Ear tubes as a kid -- does it matter?

[Arnold J Wright]

I had tubes multiple times, 6 years ago had the malleus and incus bones remove and replaced with a KURZ implant. My ENT MD stated I should be fine as long as I paid attention and equalized often. The only problem I had was I went overboard with the equalizing. Blood vessels in the nose. Ears are fine. Slow descents and easy equalizing.

 

[ScubaJCBS]

My oldest daughter had tubes at age 1 she has been certified since she was 12 she is now 18 and dives like a fish equalizes without touching her nose so I don't know if that's always the case but that's her story.

 

[doctormike]

Still here, 10 years later! Not much has changed...

A couple of points:

1) Tubes are a temporary method of bypassing the transient Eustachian tube dysfunction (causing middle ear fluid or infections) that is extremely common in very young children. The vast majority of people who get tubes placed have them placed around age 1-3, and they usually spontaneously extrude as the ears heal (4 months - 2 years, depending on the model of tube), with no more middle ear fluid or infections. If this is your history, you are no more likely to have ear problems with diving than anyone else.

2) A very small percentage of patients may have persistent ET dysfunction into later childhood and still need tubes. Even these kids may eventually outgrow the problem. If the ears are healed and there is no ETD, and if they can equalize in a pool, they can dive.

3) An even smaller percentage of patients may have ETD as an adult, requiring tubes. These patients probably won't be diving, although some people like this (or people with unrepaired eardrum perforations) will dive using a Pro-Ear mask. I don't recommend this, but some people have had good luck with it.

4) To see if you can dive with any kind of ear history, you need to confirm that the eardrums are intact and that your ETs are functional. This is something that can be easily done by any ENT doctor. If all is good, you can try equalizing in a pool.

5) There actually are some new interventions that address the ET itself with a balloon or laser to improve functioning in people who can't equalize. There isn't enough data yet for me to recommend it, especially not in kids, but this is something I'm watching. If you want to read my whole impression of this, I can post it here...

 

[RyanT]

If you want to read my whole impression of this, I can post it here...

Yes, please!

 

[doctormike]

Yes, please!

OK, cut and pasted from a conversation with a friend who asked me about this. Apparently someone had come into his shop handing out flyers for a local ENT doc who does this, claiming to help divers who can't equalize...


You raise an excellent question, and the short answer is “I don’t know”. The longer answer is this.

I’m a pediatric ENT doc, and there simply isn’t much data on this in kids. Furthermore, pediatric Eustachian tube (ET) dysfunction is usually a transient condition of early childhood, and it tends to improve on it’s own, so hard to justify this for most patients. The technique has been used successfully in some adult populations, but the numbers are small, and there have been studies with both laser tuboplasty and balloon dilation. This is a procedure early on in it’s evolution, but hopefully more data will be forthcoming.

Here are some other things to consider. The ET isn’t just a clogged pipe that needs to be opened. This is the case with the coronary arteries, where balloon dilation or stents can restore flow into a compromised pathway. The ET is a complex passageway where malfunction is often related to problems with the muscles that actively dilate the tube. In most cases of divers having problem equalizing, it’s a technique issue. There is also a lot if misunderstanding of the anatomy, where people think that improving nasal issues like a deviated septum will help the ET work better.

Now there are some patients that do have a problem of simple stenosis of the tube that can be treated by dilation - people who have ET scarring from radiation therapy. But most people with ET issues aren’t in that situation.

I have been watching the data come in on this procedure, and it’s still not clear to me that this should be done on most divers with trouble equalizing. Remember, the ET runs right next to the internal carotid artery, the big pipe that supplies most of the blood to the brain. I would want to be very sure that any pressure treatment didn’t have a chance of causing cerebrovascular issues. There is some limited evidence that this is safe, but those numbers are small - it’s possible that there will be more concern if this becomes a common procedure. And there are reports of other significant injuries from the operation.

So in conclusion, for very selected divers who have adequately addressed technique issues, it may be a viable option in experienced hands.

 

[RyanT]

@doctormike, many thanks! As someone who studies acoustic communication, I'm always interested in learning more about ears!

 

[doctormike]

@doctormike, many thanks! As someone who studies acoustic communication, I'm always interested in learning more about ears!

Sure!

You might be interested in this thing...

I just bought one to try out in the pool. It definitely has potential, but needs work:

Voice in the sea toucan