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Unplugged: DAN Examines the Use of Earplugs In Scuba Divers

By Wesley Hyatt, DAN Communications, and Joel Dovenbarger, Vice President of DAN Medical ServicesI have had trouble clearing my ears, and recently had an eardrum (tympanic membrane) rupture. My ENT (ear, nose and throat) doctor found no problems that would lead to clearing trouble. Even though my eardrum has healed completely, he has advised caution in returning to diving.

Is this something that I should consider using an earplug for in the future? If I have another ruptured eardrum, can I dive if I use an earplug? I have heard a lot of pros and cons. What’s the main issue with earplug use?

Once a ruptured tympanic membrane (TM) has healed, a diver usually can return to diving. Divers with this injury should exercise caution, however, because a small scar is left in the layer of tissue that makes up the TM. Forceful clearing could cause repeated problems with the membrane.

Although your doctor found no ENT problems, it is possible for you to irritate the eustachian tube (which connects the middle ear with the back of the throat and regulates air pressure on both sides of an eardrum) when you’re trying to clear your ears and sinuses. You may even have small eustachian tubes, sensitive to rapid pressure changes. Descend slowly, clearing often, and you may avoid future injury.

As for the use of earplugs, opinions differ on their use in scuba diving. In general, they are not recommended. However, some divers use earplugs in special situations. Divers should also know special considerations before trying them.

Dr. Allen Dekelboum, an ENT and DAN consulting physician in California, reiterated the common view that earplugs create an air pocket in the ear canal, preventing equalization and resulting in differences in the pressure between the water and a diver’s ear canal. This situation could lead to serious injury, he said.

“With an intact tympanic membrane, the increasing water pressure against the earplug and the decreasing volume of air between the plug and the tympanic membrane would have a tendency to drive the plug against the TM,” Dekelboum said. “The increasing water pressure also could wedge the plug in the ear canal. If this occurs, there is risk of external ear barotrauma.”

To address these concerns, some manufacturers promote the vented earplug, which has a small hole for venting between the water and the ear canal. The holes typically have a valve for pressurization without letting water enter the ear canal.

Dr. Robert Scott, creator of Doc’s Proplugs, said his vented earplugs are safe for divers to use. It has one chief advantage, he said: “They make pressurization easier.”

Dr. Shannon Hunter, an ENT physician at Duke University Medical Center, N.C., also expressed reservations. “I have reviewed the limited information on the vented plugs, and it appears that there is too much of a chance for failure — “Too many ‘ifs’,” Hunter said. “If the plug vent is occluded by wax or debris, it should be removed — at depth? In cold water, where the temperature in the ear canal is warmed by the presence of a plug?

“An influx of cold water to the vestibular system is a setup for vertigo, nausea and even vomiting — this is duplicated every day in vestibular testing procedures used to test patients for balance disturbances. A similar situation at depth is possible if a fouled earplug were removed and allowed for an abrupt influx of cold water into a warm ear canal. The resultant effects of nausea, vomiting and vertigo could be deadly.

“There is just not enough data or evidence to recommend the use of plugs for divers. The risks of complications underwater from malfunction or removal of an earplug are real and can potentially place the diver at increased risk for injury.”

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