Diving Modification For Weakened Ear Drum

[altsaint]

Hi - newbie Scubaboard member here, but not newbie diver. I’m 61 and have been scuba or freediving for all but the first eight years of this. Up until 9 months ago, the only issue I have been having has been the onset of age-related hearing loss, and gradual worsening of Eustachian Tube Dysfunction. The latter impacts my equalisations in that it takes a bit more pressure on descent to open my right ET.

Ten months ago I had an RHS reverse ear block when ascending on a scuba dive. The eardrum ruptured. Examination showed that the perforation was very small and it healed within a month, although I stopped diving until last month.

When I started diving again, after several visits to an ENT specialist / GP / audiologist, the advice was to continue diving but use a steroid spray (Mometasone Furoate) as a precaution. I did this, and also took more care to equalise more regularly on descent. Everything was fine for the first day of three dives to about 25 metres. On the first dive of the 2nd day I noticed a slight discomfort in my right ear after a back-roll from the boat, but equalisations to 20m were fine. After a few minutes remaining at this depth, I felt a movement within the ear, and a sensation of cold water ingress. A gentle equalisation resulted in air exiting my right ear - I had again perforated it, but this time without an obvious cause. A GP investigation revealed that the perforation must again have been small, as 11 days after the event he could not locate it.

I must conclude that my right eardrum has a weakness and I need to dive differently to avoid further ruptures.

What I am looking for now, is an understanding of what other divers do, who have had a similar experience, in terms of limiting no. of dives / depths / durations or any other mitigation. I’m sure some will say, “see your ENT specialist”, but I have already done this and both I have consulted have not been able to relate any advice to the practice of scuba diving. I have also looked (in the UK where I am based) for a combined ENT specialist / diving doctor, but not found such a person. So I am therefore wanting to know the practical experience of others. I have looked at similar threads here, but if I have missed one where someone has had the same question answered, I’d be grateful for a link! I also put a lot of value on the advice @doctormike has given on similar threads, so if he has time to comment that would be well-received too.

[Specific questions added on 09 Apr 23]:

1. Do frequent repetitive equalisations stress the eardrum enough to the point that a previously ruptured eardrum may again rupture?
2. Has anyone experienced an eardrum perforation, and then made modifications to the way they dive that have prevented it happening again?

Thanks in advance.

 

[Angelo Farina]

First, follow guidance of your ENT specialist.
Second, get rid of crap and dangerous Valsalva. There are many better equalising methods, more gentle and safer: Toynbee, Frenzel, Marcante-Odaglia, BTV, Lowry, etc.
Third, evaluate switching to the Scubapro Pro Ear mask: with its pressure-compensated earcups it avoid ingress of water into your ear channels, while allowing proper equalization.

 

[altsaint]

Thanks Angelo. What I didn't mention on the original post, is that my ENT specialist did not give me good advice in the fist place. He went to great lengths explaining the trilaminate structure of the TM, and then said that scar tissue on the outer layer improves the tensile strength and helps to avoid future ruptures. From what I have now read everywhere else is pretty much the reverse of this! Hence me posting here.

BTV is not possible due to my ETD. When I was a competitive free diver I tried everything I could do achieve this, but it doesn't work with my physiology. But I do think I can make improvements with making equalisations more gentle, so will look into that. BTW, I know I said I used valsalva on the original post, but I used that term as it is more well-known. I actually use Frenzal from my freediving days, never Valsalva. Sorry to be misleading there.

I'm weighing up the idea of the pro-ear mask, but not sure it will actually prevent further rupture. Admittedly it will stop water getting in, which is a plus.

Thank you for your reply.

 

[MB NZ]

You have my sympathy. In brief, I had horrendous problems with "glue ear" and grommets as a child, then did some stupid things as a teenager which resulted in multiple perforations of my right ear drum which followed me in to diving. In 2010, it culminated in yet another perforation that wasn't going to heal. Fortunately for me, I am in the business of medicine and spoke to a friendly ENT who performed a myringoplasty. In subsequent years, I was diving at every available opportunity and had no further problems. My diving has eased off a bit of late, but 13 years later and my ear drum remains intact, although I am cautious on descents (as we all should be).

The difference between my situation and yours is that my underlying pathology (i.e. glue ear) went away, whereas your pathology (i.e. ETD) sadly remains and is worsening. The blanket advice would be to stop diving. If you're not prepared to do that, then you risk further ruptures, vertigo underwater and middle ear infections. Other than very careful, slow descents, I don't think changing the way you dive is going to help. As you know, the greatest pressure changes occur at shallower depths. You could think about a Pro-Ear mask. I dived with one for many years due to my problems. I'm not convinced they make equalisation easier, but in the event of a perforation, will keep water out of the middle ear which causes the problems I mentioned. That said, Pro-Ear masks have to be setup properly and even so, do leak occasionally.

 

[altsaint]

MB NZ - thanks for the reply, and good to know you have overcome your ear issues.

Although my ETD isn't getting any better, I can at least manage it with caffeine and nasal sprays - both make an improvement, but I am left with the issue that a bit more pressure is needed to open up my right ET. If that extra pressure is too much stress for my right eardrum to cope with, then I may have to abandon hope. However, I still feel that there is room for improvement with a gentler equalisation technique, and I'm keen to try that.

The idea of limiting depth / duration / frequency is just that reducing each (including depth) means I reduce the number of equalisations I have to do each day. Therefore hopefully reducing the stress on the membrane. Or am I just delaying the inevitable?

 

[MB NZ]

Are you delaying the inevitable? I don't know and doubt that anyone, doctor or diver could tell you for sure. I know that's neither very helpful, nor what you wanted to hear, sorry.

 

[altsaint]

Are you delaying the inevitable? I don't know and doubt that anyone, doctor or diver could tell you for sure. I know that's neither very helpful, nor what you wanted to hear, sorry.

Still helpful. It seems to me that my previous ENT consultant told me something I did want to hear. That was much more unhelpful.

 

[VikingDives]

It seems that the rupture and the bubbles should have different causes and are possibly unrelated. Perhaps a call to DAN Europe for a recommendation on an ENT with more diving experience?

You may also want to try some alternate clearing methods.

6 Methods to Equalize Your Ears

All methods for equalizing your ears are simply ways to open the lower ends of your Eustachian tubes, so air can enter.

dan.org

In my experience, cold water causes many more issues than warm water. There are some people that swear by these:

Doc's Proplugs - First Time User

First Time User

www.proplugs.com

but I have no experience with them. Good luck!

 

[altsaint]

It seems that the rupture and the bubbles should have different causes and are possibly unrelated. Perhaps a call to DAN Europe for a recommendation on an ENT with more diving experience?

You may also want to try some alternate clearing methods.

6 Methods to Equalize Your Ears

All methods for equalizing your ears are simply ways to open the lower ends of your Eustachian tubes, so air can enter.

dan.org

In my experience, cold water causes many more issues than warm water. There are some people that swear by these:

Doc's Proplugs - First Time User

First Time User

www.proplugs.com

but I have no experience with them. Good luck!

Thanks VikingDives, although I can't see how the perforation and bubbles coming out aren't related. There was no more equalisation - all the air I was pushing through my ET was coming out of my ear, however small the rupture may have been.

Both ruptures were in warm water (28 degrees C) or thereabouts.

I did contact DAN about a week ago, and they were helpful, but said, "Diving ENTs are actually rare, and unfortunately, we are not aware of any within the UK".

I'm cautious about proplugs - they have a small hole to let water in and if that gets blocked by wax or something, I'd worry about an external ear squeeze. Happy to be challenged on that though.

 

[VikingDives]

I should have more coffee and brush up on anatomy before posting, because clearly the bubbles seem to be related to a rupture.

I'm cautious about proplugs - they have a small hole to let water in and if that gets blocked by wax or something, I'd worry about an external ear squeeze. Happy to be challenged on that though.

I have friends/acquaintances who have used them and claimed that they were helpful in cold water. It could all be a placebo though. I'm not sure they'd serve much purpose in 28c waters.