Ear Ventilation Tubes
My 13-year-old son is scheduled to begin scuba lessons. When he was about 7 years old, he had tubes placed in his eardrums for frequent ear infections. He has not had any trouble in several years, but I am wondering if it will be all right for him to dive.
Placing small ventilation tubes through the eardrum (tympanic membrane) is not an unusual practice to help interrupt the cycle of repetitive middle ear infections. The tubes allow the middle ear to dry out until the draining function of the Eustachian tubes returns to normal. Swelling and inflammation from the infection process in the Eustachian tubes prevents fluid from draining properly. The insertion of the tubes through a small incision (myringotomy) in the tympanic membrane usually corrects this situation.
The tubes are not meant to be permanent implants and usually fall out on their own or are removed by the physician. The small incision usually heals shortly after the tubes are removed. In rare cases a small hole may remain after the tubes are left in for a long period. This situation can be tested for and is best addressed by your son's physician. It is unlikely that the tubes are still in place after six years, but you should have your son's ears checked by his physician.
Diving is not recommended while the tubes are in site, as they will allow water to enter the middle ear, risking vertigo and infection. However, after removal or extrusion, adequate time for healing must be allowed, at least six weeks, and middle ear and Eustachian tube function must be confirmed as normal before diving is considered.
A bigger problem may be scarring to the Eustachian tubes from the chronic ear infections. This can make ear clearing difficult for the young diver. There is no surgical procedure to date that can correct an Eustachian tube that is partially occluded. Loss of Eustachian tube function can be big trouble for divers. Children and adults alike need immediate attention for symptoms of middle ear infection and barotrauma. Symptoms may include – but are not limited to – pain, ringing or roaring in the ears, a sensation of partial loss, decreased or muffled hearing and drainage from the ear canal.
The tubes are not meant to be permanent implants and usually fall out on their own or are removed by the physician. The small incision usually heals shortly after the tubes are removed. In rare cases a small hole may remain after the tubes are left in for a long period. This situation can be tested for and is best addressed by your son's physician. It is unlikely that the tubes are still in place after six years, but you should have your son's ears checked by his physician.
Diving is not recommended while the tubes are in site, as they will allow water to enter the middle ear, risking vertigo and infection. However, after removal or extrusion, adequate time for healing must be allowed, at least six weeks, and middle ear and Eustachian tube function must be confirmed as normal before diving is considered.
A bigger problem may be scarring to the Eustachian tubes from the chronic ear infections. This can make ear clearing difficult for the young diver. There is no surgical procedure to date that can correct an Eustachian tube that is partially occluded. Loss of Eustachian tube function can be big trouble for divers. Children and adults alike need immediate attention for symptoms of middle ear infection and barotrauma. Symptoms may include – but are not limited to – pain, ringing or roaring in the ears, a sensation of partial loss, decreased or muffled hearing and drainage from the ear canal.
Posted in Dive Safety FAQ
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3 Comments
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s d
Background: I have had 7 sets of PE tubes as an adult while serving in the Navy. The last 2 sets were T-Tubes which were not supposed to come out on their own, but they did. The last set that came out left a hole in each ear, therefore making a permeant PE Tube like opening in each ear. My Eustachian tubes are also closed.
My comment is with this statement: "There is no surgical procedure to date that can correct an Eustachian tube that is partially occluded."
The VA Hospital is scheduling me as I write this for a procedure that they say will correct my Eustachian tubes from being closed/collapsed. It is a ballooning procedure like they do on heart patients without installing a stent. They tell me that once the procedure is done that my Eustachian tubes will remain open and operate as they should, then I can have the holes skin grafted close and everything will be back like normal.
Just food for thought, maybe worth checking into if you have this problem. Thanks.
Hi James
The procedure you are describing is called BALLOON EUSTACHIAN TUBE DILATION. I have reviewed the current data available and you can read some of the articles I refer to yourself (see later) if you wish.
There are retrospective analyses, systematic reviews, and a small cohort study that provide some data which I believe can be used to base a recommendation on, although saying that, the scientist in me would prefer stronger evidence to confidently support this procedure as the "cure" for divers with ETD (scarring in particular). From the current data it could be recommended as a procedure to discuss and explore with one's ENT specialist, and indeed if one underwent it, to have follow-up with the specialist, in view of, and preparation to undertake diving again. Functionality of the ETs can be fully assessed post procedure.
For further reading refer to:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526055/
https://pubmed.ncbi.nlm.nih.gov/32551960/
https://pubmed.ncbi.nlm.nih.gov/34075678/
https://pubmed.ncbi.nlm.nih.gov/35442523/
Yours in safe diving,
Dr Louis van Heerden