perforated air drum

Question
Hi Mike,
I became a Padi instructor about six years ago,but never really used the qualification due to an ear injury.Its now six years later and i wanted to go travel and hoped to dive professionally along the way.The problem i have is that my eardrum has perforatd three times.The first being the worst and it never really healed entirely.Each time it heals,its only a matter of time before it tears again.It was approximately 20 dives before the second perforation and maybe ten dives before the third.I was upset that i couldn't carry on with diving.If you could please help me.People have recommended that i have surgery and have a skin grapht of my eardrum.I would prefer not to do this.Would itin any way be possible for me to carry on as a padi instructor without the operation.I ve heard about helmets and other gadgets?Thank you
Robert Paterson

Answer
Hi Robert,

I'm sorry to hear about your ear problems, especially after all the work you put into gaining your instructor certification.  I'm not a doctor so what I'm going to tell you is only my opinion and does not substitute for sound medical advice.

Have you talked to Divers Alert Network (DAN)?  You can reach them on the internet.  They have a medical advice hotline and will be happy to discuss your problem with you.  I have a feeling, however, that their advice won't be what you want to hear.

A ruptured eardrum (tympanic membrane) will frequently heal itself depending on the type and severity of the injury.  It seems like you've tried that and it didn't work very well.  Repeated injury only makes the problem worse since scar tissue will interfere with the integrity of the healing.  As you've already found out, these self-healing repairs may not hold up to the stresses of diving.

From what you're telling me, it seems that a graft would probably be the best solution to repair at this point but even that is not guaranteed to hold.  It will also be expensive.  If you investigate this route, be sure to tell your doctor that you're doing it so you can return to diving and get his advice before proceeding.

Diving helmets will not relieve the pressure problems and they wouldn't be practical for your use even if they did.  You simply cannot teach scuba to students while wearing a helmet.  You need to be able to demonstrate such things as clearing or removing and replacing a mask underwater and you won't be able to do that.  Nor will you be able to demonstrate breathing underwater without a mask, using a snorkel or alternate air source use.

You may still be able to take advantage of your instructor ticket but I'm afraid it won't be in deep water.  You may be able to work in a dive shop teaching classroom sessions and possibly pool sessions and then hand the open water dives over to another instructor.  You may also be able to conduct scuba reviews in a pool.  You'll just have to avoid diving much deeper than 8 or 10 feet. All of this assumes, however, that your eardrum can heal itself again.  Maintaining your instructor credentials does not require deep diving so you can do activities like these indefinitely if you like.

Of course, if you can obtain a satisfactory eardrum repair then you might be able to return to diving.  If you do, equalizing pressure EARLY AND VERY OFTEN will be critical to avoiding further damage to your eardrum.  Any type of forceful Valsalva maneuver could be destructive to your fragile eardrum.

Robert, I know this isn't the "magic bullet" you were hoping for and I wish I could provide it but I'm afraid I just can't do it in this case.

Best wishes for a satisfactory solution to your ear problem.

Mike Giles
Mike's Dive Center
mikescuba.com