Verdana, sans-serif]Recurrent otitis externa
• Significant obstruction of external auditory canal
• History of significant cold injury to pinna
• Eustachian tube dysfunction
• Recurrent otitis media or sinusitis
• History of TM perforation
• History of tympanoplasty
• History of mastoidectomy
• Significant conductive or sensorineural hearing impairment
• Facial nerve paralysis not associated with barotrauma
• Full prosthedontic devices
• History of mid-face fracture
• Unhealed oral surgery sites
• History of head and/or neck therapeutic radiation
• History of temperomandibular joint dysfunction[/FONT]

[FONT=Verdana, sans-serif]Absolute Contraindications:[/FONT]
• [FONT=Verdana, sans-serif]Monomeric TM
• Open TM perforation
• Tube myringotomy
• History of stapedectomy
• History of ossicular chain surgery
• History of inner ear surgery
• History of round window rupture
• Facial nerve paralysis secondary to barotrauma
• Inner ear disease other than presbycusis
• Uncorrected upper airway obstruction
• Laryngectomy or status post partial laryngectomy
• Tracheostomy
• Uncorrected laryngocele
• History of vestibular decompression sickness[/FONT]


Here are the UK HSE guidelines, relevant to ENT medical issues with commercial diving:

J4. The ear canal must be free from obstruction such as wax. Narrowing of the ear canal such as exostoses should not prevent diving unless severe enough to limit or prevent ear equalisation.
J5. The tympanic membrane must be intact. Movement of the tympanic membrane on ear clearing should be sought. In doubtful cases referral for a tympanogram may be required to demonstrate normal middle ear pressures.
J6. Diving should not be permitted after middle ear barotrauma until any middle ear fluid has been reabsorbed. Tympanic membrane erythema and retraction should have resolved.
J7. Individuals with long standing scarred tympanic membranes, well healed perforations or surgically healed perforations can be allowed to attempt to dive if they have normally mobile tympanic membranes, normal Eustachian tube function and no retraction or thinning of the tympanic membrane due to previous disease.
J8. All active infections of the ear canal and middle ear are contraindications until resolved. Diving medical specialist advice may be required with cases of chronic ear canal or middle ear disease such as cholesteatoma.
J9. Previous mastoidectomy is a contraindication to diving unless it was a simple mastoidectomy, which is well healed with no complications and has an intact posterior wall. Tympanic membrane and middle ear function must also be normal.
J10. Previous stapedectomy is a contraindication to diving.
J11. Individuals with Meniere’s disease and other vertiginous conditions should not dive.
J12. Hearing should be of a level that permits normal conversation to be understood. An audiometric assessment covering the range of 500 Hz to 6 KHz is required at the initial examination. Thereafter an audiogram should be repeated after an episode of aural barotrauma. In addition further audiograms may be carried out according to a hearing conservation programme. Saturation divers may need advice and regular follow up.
​

 

[Wingwalker84]

DevonDiver, your respect is noted, and yes definitely see a SCUBA Specialist Doctor.

 

[TSandM]

The big issue with ears IS pressure equalization.

The biggest issue for you, I would think, is that you have only one working ear. Any serious barotrauma to that ear could render you permanently deaf. That's something to think about and evaluate before you sign up to dive.

You will need ENT clearance, but I would think that, if you can equalize easily, you would get clearance.

 

[sjmueller61990]

one of my dive buddies has surgery on his ear he had tubes in them and removed and i believe still has a tiny something wrong with his ears, but he just got certified with me. he was a little bit worried first about something happening when he tried to clear them underwater but nothing, he was absolutly fine.