Saturday, December 10, 2005

Some ENT advice from Allen Dekelboum, MD: Hole in the Ear Drum and Diving

Hole in the Ear Drum

Hi Scubadoc,

My wife visited an Orintologist (Sp?) today (a none diver) and was told that she could never never ever dive again due to a rather large her ear drum. The doctor said that the danger of infection was too great. She also said that my wife who hears excellently needs to have an operation or she will have hearing problems with that ear in the future (my wife says NO OPERATION). The doc said the ear is very very dry (whatever that means). My wife has been diving (has her open water certification) and has found that she did not have problems with pain at less than 15 meters, but had pain after that. The doctor said that she would never be able to equalize the pressure because water would get into the inner ear.

She is very disappointed since we have just started the sport and is wondering if there are any possible ways that she can continue without damaging her hearing and maybe getting an infection in the inner ear. Is there any solution to this problem other than giving up diving? It is important to us as we do it together and it is not feasible for me to go off alone.

Thanks for your help.

Regards

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Answer:

Your request was referred to me for comment.

If your wife has a large perforation (hole) in her ear drum, then she should have some hearing loss. Since you did not say what was large in her ear drum, I assume it was a perforation. How long has the perforation been there and, if so, what was the cause of the perforation? Did it occur from one of her dives or has it been present for some time? If she has a perforation and it has been present for a long time, it will not close by itself and will require surgery to close it. The surgery is not major if that is the only problem. If the hole is not closed and she continues to dive, the risk of infection is very high and she could lose all her hearing in that ear or even worse. Pain is not acceptable in diving, even if it occurs after 15 meters.

I would strongly advise your wife not to dive with a perforation in her ear drum.

This advice was given based on the limited information you sent me, did not include an examination of the individual mentioned and is not to be considered a doctor/patient relationship.

Correspondence between the diver and Dr. Dekelboum:

Doctor Deckelboum,

Thank you again for your interest and assistance. My wife is supposed to get a hearing test as the ear specialist that checked her ear was one of her professors at the university who has a private practice but not the testing equipment. I do not believe it has actually been scheduled but she is waiting for notification as to when she can get tested.

She doesn't have any problem equalizing the good ear but has great difficulty equalizing the bad ear and when she dives without pain, she can only go down once because after surfacing the ear won't equalize again for several hours.

The perforation is at the bottom in the center of the ear drum and occurred when she was 8 years old and both ear drums ruptured as a result of an infection. She lived in a small Costa Rican town and only had access to the local doctor who worked for the socialized medicine plan run by the government which even today is generally poor to terrible in the smaller hospitals. The doctor would only treat one ear even though she had pain and drainage in the other. (There are some excellent doctors in Costa Rica but not working in the small towns for the social medicine plan and even the good doctors are hampered by a lack of equipment and trained technicians in the major hospitals. For example the waiting time to start radiation therapy for cancer patients is about 18 months!)

She might give the "Pro ear" a careful try if that is the only way she can continue diving. It is her decision, but obviously if you have recomnendations I will pressure her to: a) follow your advice and b) take any safety precautions that you might suggest. She is very hard headed (a typical Latin woman) and we are booked into Roatan Bay Islands in Honduras for 12 days of diving at Christmas which I doubt that she will be willing to just drop. If you could recommend some safety precautions to reduce the risk, I would greatly appreciate it so if she insists on diving it will be a bit less dangerous. I KNOW that I can't pressure her into the operation partly because of her studies and partially because she doesn't want to have it.

I really appreciate your assistance and advice.

Yours truly,

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Thank you for responding to my questions.

You state that your wife's hearing is unbelievable. That may be true, but has she had a hearing test that tests each ear separately? With a hole in her ear drum, she has to have a significant loss in that ear. Since she has had it from childhood and her hearing is good in the other ear, she has probably compensated well and functions at a normal level. Persons who are born deaf in one ear function quite well.

Yes, I am very familiar with the ProEar 2000. Although I have no financial relationship with the developers and manufacturers of the mask, I was fortunate to be able to test it when it first appeared. I used it on several dives and found that my ears were dry with it. But there have been many users who were unable to keep water out of their ears. While diving, if anyone bumps the mask, there is a risk of water entering the ear canal and getting into the middle ear. And the fit is not good for all people. The shape of your head plays a role in its effectiveness. It is not fool-proof and there is a risk in its use. I would be very cautious in using it for someone with a perforation. It is best used by those who have repeated external ear canal infections and have an intact ear drum.

I have another question for you. I am concerned about the reasons your wife has a perforation. When she dives, does she have pain in her good ear? Is she able to equalize that ear without difficulty? Certainly she might have no problem with her good ear, but most perforations occur because of infection in the middle ear, due to some obstruction with the Eustachian tube. She should have good function in her non-perforated ear and be able to equalize easily.

Allen Dekelboum, M.D.

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Dear Dr. Dekelboum,

Thank you very much for the information. I understand that without an examination it is not really possible to give a good assessment.

My wife has had the perforation since she was a child; however her hearing is unbelievable! I mean this seriously. She can her a pin drop on the second floor when she is on the first floor. We don't want to jeopardize her health, but she can't take time at present away from classes for surgery at the present time as she is in a 12 month a year dental school program with very little time even between semesters.

We were wondering about the feasiblity of her diving with a "Pro Ear Mask" made by IST which is supposed to prevent any water entering the ear and actually preclude a lot of pressure on the ear drum. Are you familiar with this particular mask and if so what are your thoughts on that?

I really appreciate your assistance and if you don't have time to respond it is certainly understandable. We live in Costa Rica and don't know of any ENT Specialists here that are divers - - there probably aren't any as the sport is pursued more by foreigners than locals.

If you can take the time to answer re the mask, it would be appreciated.

Thanks,

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The information you gave me suggests that the operation to repair the ear drum would be fairly easy for her with an excellent chance of repairing the ear drum. As a child, the treatment she had for one ear would have also treated the other. Perforations do occur even in the face of adequate treatment.

With a perforation of the ear drum, the injured ear does not have to equalize. There is a connection between the external ear and the middle ear and no equalization can occur because it is already equalized. I am more concerned about the pain she has. It is due to the water in her ear and I would again strongly advise that she not dive with a perforation in her ear drum. The mask might help, but there is no guarantee.

There is also the possibility that she does not have a perforation, but does have a very thin membrane that can sometimes look like a perforation. In that case she will have to equalize and if she is unable or has difficulty, then she does not have good function of her Eustachian tube and still should not dive.

Good luck.

Allen Dekelboum, M.D.