Howdy doctormike:
Would you mind expanding a bit on your recommendations for Proplugs in your pediatric ear tube patients vs. using them for scuba diving?
Which version of the Proplugs do you recommend to your tympanostomy patients? What water activities do you let them engage in with the plugs in place? Do you think that the unvented plugs are adequate protection to allow people whose eardrums are not intact to descend below the surface (eg dive)? Which version of the plugs do you recommend for divers? Do you feel that the vented plugs are adequate protection for divers whose eardrums are not intact or divers who want/need to keep their ear canals dry? Any other thoughts/advice/caveats about the Proplugs?
Thanks
OK, because this board and its members mean so much to me, I am going to drag myself out of my PBD (Post-Bonaire Depression) and try to answer. But to think that I was happily doing my morning macro dive in the Eden Beach rubble pile just yesterday morning ...
First of all, there are two types of non-intact tympanic membranes: ear tubes and eardrum perforations. It is MUCH easier for water to get into the middle ear through a perforation than through an ear tube. This is because the hole in the ear tube is so small, and the tube itself has enough length as compared to its diameter, that surface tension effects resist the flow of water through the tube into the middle ear.
In fact, there have been many many studies which show no real clinical risk of water exposure with ear tubes (as in showering, surface swimming, splashing, etc), and at least one mechanical model which demonstrated that in order to force much water through an ear tube, you need to dive about two feet under the surface.
Therefore I recommend no precautions at all for the vast majority of patients with ear tubes. For the few children who are old enough to dive more than a foot or so under water, but still have ear tubes (a very small percentage of my ear patients), I have them wear unvented proplugs. While it is true that SCUBA diving with unvented proplugs would be a problem, we are really only talking here about the few children who would be free diving in a pool, resulting in a brief exposure to a moderate pressure gradient (not enough to force the plug into the ear canal).
For patients with eardrum perforations, I do recommend unvented plugs for surface swimming and showering, just because it is so easy for water to enter the middle ear and potentially cause infections.
Now, on to SCUBA diving..!
Vented proplugs are necessary when dealing with the greater and longer pressure gradients that develop in SCUBA diving. Here we are talking about an intact tympanic membrane, and the plugs are used to reduce outer ear problems such as swimmer's ear or cold caloric responses (dizziness related to cold water in the ear canal stimulating the inner ear). The Web site also claims that they help with equalization (as I mentioned before).
This to me is a more limited application, and I would be worried about any ear plug during a dive, but apparently many people (including lots of proplug users here on ScubaBoard) use them without difficulty and swear by them. I only treat children, so I don't see a lot of patients like this. However, I would not recommend SCUBA diving with an ear tube or an eardrum perforation, since there seems to be no way to avoid pushing water into the middle ear with a vented plug, and an unvented plug would not be appropriate.
Now, back to sorting my Bonaire photos (pix and trip report to follow!).
Mike
