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Ear Nose and Throat Problems - Eardrum

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - I am a dive master candidate in Mabul Island, Malaysia. I burst my eardrum with a pin hole on the left in June. I equalized too hard in about 3 metres. However, there wasn't any pain, not till to the evening it started to ache. So, I put on some eardrop and the next day seemed alright. However, when I started to sink the next day, I felt bubbling sound when I equalized. It was so painful when I reached 14 metres and I ended the dive straight. I rest for an hour and tried another dive. When it reached 15 metres, it was so painful again but I didn't end it since I was guiding. There was some yellowish liquid came out. I stopped to dive for 2 weeks rest and after consulted the doctor. Then, I tried but still hurt. Then, I consulted to ENT.

Since the ENT said that I had to rest for at least 3 months and sorry to say that I didn't. I started to dive again after 2 months rest only. The ENT told me that the pin hole was recovered but still weak. So, when I dived in August, I burst it again I guess. I went to the ENT again and assured that the pin hole was once again there.

Till then, I stopped diving till now. Hence, I wanted to know how much time exactly I have to rest to go for my next dive. There isn't any ringing sound and besides, I can hear very well. Nothing really affects my hearing. What shall I do? I'm so keen on to dive and since that's my job too.

A - This must be so hard for you. As a diving professional, I guess if you donít dive you donít earn. And a 3 month lay off is a long time behind the desk of the dive store, filling out those PADI cards. A pin hole ear drum perforation should normally close quite quickly, and I am surprised 2 months didnít do the trick for you. But what happened, happened. I suggest you take the ENT advice, as he has seen your ear, and go for 3 months off if you can afford it. Then before diving go see him again and have some pressure testing on the drum. If its back to normal then dive on, and here you could use the Pro-Ear mask in future to take some of the strain. However, if your drum is the worlds slowest healer, then all thatís left is grafting. A small piece of skin is taken from behind the ear and placed over the drum and sewn into place. This takes a while to ďtakeĒ, and when it does it should be as strong as before.

Good luck with that, or as they say on the Malaysian border, ďNo drugs, no long hair, no guitar, hippy, stay out of countryĒ

Q - I am a PADI advanced diver with about 50 dives under my belt.

Nearly 5 months ago I perforated my right ear drum by sticking a cotton bud in too far. I've been to see the ENT specialist. He told me not to get it wet for 4 months, which I have done. I went back to see him again and he gave me the all clear saying that it has healed up and he gave me a hearing test which came back all clear. I haven't lost any hearing in the ear and I could get there ear wet now. I have just come back from Sharm el Sheik which I was nervous about because of the flying and equalising on the plane. But there was no problem in equalising and no ill affects. While I was out there I did a lot of snorkelling and again with no ill affects. I was wondering when I could get back into the water and dive again. Thanks for your time and look forward to your reply.

A - The eardrum is one of the most sensitive parts of the body. Even more than the nads. So you stick a fluffy ended plastic stick into your ear. Must have felt pain, but thought "no, despite the increasing agony I will push harder and deeper." And with a whelp you felt the give as said stick starts rattling the ossicles in your middle ear.

Next time use the blunt end of a Bic biro like everyone else.

If it's healed then you're fine to dive.

Q - My partner recently suffered great pain in the ears during a training descent at 7m. The dive was aborted.

She consulted her GP who diagnosed a small hole, severe swelling and inflammation with water in the inner ear.

He advised not to dive before a further check up, but said she would be OK to fly to the Maldives in 3 weeks and continue diving thereafter. He also prescribed antibiotics and Ibuprofen for the pain.

However, we are worried about rumours that this kind of injury may result in never being able to dive again.

A - It sounds like she either didn't or couldn't equalise on the way down to 7 metres.

Once you get too deep the Eustachian tube will close down on itself and no matter how hard you try you will not get any air through it into the middle ear, hence the ruptured eardrum and all the gunk in it. She should have ascended a bit and taken it more slowly.

She will probably be fine in 3 weeks to fly but before she dives she really needs to have a doc look in the ear.

Eardrums can heal themselves quickly and easily even within a few days sometimes, but you need to have definite proof before she dives that all is healed. So take her back to the doc for a check before you fly.

If she were to dive with a perforated eardrum the problem is that of getting an infection as the seawater would flow into the middle ear.

If the drum has healed she really must get the whole equalisation process right. And if she finds there are still problems on descent then she should abort the dive immediately and seek an ENT opinion on her return.

Rarely these sort of injuries can result in never diving again, but that would be mainly because of a permanently perforated eardrum and she would be unlucky if this were the case.

Q - Whilst on the final stage of my PADI open water course yesterday, I unfortunately lost control of my buoyancy, didn't equalise fast enough and perforated my left ear drum. A visit to the local hospital later in the day, resulted in a course of antibiotics to stave off any potential infection. I should say that this is the second time this particular ear has "blown", the first occasion being completely water unrelated. Up until the incident, I had experienced no problems equalising in depths up to 11m.

The first question is will I be able to dive again and if, so how long should I leave the ear to heal before so doing.. The second question is, how long should I wait before undertaking normal pool swimming. I generally swim twice a week - around 3Km each session - and normally get plenty of water in the ears!

A - Diving after a perforated ear drum depends on how long it takes to heal. This can depend on whether there is infection too as this will slow down healing of the drum as any pus or discharge will have come out of the existing hole. That is why you were given the antibiotics in Casualty.

Now, the eardrum can be rather like the old rubber stopped vials, that is they are resealable when they burst, but this is not necessarily always the case, especially after a barotraumas like you had. I think the safest thing to do is give it a couple of weeks to get better, then before you go diving again get the drum looked at by your GP to check it's healed OK.

Because now it's the second time you've blown it I think you have to be very careful with your buoyancy in future, always double check your weights, maybe carry a kilo extra as you know you get lighter as you drain your tank, and never dive with a cold.

As regards the swimming, I don't think its a good idea for now until there is full healing, as any contamination of the middle ear could set you back from diving for longer.

(other dive medical questions)


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