Wrong analysis of ear drum rupture?

[Jasmine Corbett]

Hello

I was working recently as an underwater photographer in the Philippines. I had a cold so couldn't dive for a while, tried to dive again but had sinus pain and trouble equalising so took a couple more days out of the water.
After these couple of days I developed a very painful ear infection in my right ear (on the 10/11/17). I still had a cold at this point. The doctor had prescribed me with ear drops and antibiotics.
The next day I was in excruciating pain and my ear starting leaking a lot...spoke to DAN doctor over the phone who said that discharge is a normal side effect of ear infections, but I should see a specialist if it got worse.

It continued to get worse and blood was in the discharge also - I went to see an ENT specialist who told me I had a middle ear infection and ear drum rupture (she said it ruptured due to the pressure build up from both the infection and the cold). She prescribed me more ear drops and decongestants.
After a couple of weeks the discharge stopped and the congestion cleared.

I travelled back to the UK where I am from, with no pain on the flight. Up until recently I could not hear at all/well from the right ear, but now my hearing is fine.
I have struggled to get any advice whatsoever with doctors here in the UK as to how bad the rupture was, and have struggled to book into to see en ENT specialist here.

I decided to go for a hearing test, as I know they can photograph your ear drums. The test assistant photographed my right ear drum which he said looked perfectly healthy and there is no sign of rupture or scarring??

I am extremely confused, as I was told I had a had a rupture in the Philippines, and most of the symptoms (continuous discharge and blood) seemed very likely to be a rupture.

Can anyone shed any light on what could have happened to me if it was not in fact a rupture??

So confused as to whether I can dive again soon or not. If anyone has experienced anything like this please let me know.

Thanks in advance

 

[ScubaD1veDiv@]

I ruptured my left eardrum during a severe case of cold and bronchitis. My experience was the same as yours beginning with severe pain followed by a popping sound and bloody discharge which brought immediate relief.

My eardrum reformed a mucous plug at the rupture site a week later and re-ruptured. I am no doctor but a bloody discharge from your ear as you described sounds more like a rupture.

I would trust a doctor over a hearing test center assistance. Perhaps you should seek a second opinion with an ENT that specializes or has a knowledge of dive medicine. They can advise you if and when it is safe to return to diving.

A ruptured eardrum is a contraindication for diving. Fortunately mine happened in my early twenties and healed in a manner that allowed me to dive. Good luck! I hope you are able to get back to diving soon!

 

[Scott from LongIsland]

I'm no doctor but I have ruptured my ear drum and it was certainly not fun. I will just say this...when it happened, there was no doubt in my mind whatsoever that I had a rupture. There was a loud pop followed by extreme (9 out of 10) pain and severe vertigo. I had major hearing loss for about 2 months after the incident. When I say major hearing loss I mean, I lost about 90% of the hearing on that side for the full 2 months. I still have not gained all of my hearing back (perhaps 70% at best) in that ear and i have a lot of scarring.

Again, I am no doctor and i have no idea what happened to you. But i would venture to say that if you ruptured your ear drum it would be quite obvious. It was to me at least.

When you say that it was leaking, was it possibly water from when you were diving? could the blood possibly been from messing with your ear with your finger or (gasp!) a q-tip? Or maybe it was sinus edema and that was where the liquid was coming from? That's my internet diagnosis

 

[BGWOJ]

I’ve got a ruptured eardrum & it’s easy to see if it’s closed or not just by equalizing (gently!!). You can then see if it’s air tight or not as air will come out of your air if not. I am also not a doctor so ask one first before doing that just in case but that’s what my ENT doctors made me do. I had one doctor who said it was healed & I could dive again but when I equalized I could feel air escaping so it wasn’t! He just couldn’t see the hole & also the fact that 2 of my eardrum layers were gone & all that was left was a very thin layer which for diving is not really any good. I ended up getting in touch with the nearest hyperbaric chamber & getting an ENT doctor that works there. She has been much more helpful as unlike the other ENT doctor she understands the pressures, dangers etc involved in diving. DAN will give you a list of more specialized ENT doctors near you. I now use an IST Proear Mask & vented DocPro plugs. I combine the 2 just in case the mask fails but so far I’ve been very happy with the mask. If you’re worried about water getting in your ear look into the mask. My eardrum bursts at the slightest change in pressure but with the mask I can continue to dive. I wouldn’t say it’s 100% guaranteed to keep water out but it’s the best/only solution to get back in the water that I’ve found so far!

 

[Duke Dive Medicine]

Jasmine,

There are a couple of possibilities. First and most likely, your ear drum has healed. Minor perforations can heal within a few days and leave little to no evidence. Second and less likely IMO, the technician could have missed the obvious signs of a perforation. If the entire tympanic membrane was visible, this seems improbable.

Best regards,
DDM

 

[Rred]

Along the lines of what DDM said: A doctor can examine your eardrum with the old fashioned otoscope (flashlight with an eyepiece on it) that they all stick in your ear. Or, if they are more up to the times, they use a small video camera and that's capable of recording and saving the images as well, to document a baseline and any changes in the ear.

Find a second ENT, who has video, and can give you an image for comparison. You may want to examine it yourself (because even alleged pros miss things) or find someone else to look at it. But at least you can, yes, stick your head in your ear so you can see it for yourself.(G)

 

[Jasmine Corbett]

I ruptured my left eardrum during a severe case of cold and bronchitis. My experience was the same as yours beginning with severe pain followed by a popping sound and bloody discharge which brought immediate relief.

My eardrum reformed a mucous plug at the rupture site a week later and re-ruptured. I am no doctor but a bloody discharge from your ear as you described sounds more like a rupture.

I would trust a doctor over a hearing test center assistance. Perhaps you should seek a second opinion with an ENT that specializes or has a knowledge of dive medicine. They can advise you if and when it is safe to return to diving.

A ruptured eardrum is a contraindication for diving. Fortunately mine happened in my early twenties and healed in a manner that allowed me to dive. Good luck! I hope you are able to get back to diving soon!

Thanks for your message. Yes all of my symptoms definitely seemed like a rupture...perhaps the rupture was small and he could not see the evidence of this well from the photograph.

Desperately trying to find an ENT doctors who specialises in diving injuries but really struggling to find one right now!

Fingers crossed I will know more soon

 

[Jasmine Corbett]

I'm no doctor but I have ruptured my ear drum and it was certainly not fun. I will just say this...when it happened, there was no doubt in my mind whatsoever that I had a rupture. There was a loud pop followed by extreme (9 out of 10) pain and severe vertigo. I had major hearing loss for about 2 months after the incident. When I say major hearing loss I mean, I lost about 90% of the hearing on that side for the full 2 months. I still have not gained all of my hearing back (perhaps 70% at best) in that ear and i have a lot of scarring.

Again, I am no doctor and i have no idea what happened to you. But i would venture to say that if you ruptured your ear drum it would be quite obvious. It was to me at least.

When you say that it was leaking, was it possibly water from when you were diving? could the blood possibly been from messing with your ear with your finger or (gasp!) a q-tip? Or maybe it was sinus edema and that was where the liquid was coming from? That's my internet diagnosis

Ok thanks for the information. I see what you mean...I certainly didn't have that sudden pop, but I do remember going to sleep with an ear infection and waking up with a leaking ear that lasted for weeks.
I had continuous pain throughout this time, but I guess this was from the ear infection that was present?

However it is so hard to know as I have never experienced anything like this before. It did not happen whilst I was diving, so I guess I didn't experience the sudden pop from the pressure, and vertigo like most divers face underwater.

As for the leaking it definitely didn't seem like water. (Sorry in advance for the disgusting description)...it was yellow mucous with blood. And I am very careful with putting anything in my ear so don't think it would be from that.

I am very curious to know more about whether it could have been sinus related though. Just not sure why the discharge would be coming out of my ear? Could you give me any more insight on this? Thanks

 

[Jasmine Corbett]

I’ve got a ruptured eardrum & it’s easy to see if it’s closed or not just by equalizing (gently!!). You can then see if it’s air tight or not as air will come out of your air if not. I am also not a doctor so ask one first before doing that just in case but that’s what my ENT doctors made me do. I had one doctor who said it was healed & I could dive again but when I equalized I could feel air escaping so it wasn’t! He just couldn’t see the hole & also the fact that 2 of my eardrum layers were gone & all that was left was a very thin layer which for diving is not really any good. I ended up getting in touch with the nearest hyperbaric chamber & getting an ENT doctor that works there. She has been much more helpful as unlike the other ENT doctor she understands the pressures, dangers etc involved in diving. DAN will give you a list of more specialized ENT doctors near you. I now use an IST Proear Mask & vented DocPro plugs. I combine the 2 just in case the mask fails but so far I’ve been very happy with the mask. If you’re worried about water getting in your ear look into the mask. My eardrum bursts at the slightest change in pressure but with the mask I can continue to dive. I wouldn’t say it’s 100% guaranteed to keep water out but it’s the best/only solution to get back in the water that I’ve found so far!

Hello. Just after I supposed it was a rupture a friend suggested that I do this.
At the time it didn't seem as if air was coming out, but it sounded like a very crackly equalisation (I could hear a popping sound). It was almost as if my ear was completely blocked and muffled, and then when I did it felt like my ear was opening up.

Now when I try to equalise gently, it is not as bad, but it still sounds very crackly and as if something is opening.
Out of interest, did you have a very small, pinhole perforation? Im thinking maybe I have this, which is why it did not show on the photograph.

That is EXACTLY what I would like to do. Unfortunately struggling to have any luck with it
I am a member with DAN and I phoned them to ask for recommendations, but they said as it wasn't an emergency they couldn't help me. Have tried to email some hyperbaric chambers but heard nothing back. I guess I just need to keep persisting.

How long did you wait until you went back to diving again after the rupture?
And do you still have problems with the ear drum bursting regularly?

Great to know about the mask and ear plugs, thanks. I will look into these as an option

 

[Jasmine Corbett]

Jasmine,

There are a couple of possibilities. First and most likely, your ear drum has healed. Minor perforations can heal within a few days and leave little to no evidence. Second and less likely IMO, the technician could have missed the obvious signs of a perforation. If the entire tympanic membrane was visible, this seems improbable.

Best regards,
DDM

Hello

Thanks a lot for your reply. Im definitely leaning towards the assumption that it healed, but was a definite perforation as my symptoms were so similar to that of a perforation.

Out of interest, do you know what would be the best way to track down an ENT doctor who specialises in dive related injuries? Eg. contacting a hyperbaric chamber/dive medical centre? (Sorry vague question I know, just thought id ask just in case.)

Thanks again