Diving after a perforated eardrum

[TechDeep]

Been diving for just over 20 years. Going back to the days of my OW training, I have never had a problem with my ears. I rarely even have to make an effort to clear. My instructor told me that there are some fortunate folks who are like that ... just able to clear their ears with very little effort. Good deal.

3 weeks ago I was diving at Lake Rawlings, as I have many many times. I did develop an ear infection, which for me was unusual, but not unheard of. I had no ear trauma that I could recall.

Later in the week, it started sounding like I constantly had my finger in my left ear. My wife dug some stuff out of my ear, I just figured she couldn't get it all. My family doctor was booked up, so I went to the ER. The nurse practitioner told me I had a whole in my eardrum, probably due to the infection causing my eardrum to swell and burst. She gave me an Rx for antibiotics and ear drops, which I have been taking as prescribed.

Fast forward another week, and even though it's better, still not quite right. I've been in a 9 foot pool, and cleared fine, no pain, it's just that it still feels a little bit like I have my finger in my ear when I talk. My actual hearing seems fine.

My main concern is still being able to continue diving. I realize I need to see an ENT, and I will. My question is, what are the chances of finding an ENT that knows about diving? The last thing I want is an ENT that knows nothing about diving telling me I'm done. A google search has not been productive. Should I contact DAN, or just make an appointment with any ENT and go from there?

 

[AfterDark]

Samething happened to me years ago. I didn't dive unitl a ENT doc gave me the OK. He didn't know about diving but he knew what a healed healthy ear looked like and that was enough been dive for 30+ years since then. Good luck.

 

[DevonDiver]

A similar occurrence happened to a good friend of mine earlier this year (long-time tech diver, no previous ear complications). It occurred without warning or significant pain, we believe via a reverse block on ascent - and he was unaware of the trauma until, the next morning, he blew his nose which caused a whistling sound from his ear!

Diving was impossible (we tried, stupid I know), as he suffered major vertigo and nausea as soon as he tried to descend.

He was back in the water and diving again within 6 weeks - no surgical intervention needed, but he did take precautionary anti-biotics and anti-inflammatories.

I talked to my partner about it (an ENT specialist) and was advised that ear-drum perforations can be of varying degrees of severity. Some instances might require surgical intervention to resolve. Thus, you need to get a proper diagnosis with regards to a prognosis for future diving. Until that is received, I advise not to subject the ear to further stress from diving.

DAN can advise on an ENT specialist with diving knowledge but, as mentioned, any ENT specialist will be able to diagnose the extent of the injury and advise, probably with further appointments, the extent to which it is healing... and when it will be ready for diving again.

 

[RonFrank]

I ruptured my eardrum as a kid. I took a few weeks to heal. Just have an ENT give you the OK. Call DAN for sure as they can recommend an ENT in your area.

 

[KCrofoot]

My 11 year old just went through the same ordeal. It took 6 weeks to heal. Check back with the ENT in a month or so.

 

[doctormike]

Hi, and thanks for writing! This sort of thing comes up a lot here in these forums. I just want to make one basic point...

With ear stuff (as with most medical problems), "the devil is in the details". Symptoms of outer ear and middle ear problems do overlap, and without a good examination it can be very difficult to determine what the actual problem is. And treatment is very much dependent on the precise diagnosis.

Tympanic membrane perforation from an acute otitis media is a possible diagnosis, but it would be pretty rare in the situation that you describe. Perforation from barotrauma is also possible, but that would have been in the setting of a reverse squeeze on ascent, and it doesn't sound like that is what you are describing.

The bottom line is that for ear stuff, there is no substitute for exam by an ENT doctor with a microscope who can clean the debris out of the ear and visualize the tympanic membrane well. I say that all the time, and I really hope that it doesn't come off as sounding arrogant. Believe me, I have a lot of respect for ER docs, family docs, pediatricians and nurses. But the bottom line is that few have the training, experience or equipment to really diagnose complex ear problems. This is especially true if using only a handheld otoscope.

Diagnosis usually involves:

1) Cleaning out the ear in the office using a microscope and curette or suction.

2) Examining the ear under the microscope

3) Getting an audiogram (which will differentiate between a number of potential different conditions).

I have been doing this for 20 years, and it is incredibly common to see a patient referred with one ear diagnosis which turns out to be completely inaccurate once a good exam is done. That's not because I'm so much better than the referring doc, it's just that the ear is sort of a "black box" for a lot of other docs and health care professionals, especially when diving injuries are involved. So it's sometimes a real specialist thing...

Don't get too fixated on finding a diving ENT doc at the beginning - just get a good diagnosis first. If you truly had a tympanic membrane perforation, and it did not heal with time, you might need to have it repaired surgically (even less likely a scenario). THEN, if there were issues about returning to diving, you could talk to DAN, etc...

Finally, you mentioned that you were now able to clear your ears. While I can't diagnose anything over the Internet, I will say that if you really had a perforation of the eardrum, you would not be clearing your ears as you had done in the past, you would have been venting bubbles out of that ear. So that by itself makes me question the initial diagnosis.

Feel free to PM me if you want me to try to give you a local recommendation for an ENT doc - depending where you are, I might know someone. Happy to see you myself as well (normally I just see kids, but I have seen a number of my dive buddies for basic stuff, and referred them to the appropriate adult specialist if necessary).

Safe diving!

Mike

 

[TSandM]

Thanks, Mike! BTW, to those reading this thread, I am an ER doc, and I wholeheartedly agree with Mike's assessment that generalists are not trained or in most cases provided with the equipment to do a really thorough examination and diagnosis of ear problems. And we typically know little or nothing about diving-related ear issues. I know that, when I watched Dr. Kay's video for the first time, I was amazed to see that barotrauma can look almost exactly like otitis media on exam . . . I'm quite sure that, before I dove, I would have misdiagnosed people. I've read any number of stories here where I was pretty sure the initial diagnosis was in error. If you're having problems that lie outside the usual spectrum of a little muffled hearing or crackling sound after a dive with difficult equalization, it's well worth getting an exam from somebody who does ear work on a daily basis.

 

[TechDeep]

I have to say when I was writing my post, I figured I would get some useful information, but you guys far exceeded my expectations. Thank you very much.

I suspected there must be a mis-diagnosis involved, because from what the ER nurse practitioner was saying, I should be doing much better by now, and after the whole bottle of antibiotics is gone, there is basically no change in my symptoms. And I mean no disrespect toward nurse practioners. My sister happens to be one, and I know what she went through to achive that.

I also know the importance of having access to the proper medical equipment. My lifes work for the past 30 plus years has been field service of medical imaging equipment for crying out loud. I suppose there could have been a barotrauma that I simply didn't notice. I was divemastering with serval classes, one of which included a 75 year old open water student. I have the utmost respect for this gentleman, I hope to have his spirit and zest should I be fortunate enough to reach his age. The simple truth is that this particular weekend did involve more than the usual amount of trips to the surface from 20-30ft.

Thanks in no small part to the response here, I am going to make an appointment with the ENT that can see me the quickest, and go from there. I will keep everyone posted as I would like to be helpful to others now and in the future who may be suffering the same way I am, and happen to stumble upon this thread.

My major concerns in order of prioity are:
1. My long term hearing. My hearing is very important to me. My son is just turning 5, and I want to be able to hear him when he asks for a hug as he is wont to do.
2. Being able to continue diving. I'm not going to be overly dramatic, but being told I'm done would be a major adjustment that would involve grieving.
3. My Labor Day weekend trip to the Keys. Seems trivial, but it's been something we had been planning for a while. Would hate to miss it, but 1 and 2 come first.

Thanks again everyone, hoping for the best.

 

[doctormike]

Thanks, Mike! BTW, to those reading this thread, I am an ER doc, and I wholeheartedly agree with Mike's assessment that generalists are not trained or in most cases provided with the equipment to do a really thorough examination and diagnosis of ear problems.

Thanks for understanding my tone, Lynne... always hard for me to bring that point up without sounding like a jerk...

As you know, I continue to be in awe of all of your mad skills - medical, diving and moderating!


TechDeep, feel free to keep us posted once you have had your ear exam. Good luck!

Mike

 

[TechDeep]

I saw the specialist today and by sheer coincidence, he's an avid diver! He told me he has had difficulty equalizing since he started diving many years ago. I feel really fortunate that this has not been a problem for me. He also had several interetsing diving stories.


He did a thorough examination. He gave me a clean bill of health, and a big OK to resume diving! He said my heariing is also normal. He said from my symptoms he has no doubt that I did have a blockage, probably due to an infection. He said he could see no evedence of a punctured ear drum but if I did have one, it had totally healed. They did do the pressure test among others. I told him my symptoms has greatly subsided, and he said he often has that effect on people. Well what do you know, a sense of humor!

So, good news for sure. Thank you to everyone who responded to thsi thread, I hope it helps someone in the future that may be suffering and looking for information as I was this past few weeks. I know you kind folks sure helped me more than you know. And to anyone out there who may happen to live in southeast Virginia and have a need for a great ENT who also happens to be a diver, Dr. Lyle in the Obici professional building in Suffolk is great! I know I'll be calling him whenevr the need may arise for me or my family.