Question Any point in a 2nd tympanoplasty?

[doctormike]

Two question for you...
1. I got to look at her perforation and the doc said as well that the edges of it were thickened and scarred over. It did not look like a new perforation, and it made no signs of closing on its own after 3 months. We were wondering if it's likely the perforation had been there for some time and she was diving with it unnoticed. Do you think that is likely? We dive 100+ days a year and we're in the water several weekends each month of 2023 before the perforation was discovered in December/January after her infection.

Hard to say much about ear stuff over the Internet, but it's pretty unlikely that you would be scuba diving with a tympanic membrane perforation and not have any idea that it was there! Maybe a very tight fitting hood kept it dry?

2. I realize this is not recommended, but in theory if she had an earplug or silicon ear cover that fully sealed her ear off, that wouldn't cause any problems since there's no need to equalize that side, right? She just needs to keep all water out of her middle ear, or am I misunderstanding the risks?

No one is going to "clear" you to do that. There are risks of ear infection if water gets in, risks of sudden vertigo underwater, risks of chronic damage... and the only way that you wouldn't need to equalize would be if the middle ear flooded with water, right? It's hard to get a reliable seal with a plug, and then you would have to rely on ventilating the ear canal through the perforation. Just not a great idea.

 

[Whiskeyjack]

Hard to say much about ear stuff over the Internet, but it's pretty unlikely that you would be scuba diving with a tympanic membrane perforation and not have any idea that it was there! Maybe a very tight fitting hood kept it dry?

She does wear a hood 100% of the time. The main reason I ask is that on the day the graft failed, she thought everything was okay and that she was equalizing the ear. She only became concerned after the dives when her ear kept releasing way more water than could reasonably fit in the outer ear... Since she couldn't actually tell the graft was gone, I wonder if she also wouldn't have noticed the perforation in the first place.

No one is going to "clear" you to do that. There are risks of ear infection if water gets in, risks of sudden vertigo underwater, risks of chronic damage... and the only way that you wouldn't need to equalize would be if the middle ear flooded with water, right? It's hard to get a reliable seal with a plug, and then you would have to rely on ventilating the ear canal through the perforation. Just not a great idea.

Yep, I realize it's not a great idea. I've been reading accounts on here of people using the IST ear mask plus various earplugs with success. My understanding of the vented earplugs is that they won't let any water in if they don't experience large pressure changes which the mask prevents... We purchased an IST ear mask but it's far too large for her face and without shaving your head to get a decent seal doesn't seem like a realistic option. We have a Socorro trip in November and are trying to see if there's any way to salvage it. We're it me I would probably wear an a docs pro earplug with a tight hood and accept the risk, but she is much less risk tolerant than I am.

In any case not trying to be obtuse but want to understand as much as possible... We have lost faith in the doctors here in PH and won't be back in the US until at least next year to see a specialist.

 

[doctormike]

In any case not trying to be obtuse but want to understand as much as possible... We have lost faith in the doctors here in PH and won't be back in the US until at least next year to see a specialist.

Sure, I understand, and I really wish I could help more. It's just that for ear stuff, it's so hard to guess what is going on from a history like this, I'm reluctant to reassure people or give advice over the Internet. I just don't want to give anyone bad advice. I have heard of people using that pro-ear dive mask from time to time successfully, but hard to say more than that...

Good luck!

Mike

 

[Whiskeyjack]

Sure, I understand, and I really wish I could help more. It's just that for ear stuff, it's so hard to guess what is going on from a history like this, I'm reluctant to reassure people or give advice over the Internet. I just don't want to give anyone bad advice. I have heard of people using that pro-ear dive mask from time to time successfully, but hard to say more than that...

Good luck!

Mike

Thanks. Last question, what should I be looking for when trying to find a surgeon in the US? I know little about ENTs. I have a opthalmologist in the family and they specialize in glaucoma and cataracts for example, they would not be able to help with LASIK or a retina issue.

I imagine there is something similar where I want to find someone who specializes in ear trauma specifically?

 

[doctormike]

Thanks. Last question, what should I be looking for when trying to find a surgeon in the US? I know little about ENTs. I have a opthalmologist in the family and they specialize in glaucoma and cataracts for example, they would not be able to help with LASIK or a retina issue.

I imagine there is something similar where I want to find someone who specializes in ear trauma specifically?

There's no such thing as an ear trauma specialist. What you want is an otologist. That's an ENT doc who just does ear work. That would be more than adequate for this problem. Lots of general ENT docs do basic ear work, but for this I would find someone who has done a fellowship in otology / neurotology and specializes in this.

If you find someone, feel free to DM me with the info and I can take a look!