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Ear Nose and Throat Problems - Grommets

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 - If I had ear grommets as a child (I am now 27) am I okay to learn to dive without getting prior doctor's consent?

A - No. You should really see a dive doc before you go diving for the first time. Grommets are tiny plastic vuvuzela-shaped tubes put across the ear drums in kiddies with gluey stuff in the middle ear. They allow air to pass through them and push the gunk out of the middle ear down the Eustachian tube into the throat, where it is spat on the street, in my area anyway. Having them allows the kids to hear properly as less gunk in the middle ear means more malleus-incus-stapes vibration and hence better hearing; better school reports and less dysfunctional behaviour during Divinity lessons all round.

Grommets tend to fall out of their own accord after a while, but before embarking on a sport where having a perfect ear drum is kinda useful it’s always best to make sure the ear has healed properly. So see a dive doc to have a look at where the grommets were placed. Scars can be left which can affect equalisation, or in uber-rare cases there might still be a hole which would affect your ability to dive.

Q - My husband and I are both keen divers and our daughter is showing an interest already, even though she's only 5. She's been quite unlucky with ear infections though, and the ENT doctors are recommending she has grommets to stop her getting them so often. Obviously we are going to do what's best for her but will this stop her diving before she's even started?

A - Harking back to last month’s middle ear extravaganza, a few words about the humble grommet. Not in this case a Lancashire cheese lover’s dog, but a tiny tube inserted into the eardrum. In the States they call them “tympanostomy toobs”. Smaller than a match head, they’re used to create an artificial perforation so that air can get in to the middle ear, and more importantly, mucus and pus can get out. The simple reasoning is this: the pain and misery of middle ear infections is mostly due to the pressure build-up in a confined space. Put a hole in one of the walls of this confined space, and the pressure won’t build up. Hence no pain, fewer infections and a happy kid. And it works. The grommets eventually fall out by themselves after a while (a few months to a few years) and the perforation left behind heals up by itself. By that stage the child is older and bigger and hopefully has grown out of infections, so quite a neat procedure all round. Luckily, once the eardrum has healed, it’s perfectly safe to dive with (although it will always be slightly more fragile than an undamaged one). No need to mourn the loss of your daughter’s diving career just yet.

Q - I had a grommet inserted in my ear last July and was wondering if it is safe to dive with it still in. Are the pro-ear masks any use in this situation?

A - No and not reliable enough. I saw a great debate on the Yorkshire Divers forum on this and the upshot is that the Pro-Ear should never be used to 100% guarantee water wont get into the ear canal. They can fall off, be kicked off, or break. They are great for equalizing issues but not for protecting a hole in the eardrum that can let water rush into the middle ear. That’s what a grommet would let happen. So wait until it comes out naturally and get the drum checked for patency, and for whatever problem there was in the first place to resolve enough for you to pop your ears on a dive.

Q - My father and I attended the PADI open-sea course last summer in Cyprus. I passed the theory and pool exercises with flying colours (even beat my dad!) but found I could not equalise during the open sea dives and abandoned at about 3 metres and failed the course. I was DESPERATE to get my PADI and tried to equalise without success. I had grommets and adenoids (removed) when I was 6 - could this related? I have a referral, which is valid for 12 months to do my 4 dives. Can you help?

A - Yes I can, but in these cases I like to have a little peep into your ears, so would need to see you.

If you have had grommets, those little tubes they put across the eardrums in kids, to let air INTO the ear and the gunk out of the Eustachian tubes, then often it's due to Eustachian dysfunction. So you could have an existing equalization issue because of this. But as a rough rule of thumb, if you are fine in planes, often with a few tricks of the trade you can get it OK with diving.

Read my piece on Easy Equalization on the e-med dive pages, then arrange to see your local dive doctor. At one end of the spectrum a piece of advice works, at the other you may need to see an ENT surgeon for a bit of surgery. But from all the divers that have come to me, I have never failed to get them equalizing fine and dandy in the end.

Q - Hi there,

I hope you can answer my question as I am going to the red sea on sat, all very last minute and had a grommet fitted in my ear about 6 mths ago as my ear kept popping. It is better now and when I had a check up the nurse said that she thought it had come dislodged but still there. Will this be a problem to dive ?

Thank you for any advice you can offer.

A - Forget the nurse. Get to a dive doc asap before you go. A grommet would be a real problem if it was still in place in any way at all. This little tube goes across the eardrum allowing air to sweep through into the middle ear and push any gunk out through your Eustachian tube. It will let the whole ocean through the same channel if you dive with one in place. Great for equalizing but terrible for infection and consequent deafness. It must not be in place still, and the eardrum healed over for you to dive. Best let an expert have a gander in your ear canal.

Q - I have been given your email address by Norwich Scuba Centre.

My 15yr old son has been advised by Bupa, that due to bad ear drum scarring caused by ear infections when he was young, and 3 sets of grommets, he should not scuba dive.

Norwich Scuba have told me about a mask called a Pro - ear mask for this sort of problem.

They have advised me that you may know if this can help and if so I would appreciate your advice.

A - If your son has had all these ear problems when younger, then there is a chance that equalizing will be more difficult. However I have seen divers with scarred drums for many reasons dive OK as the drum can still move a bit. Also in the equalizing process , if he can push air up the Eustachian tube easily, the drum wont have to move as the air equalizes the shrinking gas volume effectively, so no drum movement is required.

The Pro-ear mask is a neat way of helping ear problems with diving, and I have been recommending it more and more recently. I know a few instructors use them routinely now to prevent ear infections.

A cup sits over the whole ear, so the equalizing interface, instead of being across the drum, is across a chunky piece of plastic. The space is equalized by a sweet tube running from the mask face space to the ear cups.

So here's the plan. See your local dive doc, preferably with ear experience. If they feel its not as bad as all that, give it a go diving normally. But the first sign of trouble, yes try the Pro-ear mask.

Q - My son would like to take up scuba diving but is concerned that because he had "glue-ear" as a child and had grommets fitted for some time he may have a problem with pressure. He is now 31 years old and has had no problems for many years and flying does not affect him. Is there any reason why he should not dive?

A - Not really. If he can equalize well on planes, then it is likely that he will be fine whilst diving.
Grommets were placed in their thousands into kids ears a few decades ago. Many of those who had them now dive perfectly well. Glue ear or Chronic Secretory Otitis Media [CSOM] is a problem where mucous builds up in the middle ear in youngsters, resulting in poor hearing which affects learning. The grommet is a short plastic tube put across the ear drum that allows air to flush through from the outside, pushing all the gunk out of the Eustachian tube.

They normally fall out of the drum a few years later by which time the problem seems to be over.

However, the pressure differences in diving are more than in a plane. So for all the tips on how to equalize if it does become difficult please look on the www.e-med.co.uk site and read "Easy Equalization" on the dive pages found on the top bar.

(other dive medical questions)



   


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