Diving with ear tubes

[doctormike]

Hi,

I'll take the opportunity (literally between ear tube placement cases!) to chime in here...

1) All sorts of people will have anecdotes about all sorts of things that they did or did not get away with (and usually, the problems are underreported). So I wouldn't substitute other peoples' experience for an understanding of the actual anatomy and physiology involved in the situation.

2) Think of the middle ear as a box, connected to your airway by the Eustachian tube (ET). Unless you are using that Pro-ear mask, the ET is the ONLY source of added gas during a dive to the ears, so that is why you need to be able to have functional ETs to pressurize the middle ear during descent. If the ETs don't work, having a vented plug wont be able to add gas to the middle ear or ear canal, since there is water on the other side of that vent. They will only be able to let gas escape from the ear canal (or middle ear, if there is a tube or a perforation) during ascent, and the vent may prevent the plug from being forced into the ear canal during descent, although the shape of the plug probably has more to do with that then the vent hole.

3) I know that a lot of people have good luck using the Pro-ear mask. I haven't had the opportunity to try it out myself, but it would seem that you are depending on this system for a basic requirement of diving, and it wouldn't take much in terms of the cups getting displaced or leaking, or the tubes malfunctioning, etc.. to put you in a bad situation if you had ear tubes. That's all that I will say about it, and I see that even this company doesn't recommend it for use with ear tubes.

4) People get tubes for one reason only - because their ETs don't work. That is what they do, that is why they are called pressure equalizing tubes. They bypass a dysfunctional ET to ventilate the middle ear. So I'm not sure how someone who needed tubes would be able to reliably get air through their ETs in any case. And of course, there is a bell curve for everything, and I'm sure that there are people who have tubes for odd reasons or who have partially functional ETs who dive with tubes, etc… I'm just talking about the basic physiology and anatomy of the system here. There are people who dive deep on air and have great stories as well.

SO, I'm gonna go with TSandM's point about the dangers of diving with plugs and tubes, and also with DocVikingo point about not using an unvented plug to dive with tubes.

There are very few people of diving age who still need tubes - the ET generally matures by age 2-4 (is PADI training kids of that age yet?). This is truly the tail end of the bell curve, the people with the worst ET function, who may need ear ventilation into their teenage years and beyond. I hate to say it, but I really couldn't recommend diving in that situation. Maybe reassess if the tubes are still needed, get them out and then dive if equalization is OK.

And please, all you people who dive with ear tubes, don't flame me for this. I'm sure that you have worked out some solution, but it's just not something that I would feel comfortable signing off on. There are a lot of problems (more than just ear infections) that can happen when exposing the middle ear space to sea water at a few atmospheres of pressure...

Hope that helps…!

Mike

 

[DocVikingo]

Hey Mike,

Thanks for responding to my request to comment. You're a peach.

For a bit there I'd argue that abstaining from doing harm was being disregarded.

Regards,

Doc

 

[doctormike]

Hey Mike,

Thanks for responding to my request to comment. You're a peach.

For a bit there I'd argue that abstaining from doing harm was being disregarded.

Regards,

Doc

Yup... as they say - primum non nocere...!

And as Tim Sidell says - "Using Latin words to make myself seem smart is my modus operandi"

Mike

 

[duke dive medicine]

if you have tympanostomy tubes, which is what it sounds like you have, you would not ear plugs that are vented. you would want a solid plug that would keep all water out. I would recommend going to a DAN affiliated ENT specalist and they can make you custom plugs that will be much more comfortable and give you a better seal
(these are mearly my opinions and I recommend you ALWAYS get advise from your personal physician when dealing with any health care questions)

Concur with DocVikingo, TSandM, and DoctorMike. If one considers the physics involved and the indication for PE tubes, this is an exceptionally bad idea and could lead to permanent injury.

as long as you have tympanostomy tubes in place you would equalize be able to equalize through the TM tube hole (I actually discussed this very issue with a DAN certified ENT and he agreed that with tympanostomy tubes you can only dive with solid plugs or one of the air ear mask things) but like I said earlier I recommed that you get advise from a DAN certified ENT (like I did) before you do anything. I am not a doctor I just play one at work all day long so what do I know? oh just a few years of medical school may have given me some insight to some stuff!

DAN does not certify ENT physicians as such. They maintain a list of affiliated physicians who have met their criteria for diving medicine training and who agree to see divers, and I don't know of one who would make a recommendation to use solid ear plugs for diving. If a person has PE tubes, as DoctorMike pointed out, his or her Eustachian tubes are not functioning properly and therefore cannot be used to equalize the middle ear. An ear plug in an ear with a PE tube would just make the unequalized space bigger, with the added danger that the diver would not feel the stress on the tympanic membrane that typically signals a pressure differential in the middle ear. Again, this could lead to severe, and possibly permanent, injury.

 

[DocVikingo]

Concur with DocVikingo, TSandM, and DoctorMike. If one considers the physics involved and the indication for PE tubes, this is an exceptionally bad idea and could lead to permanent injury....DAN does not certify ENT physicians as such. They maintain a list of affiliated physicians who have met their criteria for diving medicine training and who agree to see divers, and I don't know of one who would make a recommendation to use solid ear plugs for diving.

Hey DDM,

Thanks for responding to my request to comment. You're a real Scuppernong grape.

I was quite sure DAN did not "certify" their diving medicine doctor referral base.

Regards,

Doc

 

[hbhobby]

Obviously the ENT was not a certified by DAN. It is a certified ENT that was recommended to me specifically by DAN. Therefore it was a DAN certified ENT. Just like I am a Gila County certified dive team member. not that I am certified by Gila County but I am associated with them. And once again just to reiterate what I have said from the beginning I recommed that you get advise from DAN (like I did) before you do anything using a certified ENT who is recommended to you by DAN
That is what I did and we had a lenghty discussion of diving with tympanostomy tubes (that is a hole in your ear drum and a piece of plastic tube inserted) and only using a solid plug when doing so, not a vented plug or no plug. If I can equalize my ears with an intact ear drum I'm pretty sure I can do the same with a hole in my ear drum and a plug on the other side but once again just to be clear I recommed that you get advise from a DAN certified ENT (like I did) before you do anything

 

[doctormike]

Obviously the ENT was not a certified by DAN. I thought there was a level of education that I was delaing with (apparently I was wrong) it is a certified ENT that was recommended to me specifically by DAN.

Hmmm... I'm pretty sure that most people who read "DAN certified ENT" would assume that the the ENT doc was certified by DAN. Like "PADI certified diver" or "Board certified otolaryngologist". Since we have a DAN representative here who also corrected this usage, I think that you might want to rethink your phrasing. It implies something which is not true.

if I can equalize my ears with an intact ear drum I'm pretty sure I can do the same with a hole in my ear drum and a plug on the other side

1) Not necessarily. If a person with ear tubes can equalize his or her ears, why do they have the tubes?

2) Even if equalization is possible, we previously discussed the risks of exposing the middle ear (and the stapes footplate, to be precise) to several atmospheres of sea water if (or when) the plug fails.

 

[DocVikingo]

Hmmm... I'm pretty sure that most people who read "DAN certified ENT" would assume that the the ENT doc was certified by DAN.

Amen, Brother Mike. Acccording to accepted rules of logic and of the English language, a "DAN certified ENT" means an ENT certified by DAN

Regards,

DocVikingo

 

[bdombrowski]

After having a damaging middle ear infection that lead to 5 ear surgeries, including 3 full tympanoplasty operations, I could write a book on diving with a perforated ear drum. I will summarize a few I things I learned from my experience as a diver with a perforated ear drum. (Take it for what it's worth. I'm not a ENT, I'm an engineer and passionate diver.)
1) Find an ENT who is a diver and make your passion to continue diving clear them. Otherwise they will tell you "you shouldn't dive anymore" w/o giving much thought about it. They are covering their butts. My first two ENTs were not divers. My last one was... and he ultimately achieved success in repairing my ear drum permanently.
2) I found it is possible to dive with a perforated ear drum, but you must be extremely careful to keep the water out of your middle ear, otherwise you will get severe vertigo (possibly life threatening) and nearly guaranteed to get a subsequent infection. I had a perforation from 2005 until 2009, and made hundreds of dives with the Pro Ear IST mask. There were times when I backed it up with a plug made of silicone putty but only when my perforation was large enough where I could vasalva and push air through my eustachian tube, through the perforation, and against the inside wall of the silicone plug. If you can vasalva and blow air out your ear, this configuration will work. However, I don't know if any ENT would ever give you written permission to do this. It worked for me and simple physics explains why it works. (You NEVER want to do this with an intact ear drum for reasons that should be obvious.)
3) I have a reconstructed and intact ear drum today, and continue to dive using the Pro Ear mask as a precaution to keep most all water out of my ears. If you properly learn to use this mask (with the over top head strap) it works well and is very reliable. The trick is to center the cups around the ear by moving them around and make sure the edges are not curled over anywhere around the perimeter of the ear cup. You have to practice with it. It's become second nature to me, and I've been using it heavily for 6 years now.
4) If you need a tympanoplasty, find an ENT who specializes in doing a lot of them and uses fascia from under your scalp, *not* skin from your arm. Do your research and ask lots of questions.

-Brian