Question Open eardrum diving

[Angelo Farina]

With ET function, you mean the eustachian tube function? What's the reason that influences tympanic membrane healing after tympanoplasty?

If the Eustachian tube is blocked, you cannot close the open eardrum.
The medium ear must be vented in some way. You cannot leave it entirely airtight.
There is a possibility that 25 years ago the ENT decided to leave the open hole in your eardrum because the Eustachian tube was blocked.
So, before closing it now, it is necessary to check if your tube can allow air to pass.
This is easy to check: just perform a Valsalva manouver and see if air blows outside your ear.
This is actually what was invented by dr. Valsalva: he did practice an hole in the eardrum, ask the patient to turn the ear downwards tilting the head, and blow out all the putrid liquid trapped inside.
But, again, @doctormike can explain this better.
I just heard this story of the born of the Valsalva manouvre told by dr. Odaglia, during a seminar when I was being trained for my first instructor degree, in September 1978, in Nervi (near Genoa).
He did also explain in detail the anatomy and physiology of human ears, and the various equalization techniques known at the time, starting from Valsalva and going through Toynbee, Frenzel and his own modification of Frenzel, known as Marcante-Odaglia.

 

[drrich2]

The ProEar mask sounds promising, but I agree you need to be able to tolerate water coming in the mask and in your ear...

Yes, that's one of the skills you have to demonstrate (at least in the mainstream recreational dive train I've read of - PADI by experience) in the pool and open water check out dives; mask removal.

Since the eardrum is open, I was thinking perhaps pressure in the ear is always equalized?

It's my understanding people who've had an ear drum rupture during a dive described strong vertigo, which I imagine could be quite disruptive. Then there's the infection risk from microorganisms in the water.

Scuba diving is already a multi-tasking experience. You need to monitor your depth, be mindful of gas supply remaining and dive time and of your vertical as well as horizontal position (unlike on land, where we don't drift up and down), pay attention to your buddy at times, etc...all without the ability to speak, reduced peripheral vision due to mask and often inability to tell what direction sounds are coming from.

And it's not unknown for a careless fellow diver to kick and dislodge your mask.

Tympanoplasty (closing the hole) may or may not be an option.

Dr. Mike, any thoughts on how long after a tympanoplasty one might try diving? I assume it takes awhile for the patch (if that's how they do it?) to reliably adhere.

 

[doctormike]

Dr. Mike, any thoughts on how long after a tympanoplasty one might try diving? I assume it takes awhile for the patch (if that's how they do it?) to reliably adhere.

Lots of different ways of doing tympanoplasty, and there is a big difference between patching a small traumatic hole and reconstructing a subtotal perforation from chronic ear disease, even though they are both "tympanoplasties". So the devil is in the details.

Most otologists give 2-3 months for good healing of the TM before stressing it again.

 

[doctormike]

I
So, before closing it now, it is necessary to check if your tube can allow air to pass.
This is easy to check: just perform a Valsalva manouver and see if air blows outside your ear.
This is actually what was invented by dr. Valsalva: he did practice an hole in the eardrum, ask the patient to turn the ear downwards tilting the head, and blow out all the putrid liquid trapped inside.

Yes, but a bit more complex than that. Because the ET isn't just an open tube, it's a dynamic structure. It needs to open with muscular action and close passively. Patients with patulous ETs can still have problems equalizing. With an open TM, there really isn't a great way of modeling the ET function to predict tympanoplasty success. One of the best predictors is the status of the other ear, but of course you could have asymmetric ET issues as well.

 

[mike41799]

I have perforated eardrums and dive with the ProEar Mask. Of course, do so at your own risk….

 

[gert7to3]

Stumbling across this thread way late, but have 2¢ to add. Use Docs Pro Plugs under your Pro Ear mask ear cups. That should prevent water from catastrophically entering your middle ear through the opening in your eardrum. Another observation about equalizing. If you are using a Pro Ear Mask, equalization occurs through both the eustachian tube and through the external ear canal via the ear cup. I am a ProEar Mask user with 300+ dives with this mask. With a belt and suspenders attitude, I use a Docs Pro Plug in my problem ear.

 

[Searcaigh]

I have been using the ProEar Mask for probably around 700 dives, in fact I'm on my second one as the first broke around the area where the connection tube fits into the mask skirt. I've kept it for spares but also carry a second ProEar mask when I go on trips, and it's in my dry bag when I dive locally.

Key point here, the ear covers will not keep your ears 100% dry unless you have a haircut like Kim Jong Un or no hair at all. Water does get in. I think that @gert7to3 suggestion of using Docs Pro Plugs with the ProEar Mask is an excellent suggestion.

 

[mike41799]

When I started using the Pro Ear mask, I did the plugs and fitted hood as well, great for added safety. This is the haircut I sport when I dive and I have moved away from the plugs and hood as I have gotten more comfortable.
The mask has still worked with a little more scruff than this and I have seen another use it with long hair/beard and hood successfully.

 

[gert7to3]

I have an over the ear hearing aid for my left, intact ear now. Twice I have neglected to remove it and got in the water with it under the ear cup on my Pro Ear Mask. It survived the dive both times. Unfortunately it fell into a puddle in the bottom of the boat the second time I did this. These things are insured so it was repaired after my second, inadvertent "test". Not that I recommend doing this.