Eardrum rupture during CESA

[Catherineskii]

Alas, the subject title says it all.

To clarify, I did the CESA as part of my PADI certification - it was my third OW dive, ever. On ascent - about 10 ft from the surface - I heard a small 'squeal-POP!' and was suddenly overcome with vertigo. Luckily, my Instructor was right with me and held onto me as I surfaced. The vertigo passed immediately, and I didn't feel any pain or notice any blood at all, so I actually had no idea that I had ruptured the eardrum at that time. I just figured it was particularly vigorous equalization 'pop'; and I put the vertigo down to just disorientation/dizziness due to lack of oxygen. So - albeit a little shaken up - I did another dive later on that morning, to 60ft. I completed my certification later that day.

I noticed that my ears were blocked after the dives, however I assumed I had just accumulated a little water in my outer ear (not unusual for me). So I put a few drops of alcohol in my ears for a few seconds to dry them out, followed by a cleanse with some vinegar and alcohol, just to be doubly sure that my ears were clean and free from infection. After a couple of days, however... I noticed that my right ear just wasn't clearing - although it was popping and squeaking fairly frequently. It just felt... different to the left ear. Still, no pain, or blood or discharge of any kind. So I waited one more day (3 in total since the incident) and then went to see the Dr. Who broke the news...

Unfortunately, I have what is known as an 'attic' perforation - meaning, it's located at the top of the eardrum, near to the bone. These kinds of perforations are notoriously tough to heal, so it's likely I might have to have Tympanoplasty. However the Doc asked me to come back in a week to assess if any healing had taken place: the rupture is relatively small (2mm) and so it's possible it might heal itself. Fingers crossed! It still doesn't hurt at all, and the only real discomfort is my feeling like I'm talking with my head in a bucket. Plus, I'm convinced I can hear the wind whistling through the hole into my head! It's a little unnerving, to say the least.

What's most frustrating of all about this incident is that I was SOOOO careful with my ears, during all of my pool & OW dives. I'm naturally a pretty cautious person, and I've spent a lot of time on this forum over the last couple of weeks, researching different equalization techniques. I took the 'equalize early and often' mantra very much to heart! It took me a quite a long time (about 10 minutes) to descend to the 25ft starting point of my CESA practice, and it's possible that I was a bit to forceful in my equalization towards the end, but I didn't feel any discomfort once I reached the bottom. Upon ascent, I exhaled continuously, as instructed.... I feel like I did everything I was supposed to, in fact - yet my eardrum still popped!

The only thing I can think of is that, in addition to maybe being a bit too forceful during equalization; I was slightly congested due to a cold the previous week. I didn't FEEL congested, and it had been a few days since my cold passed, but maybe there was still some residual blockage that I just wasn't aware of. A couple of days after this dive, I developed ANOTHER cold - so perhaps I was between colds, or perhaps the initial cold never went away.... I'm not sure. Either way, it's all a bit disheartening, and it's likely that I won't be diving at all for quite a few weeks.... if ever again. To be honest, this whole incident has kind of put me off diving entirely

Any thoughts or feedback would be welcomed. Thanks

 

[TSandM]

Oh, what an awful end to your certification work!

I would be willing to bet that the reason this happened is that you had residual congestion. What you said about working hard to equalize on the way down was a clue -- When you have to work that hard to get air through the Eustachian tube on descent, a rapid ascent such as a CESA has a higher likelihood of being problematic.

I hope your eardrum heals well, and I hope you don't give up on diving. You have unfortunately learned an important lesson in about the most costly way possible, which is that diving when there's any question of congestion should be approached VERY cautiously, and any problems equalizing going down should probably suggest aborting the dive.

I hope a lot of people read this, because this is the risk one is taking when one medications a cold with decongestants in order to dive. If they wear off or aren't effective, you're stuck at depth with no ability to equalize, and a ruptured TM is the likely result of an ascent carried out with blocked Eustachian tubes. One sometimes gets the idea here that a ruptured TM is no big deal, because they heal, and it's true -- the majority do. But some, like the OP's, can be much more problematic.

 

[TwistedGray]

Well I think you answered the question I was going to post.

I finished my open water dives (for certification) last Thursday and my left ear feels the same as you described your ear however not as bad...

It acts as though it still has water in it or clogged and there is no discomfort. What did they say would happen if it didn't heal itself?

 

[AbyssalPlains]

Sorry to hear that your certification went the way it did. But like TSanMan said, don't let that deter you from diving! Some kids when they learn how to ride a bike (like me) crash hard first. Look at it as a lesson that will spare you from going through that experience later on. I hope you drum will heal fine by itself. Thank you also for posting a detailed account of your experience. I'm having iffy ears myself, too, and reading accounts like yours really help me understand better the do's and don'ts of diving when it comes to ears. What was a huge red flag to me was when you said it took you ten (!!!) minutes to do a descent that should not take more than a minute under normal circumstances. I recently experienced a sinus squeeze for the first time, and tried to do a second dive regardless. Didn't work, any change in depth was painful. I am a very cautious person, like you, and thus have a tendency to talk myself into doing something against my better judgement, because I tell myself "Come on, you're always way more cautious than most people, so don't make it a bigger deal than it is." So in that case, I forced myself to dive despite the sinus squeeze. But I learned from it and now I don't dive if there is even the slightest hint of a problem with my ears or sinuses. Again, thanks for posting and all the best.

 

[AbyssalPlains]

Well I think you answered the question I was going to post.

I finished my open water dives (for certification) last Thursday and my left ear feels the same as you described your ear however not as bad...

It acts as though it still has water in it or clogged and there is no discomfort. What did they say would happen if it didn't heal itself?

You may have a mild barotrauma without actual perforation. I've had those numerous times. Ear feels stuffed up for a few days, then usually goes away. However, I strongly suggest you see an ENT to rule out a perforation.

 

[RonFrank]

Hmmm, Bummer!

Give your ears some time to heal. See an ENT to make sure you did not do more damage than you think.

When you feel better, try another dive. Make sure you do NOT have any congestion/cold symptoms before you dive again.

 

[DeltaWardog]

TwistedGray: I had a similar feeling in one ear after my certification dives. Felt like I had water in my ears but I couldn't get it out no matter what I tried. Turns out I had actually inhaled some water that went backwards up my eustacean tube and was sitting behind the eardrum. (Ta daaaa!)

Doc told me to take sudafed for a week to open up the pathway and allow the water to drain. Worked like a champ.

Go see your doc, let them figure it out.

 

[muddiver]

I can agree with TsandM on the residual blockage. I have had to and also not-had to dive after having a cold. If I don't wait long enough it will force some of the draining fluids back into the ear and "presto" I get a second cold. So I feel for you, been there, done that , gat a Tee shirt.

 

[BrianDiver]

Good luck on healing and I too hope you don't give up on diving. Its really a great way to spend some time.

I had an ear drum get ruptured in a karate tournament badly enough that I could breathe through it (I did win the match). Thankfully it fully healed and I've been diving ever since. I did have to cancel a trip though, but small price to pay. Some antibiotic drops and some mild packing with cotton to keep the air from flowing through the hole and allow it to heal.

Take care and good luck again.

 

[Catherineskii]

Thank you all for the feedback. Based on some of your comments (thanks, TSandM!) - and my own suspicions - I think that I must've been just very slightly congested after my cold, which caused my inability to fully equalize and subsequent rupture on ascent. But... damn!! Any congestion I did have was so subtle! I mean, subtle enough to not even notice. I felt better than I had the previous week, I felt fine, so I decided to dive....

Unfortunately, my complete lack of diving experience really didn't give me any kind of 'gauge' with which to assess my ability (or lack thereof) to equalize.... I mean, it wasn't as if I could say "Hm, well THIS is taking longer than usual, I'm having some trouble here. Maybe I should abort?" - because there WAS no 'usual'! I just assumed - wrongly, it turns out - that I had more trouble equalizing than others in my group because - well, it's different for everyone, right? Some people just have to take it slower than others, period.

Pteranodon: I can completely related to your tendency to talk yourself into doing something against your better judgement, re: "Come on, you're always way more cautious than most people, so don't make it a bigger deal than it is."! That's me, all over. I should've just quit when I couldn't equalize within the first 5 minutes or so but... well, I just figured I needed to work harder and concentrate, and not give up so easily! I guess I paid the price for that one

For those interested, I'll keep SB posted on my progress (or lack thereof, hehe).