How'd I screw up my ear drum?

[CWC]

A few days ago I was descending during a tec dive in Rock Lake, NM. We paused our descent at around 30' to switch from travel-gas to back-gas, and then continued down. I was feeling great, and having no problems clearing my ears. At around 150' I felt a strange feeling in my right ear, like cold water running into it. A few seconds later I was hit with intense vertigo, causing me to abort the dive.

I knew that this was most likely a perforated eardrum, but had some lingering doubts because I didn't experience any pain or pressure when it occurred. I went to an ENT doc today. She confirmed that I had suffered a "pinpoint" hole in my eardrum, which was already healing nicely.

So, my reason for posting this is to try to figure out why this happened. I am very lucky that it happened close to our descent line, with no deco obligation, and with a very competent dive team to look after me. I want to figure this out to make sure it doesn't happen again. Here's some more details and thoughts:

I am aware that you can damage an eardrum by not properly clearing, or clearing to forcefully, but neither of those happened. I was feeling fine, and experienced zero pain. It was a complete surprise when I felt the water start to trickle in.

Four weeks prior to this dive I was on a dive trip with a bad head cold. On the flight to get there my ears would not clear as the plane was descending. I used Sudafed and Afrin to clear myself up enough to equalize my ears. I then did 10 dives over four days, using Sudafed and Afrin to try to relieve some of the congestion. I was able to clear, but not as well as usual. There were several times I had to clear more forcefully than usual, and experienced ear pain.

Could I have damaged the eardrum on the dive trip a month ago, leading to it finally giving out this past weekend? That sounded reasonable until I remembered that I made several dives the week after returning from my trip, with no problems. If it was going to flood it should have been then.

So, anyone have any thoughts about why this happened? Has anyone heard of an eardrum rupturing without feeling pain? I'd appreciate any feedback or advice you guys have. Thanks!

 

[scubadada]

I had a very similar thing happen to me toward the end of a dive trip in September. I usually have no trouble equalizing and generally do not have to take any specific measures on descent. On the 2nd to last day, I was descending at a normal rate to tie into a wreck at about 100 feet. Just before tying in, without any pain or discomfort, I had the sensation of water rushing into my left ear, followed by vertigo. With difficulty, I was able to make the tie in. The vertigo cleared over the next several minutes and I completed my dive. On the second dive that day, and 2 the next day, I had a similar sensation of water entering my left ear and mild vertigo that passed quickly.

I also assumed I had perforated my eardrum but did not seek medical care. I did not dive for a little over a month. When I resumed diving, I had no recurrence of the sensation of rushing water or vertigo. I probably also healed a small perforation. I do not understand why it happened on that specific dive nor what I can do to prevent it from happening again. I have occasionally had difficulty equalizing when I dived with an upper respiratory tract infection, had some discomfort, but have not had any previous injury that I'm aware of.

I'd be interested if someone can shed additional light on what happened to us and why, maybe a diving otorhinolaryngologist

 

[Dan]

It happened to me in my 1st dive vacation trip (11 years ago). I felt water inside my ear that just couldn't drain out probably for the whole month.

One of my experience dive buddy told me to equalize every 3' (1m) descending, regardless you feel the pressure or not, because sensitivity of feeling pressure varies from one person to another. Your eardrums are already flexing, stretching & stressing enough then. Cold temperature can lessen the sensation. You could also be distracted or preoccupied by the tasks or action underwater, like when you shoot a gun, the sound may not be loud when your focus on the target. Once I start doing that to the point become a routine. If I can't equalize my ears then, I thumb the dive. I have no more ear problem since (for 11 years so far, knock on woods).

 

[DocVikingo]

Bummer, CWC.

Answering the easiest of your questions first, pain generally accompanies rupture of the tympanum, but by no means always. Moreover, some diving-related perforations manifest no immediate signs/symptoms whatsoever.

Tympanum perforation sustained in the absence of identified improper equalization can sometimes be a function of an eardrum that is already compromised, such as by previous injury/disease. This compromise may have occurred relatively recently (such as on your dive trip of about a month ago where you apparently had significant difficulty with clearing) or date back to a considerably earlier time.

As to why your event happened exactly when it did, we well may never know.

Heal quickly.

Regards,

DocVikingo