Diving after Tympanoplasty

[helen67]

Hi everyone,
I just returned from a 5 week dive trip and blew my ear 3 days before we were leaving. This is the 3rd time this has happened so I think its time to have the tympanoplasty surgery. The first time it ruptured I didn't know since I had no pain but felt bubbles coming out of my ear and continued to dive with no problems. The second time I did have severe pain coming down my jawbone. This time, just bubbles and no pain but I aborted the dive. Each time it ruptured, it was from just jumping in the water except this last one happened at 8 feet as I went to equalize. It's been 4 years since I've ruptured my eardrum, always been careful with my ears and equalizing BTW, it's always the same ear that ruptures and I did have tubes often as a kid so I think that has contributed to the issue. The other ear is fine, occasionally it gives me problems but I just go slow, wait it out or go up to get it to equalize until both ears are good.

So the ENT, a few years back, said he can do tympanoplasty and rebuild the eardrum with new tissue. So my question is, how successful is this type of surgery? I REALLY love diving and want to be sure I'm making the right choice in terms of how to resolve this issue.

How long would it take to heal? How long should I wait before diving again? Does anyone have any ENT recommendations in the Boston, MA area? I'll call DAN to ask as well but just want to get additional input.

My next trip is in November but I'll pass on diving but I want to be good to go for my annual February trip where we dive a lot during the 5 week vacation. If anyone has any experiences, suggestions or any information that would be useful, I'd appreciate your input. Thanks everyone

 

[Duke Dive Medicine]

@doctormike is our resident ENT specialist, I've tagged him here. Meanwhile, considering that you've ruptured your eardrums three times while diving, can you describe how you equalize your ears?

Best regards,
DDM

 

[fmerkel]

Either:
1. you are not doing a good job of clearing, though it sounds from your description that you are being careful.
2. you have damn fragile eardrums

Most people are in category 1.
I do have a very experienced friend that is in category 2. She went to a Pro-Ear mask and that did the trick for her.
Can't help with recovery from that kind of surgery. You could look into the mask as a potential solution.

 

[Duke Dive Medicine]

Another alternative is that the OP has some form of Eustachian tube dysfunction. If @helen67 is equalizing properly then it would raise the index of suspicion for that as well.

Best regards,
DDM

 

[doctormike]

Not sure exactly what is going on, but the story sounds more like just a non-healed perforation that occasionally becomes symptomatic, rather than recurrent perforations (suggested by the depth, etc..). But it could also be a poorly healed but intact eardrum with poor equalization, as DDM suggested.

In any case, the success rate of tympanoplasty really depends on a lot of individual factors. For a small perforation with good ventilation of the other ear, the success rate is probably over 90%. For a large, chronic, draining perforation with ear disease on the other side, the success rate is much lower.

As far as time off from diving, etc... that is something that depends on the specifics of the case, so it's not a good idea to make any decisions based on the experience of other people online. There is a lot of variability in these cases, and you need to get specific answers from your surgeon who has had the chance to examine you and who will be doing the operation.

Lots of great ear specialists in Boston, this is a good place to start looking.

Good luck!

 

[gert7to3]

I have had a tympanoplasty. While it worked and I could dive with it, it just wasn't as strong. I use a Pro-ear Mask as insurance now.

Docs-Pro Plugs, a vented silicone earplug for diving, is another product which may help. It won't keep all the water out, a small drop will go past the vent at 30 ft./10 metres. However, they keep most of the water out and water won't be sloshing in on the surface. You can even use both in case the ear cup becomes dislodged or leaks for some reason.

 

[helen67]

I've been clearing my ears by using the Valsalva Maneuver, moving my jaw or by swallowing. I always pop my ears before getting in the water to make sure all is good and listen for a click when swallowing. If I can't equalize on land, then I don't dive. I also descent feet first and when I jump in, I block the bad ear since it's ruptured a few times by just jumping in the water. The first time I blew my ear, it was my fault but since then I've been VERY careful. Sometimes the bad ear equalizes with no problem but the good ear doesn't and vice versa, so I just wait it out and ascend until everything is good. I do have Eustachian tube dysfunction on the bad ear from what my ENT said. I think the root cause is that I've had tubes numerous times in my ears as a child that it just weakened the ear drum and the ETD too.

 

[helen67]

You've had the surgery and its just not as strong, do you still get a perforated ear drum? Is that why you use the Doc's pro ear plugs so you can dive with a ruptured eardrum?

 

[BGWOJ]

Hi,
From what my ENT doc told me the surgery isn’t normally very successful (for diving). The “new” skin they put in is too rigid & doesn’t flex enough when equalizing so will normally end up rupturing again. I’m no doctor, this is just what I was told!
My eardrum was destroyed after I was struck by lightning & I was told I’d probably not be able to dive again. After advice from fellow divers & people on this site I bought the IST Pro ear mask & DocPro earplugs. Be very careful when buying the plugs as they come in various different sizes and you need to get the exact one to get the best seal. Also they sell vented & non vented, make sure to get the vented ones! The IST Pro mask has worked very well for me although I’m looking into transplanting the ear muffs & tubes onto my normal mask. I highly recommend it. I hope this helped!

 

[doctormike]

Hi,
From what my ENT doc told me the surgery isn’t normally very successful (for diving). The “new” skin they put in is too rigid & doesn’t flex enough when equalizing so will normally end up rupturing again. I’m no doctor, this is just what I was told!

There are a lot of different ways of doing tympanoplasty, and I'm not an otologist, so I might not be up on the latest techniques. But bascially, it's not a question of replacing or reinforcing the TM with something else. The idea is that you put some sort of scaffolding up that helps the natural eardrum grow back. Once the TM is healed, the scaffolding (usually fascia, which is sort of a tough layer that covers muscles) goes away. So people with fully healed TMs can often equalize successfully. Of course, there is a bell curve for everything!