Perforated ear drum

[Lopez116]

I am currently in Grand Cayman and was diagnosed with a perforated ear drum on Monday 7/27.

On Day 2 of the trip, I made two dives to 100' and 80' and, to the best of my recollection, had no issues equalizing or otherwise.

The next day, my wife had some photographs scheduled for the family with a local photographer. At the end of the shoot, she wanted us to jump from a set of rocks 10 or so feet above the water. I didn't want to do it, but reluctantly agreed. When I jumped and hit the water, I immediately felt pain to my left ear. It hurt pretty bad. As I was coming in to shore, I dipped my head underwater just to see if I felt pain, and I did. The pain went away in about 5 min or so and I didn't think anything else of it.

About an hour later, we did a shore dive. In the first 15' or so, I experienced no issues at all. As I descended further, I could feel that my left ear didn't need to equalize. I could also feel water rushing into it with no feeling of pressure building up.

At 35', water was still coming into my ear and I experienced bad vertigo. Kind of scary, but I immediately made a safe ascent to the surface and called the dive. Total dive time was 9 min.

On the surface, my left ear was extremely muffled - couldn't hear much out of it at all. I was extremely nervous to say the least. I was in no pain, however. I swam to shore and called DAN, who sent me to a local clinic. At the clinic, a doctor took a look and confirmed a very small perforation in my left eardrum. I was prescribed CIPRO and have been taking it. No diving or even getting my ear wet since then. That was Monday.

On Wednesday, I followed up with another ENT on island who was recommended by the previous doctor and DAN. His equipment was much more specialized and he confirmed a tiny perforation. He also took pictures and I took pictures of those with my phone.

The ENT said there was already a lot of evidence of new growth and that the hole was closing on its own. He said based on this and my age, etc, it should heal up fine, but to follow up with an ENT when I got back home (this will be 3 days from now).

Now I'm a little scared I won't be able to dive again or that my diving will be limited. In fact, I'm more than a little scared because this is truly the one hobby I feel a strong passion for and I can't imagine not doing it again!

What experiences do others have with this and what are my chances are of diving again?

What would be an appropriate time for the issue to resolve and for me to be cleared to dive again?

Lastly, I would like to schedule a trip to come back for Thanksgiving since I didn't get to dive this trip. That is approximately 15 weeks from now. Do you think it's feasible to be able to dive then? I don't plan on diving any at home (Orange County, CA) to give it plenty of rest.

Thanks so much for everyone's help!

 

[KathyV]

Sorry about your trip but there are a lot of fun things to do on GC even if you have to avoid watersports, see the links below.

My husband perforated an ear drum during our first trip to Bonaire. He had a head cold and shouldn't been diving but we were young and on vacation and so he risked it. He got a reverse block on ascent and tried everything but it wouldn't clear. He finally had to come up and he had sudden, severe pain and there was blood pouring out of his ear. It was more than a tiny perforation it was a major rupture.

But he followed up with an ENT and it healed quickly and we did another trip to Bonaire 6 months later in the fall and everything was fine. And we have done many, many wonderful dive trips since then. So do not worry that your diving days are over.

But he has been very cautious of his ears ever since that episode and he will call the dive if he feels pain and cannot clear his ear(s). I sometimes have ear troubles too and I have allergies and have had sinus surgery; so we both take a lot of preventive precautions to avoid ear problems on dive vacations including: antihistamines, neti pot rinses, and giving ourselves time at the start of the trip to relax and feel healthy before we start diving. And each of us is patient and quietly waits for the other partner to clear before starting the dive.

We will also occasionally sit out dives that seem risky to the ears. Like when the divemaster says "the current is really strong today so pull yourself down the mooring line quickly hand-over-hand and try to get over the wall fast." Those are usually lousy dives anyway so we skip them. We also swim over swim-throughs that have significant changes in depth from start to finish.

These precautions have not been hardships and we have had many wonderful dives, so just play it a little bit safe in the future and you should be fine.

http://danilew.biz/blog/2014/03/03/grand-cayman-paradise-found/

http://www.scubaboard.com/forums/cayman-islands/437891-topside.html#post6532430

 

[doctormike]

PM sent

 

[Lopez116]

This is a photo I took of the perforation. It's the small pinhole to the left.

I haven't had any hearing issues or pain of any kind.

 

[gert7to3]

If you had over 100 dives already, without issue, you should be ok after you heal. You may want to look into Doc's Pro Plugs or a Pro-Ear mask to shield your ear. Figuring out exactly how/why you perforated your eardrum in the first place might also be helpful. When you tried to equalize, were you able to force air out through your ear?

Did you have ear problems as a child? Any plugs or drainage care? It seems that your 10 ft. jump may be the issue.

 

[Lopez116]

If you had over 100 dives already, without issue, you should be ok after you heal. You may want to look into Doc's Pro Plugs or a Pro-Ear mask to shield your ear. Figuring out exactly how/why you perforated your eardrum in the first place might also be helpful. When you tried to equalize, were you able to force air out through your ear?

Did you have ear problems as a child? Any plugs or drainage care? It seems that your 10 ft. jump may be the issue.

As I was descending, I was equalizing only because of the pressure buildup in the right ear. The left ear never really felt that build up in pressure you get before you equalize. When I did equalize, the left ear would just make sort of a cracking noise, but I could feel water entering the ear canal much deeper than usual. Once I got to 35' or so, the vertigo hit.

I never had any sort of difficult equalization in the two dives I did the day before or that dive. I just looked through my dive profiles for those dives and I was descending about 5' for every 20 sec (15' per minute).

As an infant, I had tubes put in my ears and the occasional infection, but nothing else.

The impact with the water when I jumped off that rock was the only time I felt pain to be left ear. I am still troubled by the fact that such an innocuous act could have caused this, but I don't remember any other strain on my ears.

 

[gert7to3]

I am speculating whether there was a scar leaving a weak point in your eardrum from a tube. I don't know much about tube placement, Dr. Mike or DocVikingo could probably answer this question factually. I just thought the perforation looked like an old scar.

That you had no sensation of pressure build up makes me think you had a perforation before the dive started. I saw a video of a diver with a Docs Pro Plug blowing bubbles out his perforated ear. IMHO, time to hit the beach, but then again he is a diver. Pre-pressurizing my ears before I start descending and trying to keep ahead of the build up seems to help me. I think the strain of trying to overcome increased pressure during descent can make it more difficult to equalize.

 

[Lopez116]

I am convinced the perf occurred prior to the dive. The scar tissue you see around the perforation is what the DAN-referred ENT told me was new growth (healing).

Now that in back stateside, I have an appt Tuesday to get a referral to an ENT (my insurance requires I get a referral). Eventually, I'll have an ENT look at it...hoping it has healed by then and I get good news. My fingers are crossed!

 

[doctormike]

I am speculating whether there was a scar leaving a weak point in your eardrum from a tube. I don't know much about tube placement, Dr. Mike or DocVikingo could probably answer this question factually. I just thought the perforation looked like an old scar.

Usually, the tube site heals and the TM is essentially normal. In some cases, where there was a large perforation that healed (possibly from a long acting tube or other ear disease) the ear will heal with a monolayer, which is more transparent than the surrounding drum and can look like a perforation on a quick look. It's rare for those to blow out, although if you really stress it (by not equalizing, generating a large pressure gradient) I suppose it's possible.

Scar tissue is usually not from the healed perforation, and true tympanic membrane scars are generally of no clinical significance. Sometimes, tympanosclerosis (calcium deposits in the eardrum) is referred to as "scar", but other than complicating middle ear surgery, this usually has no clinical significance either.

 

[gert7to3]

Doctormike,

Thanks for the insights.

My tympanoplasty is decidedly thinner and more delicate. I don't like to get it wet, though 40 years of aversion therapy has something to do with this.