(Q) I am a pre-grad med student from South Africa. I have had otitis media (middle ear infection) and in May 2010 received bilateral grommets. The right one gave me recurrent infections and I had it removed but the left one is still in place. I am a scuba diver and spearfisherman and am going down to the coast the end of the month to do mandatory training with a private GP for 2 weeks. I am planning on doing a lot of spearfishing. I have been told that the water will only pass through the grommet at a depth of 30m below surface and seeing that we spearfish on apnea diving I am only able to dive to about 20m. My question is, can I dive up to 20m or not and if not what can I do to make this possible. I have consulted with our local ENT and he gave me the advice that technically speaking the water would only enter my middle ear at 30m. I just want to be certain of this.
(A) It is not unusual to have ventilation/ tympanostomy tubes placed following a history of repeated or intractable middle ear infection.
I am not familiar with the reasoning that water will not enter a patent tympanic grommet until a depth of ~30m or greater is reached, nor can I say that this makes any sense to me. However, I am not an ENT and must assume that yours wouldn’t say this without research, anecdotal or other sort of evidence to support it.
In any event, diving with an open grommet would place you at risk for infection in the middle ear from pathogen-containing seawater and for caloric vertigo from temperature changes in the water column.
The most conservative advice would be not to dive until the opening has healed.
Although I think it unwise, some individuals do continue to dive with tubes in place. They typically use one of the following devices:
- Doc’s Proplugs http://www.proplugs.com
In this regards, the following piece may prove informative. It is compliments of Undercurrent (http://www.undercurrent.org , Oct ’09 issue):
The question of divers using vented ear plugs to ease equalization and keep water out of their ears is often raised on divers’ online message boards. These soft polymer plugs form a tight seal and have a very small hole, or vent, running through them to allow for equalization of the ear. Many responders indicate that the plugs reduce the frequency of external ear canal infections and ease clearing of the ears.
Doc’s Proplugs (Doc’s Proplugs: The Doctor’s Choice for Ear Protection) is the primary purveyor of vented ear plugs. It claims that when fitted properly the plugs reduce “ear squeeze caused by inability to equalize between the outer and middle ear and help “prevent outer ear and inner ear infection, vertigo and thermal reaction. Its Web site includes a list of undated and unverifiable testimonials.
Only the most minimal medical research has been conducted on these ear plugs. A self-published, undated piece by the “Sardinian Institute of Underwater and Hyperbaric Medicine” evaluated two professional divers with histories of perforated eardrums “who in the summer made constantly 3 dives per day.” After observing one diver for 17 months and the other for three months, no problems with inflammation of the middle ear were noted.
Another study found that in patients involved in various watersports, the use of earplugs substantially reduced surfer’s ear/exostosis (benign bony growth in the external ear canal caused by exposure to cold, wet and windy conditions).
If a vented ear plug did lessen the flow of water into the external auditory canal, the expectation is that outer ear infections (swimmer’s ear) would be reduced. As regards the claim of prevention of “inner ear infection,” this isn’t credible and I much suspect the author is confused regarding the anatomy of the ear. Water does not enter the middle ear space from the outer ear unless the eardrum is ruptured. It doesn’t enter the inner ear unless both the eardrum and either the oval or round window are ruptured.
Decreased water flow also would be expected to reduce temperature-related abnormalities, such as caloric vertigo and surfer’s ear.
The claim of easing equalization is difficult to support, as there is no reasonable mechanism of which I am aware to explain how this might occur. Doc’s Proplugs’ Web site states, “Due to surface tension, the vented plug also reduces abrupt pressure changes from reaching the sensitive eardrum which contributes to easier equalization.” I find this assertion not compelling.
I was unable to find any published reports of harm to the ear from such plugs. Provided the vent in the plug remains unobstructed, these devices appear to pose little danger to the ear. However, if a vent should become clogged, especially upon descent, equalization could become impeded and the eardrum damaged.
As for using such plugs to protect a ruptured eardrum, remember that these devices still do admit a small amount of water. Plus, the diver runs the risk of losing the plug altogether, thus allowing water to freely enter the middle ear space and resulting in pain, disorienting vertigo and possible middle ear infection.
The bottom line? If you’re experiencing external ear infections or worried about surfer’s ear, vented plugs may be worth the small investment. However, divers with a history of middle-ear congestion or infection are unlikely to benefit from these plugs, and they should refrain from diving until seen by an ear, nose and throat specialist. For those with continuing difficulty in equalizing, experiment with various clearing techniques before trying vented ear plugs. — Doc Vikingo”
- ProEar200 -> http://www.proear2000.com/
I am acquainted with the man who developed this device and he gave me one some years ago (I’ve since given it to another diver). They’re kind of silly looking and take a while to master, but used properly typically are effective in keeping water out of the outer ear.
I know one diver (a diving medicine doctor!) with ruptured tympanic membranes who uses both simultaneously.
Best of luck.
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.