What It’s Like to Have an Eardrum Perforate…While Scuba Diving

I would prefer not to know this from firsthand experience, but here I am.

I have been scuba diving for over 25 years, almost completely without incident until this week. [Yes, the slip & fall incident happened on a Scuba vacation, but it happened topside, not in the water.]

It started like any other dive: Spousal Unit & I were diving with a new group of people, and we waited for everyone to get in the water and then we all descended. I had no problems clearing my ears on the descent. We had a mellow dive, checking out a new reef. When one of the divers in our group reached 1,000 psi of air remaining, we started our ascent. I was in no particular hurry to ascend, as I still had plenty of air in my tank.

But at 20 feet below the surface, my ear started hurting. I leveled off (stopped my ascent), and worked my jaw. Next, I massaged the area under my ear where my eustachian tube is, but my ear still wouldn’t clear. Not realizing that my problem was too much pressure in my ear, rather than not enough pressure in my ear, I did a valsalva maneuver. My ear still didn’t clear. More jaw rocking, more eustachian tube massaging – still nothing. So I did another valsalva maneuver – and my eardrum perforated.

I felt and heard a loud pop in my affected ear, followed by a sensation of cold water rushing into my ear. The pressure equalized, and my ear pain lessened significantly. But I suspected that something very bad had just happened.

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I did not see any blood or mucus in the water, but usually when my body pops, it means something ruptured. Since my ear had equalized, I resumed my ascent up to the 15 foot safety stop and caught up with the rest of my group.

During the safety stop, I continued to troubleshoot my ear. I did another valsalva maneuver, and heard and felt air escaping through my ear – I could hear and feel the air transiting my eardrum, and then I could hear and see bubbles coming from my ear. That pretty much confirmed to me that I had perforated my eardrum.

During the safety stop at 15 feet below the surface, I had a huge wave of vertigo wash over me, and I became very disoriented. Disorientation can be very dangerous when you’re diving; however, I was in a group, at 15 feet, and I could see the surface. And I have a lot of experience with vertigo, since I’ve had Migraine-associated vertigo for ~ twenty years. I decided to maintain the safety stop, rather than immediately ascend to the surface, so that I did not create any more physiological problems.

[I am not advising anyone else on what they should do in this situation, I am merely relating my own thought process.]

Thankfully, the vertigo slowly subsided, and I was able to safely ascend. At the surface, I told Spousal Unit that I thought I had ruptured my eardrum. Spousal Unit looked at my affected ear, but did not see anything unusual.

We returned to the boat and took off our gear. Spousal Unit still didn’t see anything unusual, although I did another valsalva maneuver and Spousal Unit could hear air escaping my ear with a whistling noise. The group started getting ready for the second dive. I started to question whether I had really ruptured my eardrum – it really hadn’t been that violent. In fact, it had been somewhat subtle. I briefly contemplated getting back in the water – we were supposed to be doing two dives for a specialty certification, and I wanted to finish the training.

Here’s what the mental math looked like:

Pros:

• Log the second dive and perform the necessary skills to complete my specialty certification.

Cons:

• Might not be able to clear ears on descent or ascent.
• Might get disoriented at depth, leading to a possibly life-threatening situation.
• Might get an inner ear infection if eardrum *is* ruptured and bacteria get behind the eardrum/inside the ear.

I decided discretion was the better part of valor, and I should sit out the second dive.

Next, I informed the instructor that I believed I had ruptured my eardrum. I was not prepared for his response – he did not seem to believe me. He asked if there was any blood or mucus. He looked at my ear. He said, “Sometimes my ear crackles; are you sure it wasn’t just that?” He did not pressure me to get back in the water, but it was clear he didn’t believe I had actually ruptured my eardrum. He said something to the effect of, “Most people, when they rupture an eardrum, are screaming in pain and vomiting.”

Even though I knew sitting out the second dive was the more conservative course of action, it was still difficult to stay onboard the boat. I had never sat out a planned dive before. I felt guilty and like a slacker because I left Spousal Unit without a buddy, and because no one seemed to believe my injury.

[For the record, Spousal Unit was completely not bothered to be diving without me, and agreed that staying out of the water was the right choice.]

So I sat on the boat while the rest of the group completed their training on the second dive. And even though the seas had calmed considerably after our first dive, I was feeling very nauseated. So, I sat on the boat cold, wet, and queasy, determined that I was NOT going to vomit.

Meanwhile, I had noticed that the tinnitus in my injured ear was orders of magnitude louder than usual, and that my hearing was very muffled in that ear. Again, tinnitus was a pre-existing condition for me, but never had it been this bad. And muffled hearing sometimes was a part of my tinnitus symptoms, but never this extreme.

After the group completed their second dive, we returned to the dive shop. On the boat ride back in, I spoke to the instructor about getting medical care. Since it was the Sunday of a three-day weekend, and we don’t know any ENTs in the area, not having lived here that long, I was hoping he’d have some suggestions.

The dive instructor coordinated for me to talk on the phone with a retired military flight surgeon (they know a lot about ears and pressurization problems), and after our consult, she confirmed that I had probably perforated my eardrum, meaning there was likely a hole, but not a large tear across the membrane. She recommended I see my GP (general practitioner) the following day, since they would not be open on a Sunday.

However, since it was a holiday weekend, I didn’t think my GP would be open on Monday either. After we got home, I did some internet sleuthing and even called the office, but the recording didn’t say whether they would be open on MLK Day or not.

But, the recording *did* have the number for the 24 hour nurse care line, which I called. The nurse was not experienced with perforated eardrums, but decided that I should go to Urgent Care when they opened Monday morning (since they had already closed for the night), and authorized an Urgent Care visit.

After very carefully inserting an ear plug in my damaged ear, I took a shower and washed all the salt water off, and then I resumed my internet research.

According to the Mayo Clinic and emedicinehealth, my symptoms matched the symptoms for a perforated eardrum*; a perforated eardrum will usually heal itself; and an infection in the inner ear is really bad and could lead to permanent hearing loss (among other things), so you should treat with antibiotics, especially if your ear was underwater when the eardrum ruptured.

*Symptoms of a Ruptured Eardrum:

• Feeling something is not right with the ear
• Ear pain that may subside quickly
• Clear, mucuslike, pus-filled, or bloody drainage from your ear
• Hearing changes/hearing loss
• Ringing in your ear (tinnitus)
• Spinning sensation (vertigo)
• Nausea or vomiting that can result from vertigo

Feeling comfortable in my decision not to go to the emergency room, but to go to urgent care in the morning, I took an OTC pain reliever and went to bed. The next morning, after confirming that my GP’s office was closed but Urgent Care was open, off we went to Urgent Care.

I was seen by a PA, who bounded into the room saying, “I wanted to see this!” After I recounted my story to him, he took the otoscope off the wall, looked in my ear, and said, “Yup! There it is!” And he offered Spousal Unit the chance to look, which Spousal Unit took him up on. [I was envious, and wistful that I could not see inside my own ear.]

[Geek moment: The PA first examined my good ear, upon which, I exclaimed, “Cool! I am my own control group!”]

The PA confirmed what I had read online: I cannot dive until the membrane has fully healed; it *is* safe to fly with a perforated eardrum; I should take antibiotics to hopefully stave off any potential infection; and I should keep my ear dry while it is healing, including using an ear plug in the shower.

He told me that I had a pinhole perforation, meaning that it was quite small, and that it would therefore hopefully heal much more quickly and easily than a large rupture. And he wrote a prescription for oral antibiotics and for antibiotic ear drops. He also gave me the phone number for an ENT, and recommended I follow-up with them, although he couldn’t tell me a timeframe for doing so. [I’ll either get authorization from the VA to see an ENT, or I’ll self-refer through Tricare Select, and make sure the ENT gives me a clean bill of health before I dive again.]

Finally, I went to the pharmacy to pick up my prescriptions, and the pharmacist told me that the oral antibiotic that was prescribed has known cross-reactions in people with chlorhexidine allergy (IOW, because I am allergic to chlorhexidine, I might have an allergic reaction to the prescribed antibiotic even though it does not contain chlorhexidine). So the pharmacist diligently determined which antibiotic would be safest for me (ruling out several due to known or possible allergies), and called Urgent Care to change the prescription. The pharmacist also double-checked to make sure the antibiotic ear drops would be safe for me.

I am grateful for the pharmacist’s diligence, as the *last* thing I want is a life-threatening allergic reaction while dealing with a perforated eardrum.

I am currently on day four of five of the antibiotics regimen and have had no problems, for which I am very grateful.

My outer ear and the area below my ear were inflamed (red and swollen) for about the first 18 hours or so; I assume it was white blood cells and mast cells reacting to the injury. The PA also said my inner ear was a bit inflamed when he looked at it. The profound hearing loss/very muffled sensation lasted for about 24 hours. I have regained some of my hearing in that ear since then, although there is still hearing loss and a muffled sensation. I continue to have some balance problems and episodes of dizziness, although they are very mild compared to my usual episodes of vertigo.

After Action Report (AAR):

Leveling out (stopping the ascent) once I realized I was having problems equalizing the pressure in my ear was a good first step, but what I should have done when that wasn’t enough is slowly descend (reverse direction) until I no longer felt pressure/pain in my ear, and then slowly ascend while trying to equalize, re-descending as necessary to avoid putting too much pressure on the eardrum. I now know (and will never forget) that if I (or anyone else) is having a problem equalizing the pressure in one or both ears, the correct course of action is to reverse the direction one was going until the pain/pressure stops. Then keep an eye on your air gauge (to make sure you don’t get too low on air) and work the problem.

Also, always trust your gut. I knew my eardrum was perforated even though there were no outward signs that anyone could confirm. Had I tried to do a second dive, very bad things could have happened.

According to my online research, I will likely be beached for about two months while my eardrum heals, barring any complications. I intend to wait until it is full healed and I have clearance from an ENT doctor before I resume diving. I have heard of other divers who started diving again before their eardrum was fully healed, and they wound up doing more damage and being unable to dive again. I would rather have this be a short hiatus from diving instead of the end of my diving days.

Have you ever had a perforated/ruptured eardrum? What was your experience like? How long did it take you to heal? Please comment below: