Recently injured eardrums and flying

[kenicholas]

Hi All,

5 days ago I had the great fortune to go diving in Roatan Island, Honduras.

However, in my eagerness to equalise I blew out my eardrums: stage 5 in the left (2 small holes), and stage 3 in the right. Pain and dizziness sent me to the island's dive medical centre, where the doctor gave me painkilllers, antibiotics to ward off infection and some sudafed to deal with my congestion. He said to keep the stage 5 ear dry, but I would be all set to dive again in 5 days as that is all it takes for the drum to heal. Unfortunately I did not have the presence of mind to ask how the ear may be affected by flying, and my friends in the developed world are now insisting I need to wait 6-8 weeks before the wound fully heals and I won't risk blowing out the drum.


I'm due to fly out from San Jose, CR to Sydney next week, ten days after the injury. Has anyone here had a similar timeframe and injury for flying? My doctor in Roatan was so blasé about the perforation that I feels bit silly asking, but I don't want to be ignorant/not paranoid enough and end up with a big(ger) hole in my head.

Thanks for any feedback you can provide.
Kari

 

[DocVikingo]

Bummer, Kari.

I'm not sure what the "stages" you mention mean, but I suspect that they come from one of the grading systems for classifying such perforations, none which are universally accepted to the best of my admittedly limited knowledge. Be that as it may, the "stage 5" ear is obviously perforated, while the "stage 3" ear probably has no rupture, but rather some observable evidence of blood collection around the membrane or the like.

Let's answer the easy question first. If your eardrums & related otic apparatus are entirely fit for scuba, they are fit for flying.

If an eardrum remains perforated, then scuba is out for obvious reasons and should not be resumed until okayed by a competent ear specialist. As regards flying, the expectation would be that the barometric pressure changes inherent in take-off and landing (the latter being the most consequential) would be spontaneously & without issue equalized without blasting a "big(ger) hole in your head." In fact, it is highly likely that air pressure in the middle ear would equalize more easily because air is able to pass freely through the hole(s).

The healing time issue is a bit less clear as this depends on many factors such as the size of the holes, age of the diver, possible complications, care of the ear post-injury, etc. I can tell you, however, that meaningful perforations are not likely to completely heal in 5 days; 8 weeks is closer to the mark, and perhaps longer.

We have a diving ENT ("doctormike") on the forum and I will bring your question to his attention. He will probably blow my reply out of the water ; )

Best of luck.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[doctormike]

Hi All,

5 days ago I had the great fortune to go diving in Roatan Island, Honduras.

Lucky! Not so lucky about the ear stuff. I'll try to answer as best as I can. I'll also point out that unless you had bubbles coming out of the ear while equalizing underwater (which you can only get from a perforation), the diagnosis may be inaccurate. In my experience, the diagnosis of a perforated eardrum is one of the most common inaccurate diagnoses in all of medicine. Not saying that you didn't have that, it's just hard to know for sure what the actual status of your ear is over the Internet. Nevertheless, I'll try to help as best as I can. DocVikingo has also given you good advice...

However, in my eagerness to equalise I blew out my eardrums: stage 5 in the left (2 small holes), and stage 3 in the right.

Not sure what this means, since there is no standard "staging" used for describing eardrum perforations, at least in the English medical literature. While perforations can be described as central, marginal, pinhole, subtotal or total, I really don't know what this doctor was seeing.

Pain and dizziness sent me to the island's dive medical centre, where the doctor gave me painkilllers, antibiotics to ward off infection and some sudafed to deal with my congestion.

Again, non standard treatment for traumatic tympanic membrane perforations. Since I didn't see your ears myself, I have no idea whether or not this is appropriate for you, but for actual perforations, the initial treatment is dry ear precautions while healing, and sometimes topical antibiotics drops (not always necessary, depends on the status of the middle ear). Sudafed would help for nasal congestion - no role in the treatment of traumatic TM perforations.

He said to keep the stage 5 ear dry, but I would be all set to dive again in 5 days as that is all it takes for the drum to heal.

Kind of odd to make a prediction like that, this statement alone makes me question the experience of whoever saw you. Diving is particular stress on a healing eardrum, and while many perforations in patients without pre-existing ear disease may heal shortly, it is not logical to clear someone to dive ahead of time because you are guessing that the ear might be healed in five days.

Unfortunately I did not have the presence of mind to ask how the ear may be affected by flying, and my friends in the developed world are now insisting I need to wait 6-8 weeks before the wound fully heals and I won't risk blowing out the drum.

Well, if the perforation hasn't healed, then there really is no problem with flying - in fact, the perforation will eliminate any pain you feel with ascent or descent. If it has healed spontaneously, then the ear might be OK as well, especially since modern commercial passenger aircraft are pressurized fairly close to sea level (I assume that you are not traveling in the cargo hold of a C-130 or in the cockpit of an F-16!).

The one time that I tell patients to avoid flying during healing is after tympanoplasty - the operation in which you place a muscle lining graft beneath a large perforation that has not healed spontaneously, and you don't want to displace the graft until you are sure that the eardrum has healed.

Sorry I can't be of more help, but maybe you can see an ENT doctor there?

 

[kenicholas]

Thank you both so much for your swift and thorough responses!

I can't speak to the 'staging' element of my diagnosis; the doctor pulled out a sheet with a series of five photos and descriptions, and associated my right with the third (pressure from the ear pressing the eardrum outward but no perforation), my left with the fifth (perforated, with blood coming out of the nose [which I did have]). The ear made a horrendous squeaking noise you could hear across the room when the doctor had me equalise, but no bubbles that I noticed when submerged.

All in all the ear is much improved, we've been driving up and down a heap of mountains and the ears have been equalising on their own no problems, so I am feeling confident about flying and will consult an ENT on my return to Sydney.

Once again, thanks for your help. It's truly a comfort to get a rational opinion rather than some of the dramatics I have seen elsewhere. Also-dive in Roatan if you can, it's spectacular.

 

[doctormike]

I can't speak to the 'staging' element of my diagnosis; the doctor pulled out a sheet with a series of five photos and descriptions, and associated my right with the third (pressure from the ear pressing the eardrum outward but no perforation),

Theoretically possible for there to be a positive gradient in the middle ear after a dive with a reverse block, but pretty rare. Never heard of anyone using that "staging" system - maybe something that this doc came up with?

my left with the fifth (perforated, with blood coming out of the nose [which I did have]).

TM perforation is generally graded by size (percentage of the eardrum) and location (central or marginal). Blood from the nose has nothing to do with an eardrum perforation - it generally comes from a sinus squeeze (same pathology, same barotrauma, different anatomic location. Even if you had a lot of blood in the middle ear, that space is tiny, and even if a bit of it made it's way down the ET, the ET opens way in the back of the nose and it would just drain into the throat.... Sinus barotrauma is definitely associated with nosebleeds, though.

The ear made a horrendous squeaking noise you could hear across the room when the doctor had me equalise, but no bubbles that I noticed when submerged.

That suggests no perforation on that side, if there was a perforation you probably wouldn't have heard anything...

All in all the ear is much improved, we've been driving up and down a heap of mountains and the ears have been equalising on their own no problems, so I am feeling confident about flying and will consult an ENT on my return to Sydney.

Once again, thanks for your help. It's truly a comfort to get a rational opinion rather than some of the dramatics I have seen elsewhere. Also-dive in Roatan if you can, it's spectacular.

Sure, always happy to help as best as we can..! Of course, I really can't diagnose anything online or tell you what to do, but it sounds like you are on the mend. Had a great dive in Roatan a few years ago...

Best,

Mike

 

[DocVikingo]

I can't speak to the 'staging' element of my diagnosis; the doctor pulled out a sheet with a series of five photos and descriptions, and associated my right with the third (pressure from the ear pressing the eardrum outward but no perforation), my left with the fifth (perforated, with blood coming out of the nose [which I did have]).

Could have been a Teed classification -->

http://img.docstoccdn.com/thumb/orig/68825188.png


Regards,

DocVikingo

 

[doctormike]

Could have been a Teed classification -->

http://img.docstoccdn.com/thumb/orig/68825188.png


Regards,

DocVikingo

Hah, that's a new one one me! There you go, he must have seen Dr. Teed...