Apple #470: Broken Eardrum

As you faithful Daily Apple readers know, I had my first scuba diving lesson last week.  Unfortunately, my ears have been all weird since then.  I had trouble equalizing the air pressure in my ears during the diving, and since then, they have not stopped clicking and clunking and popping and crackling etc. every time I swallow.  The right ear is worse than the left, but they're both doing it.  So I'm kind of hung up on ears at the moment.


Side view of the inner workings of the ear. The eardrum vibrates as sound waves enter the ear, and those vibrations are transmitted to those tiny bones just beyond it.  The bones further transmit the vibrations to all the sensitive stuff in the cochlea, and that all gets transmitted up the auditory nerve to the brain.  That's how we hear sounds.
(Diagram from Answer Bag)


Not only is all the clicking and clacking driving me nuts, I'm afraid it may mean I won't be able to scuba dive anymore.  Some people, because of the shape of their ear canal or something, are never able to "pop" their ears as they descend in a dive, which means the air pressure behind the eardrum builds and builds, and the only way to rectify the problem is either to surface and not go back down again or suffer a burst eardrum.

I do not want to be ineligible to dive ever again, nor do I want my eardrums to burst.  I have been reading somewhat obsessively about ways to equalize the pressure in one's ears.  If there's a suggestion out there, I've tried it.  In brief, here's what I've tried so far:

• swallowing
• yawning
• chewing gum
• moving my jaw side to side
• stretching my mouth as far as it will go
• thrusting jaw while tilting head sharply
• massaging the area behind my ear
• holding my nose and swallowing, then swallowing again
• Valsava maneuver: hold the nose, close the mouth, and blow air
• Frenzel maneuver: hold the nose, close the mouth, make a K sound
• blowing my nose
• sneezing
• hiccups
• ibuprofen
• aspirin
• Sudafed (decongestant, to help clear any build-up in the ear canal)

Most of these I have tried not just once but several times, to no avail.  I used to swim and go into the deep end all the time when I was a kid and I never had problems like this.  So I am becoming more and more concerned that this may be an intractable problem.


Here is a close-up of just the middle ear.  When everything's working properly, the Eustachian tube should work like a valve, opening and closing for a fraction of a second during swallowing or yawning so that the air pressure on the inside of the eardrum equals the air pressure on the outside of the eardrum.  My Eustachian tubes, apparently, are not opening and closing like they should be.  Or if they are, maybe there's some sort of blockage in the middle ear that is preventing air from getting in there the way it's supposed to.
(Diagram from Eon Meditech)


[EDIT:] I found out that what I have is called Eustachian Tube Malfunction or Dysfunction.  The tubes stay closed even when things you do should make them open.  Allergies, pollution, cigarette smoke, colds, the and the flu are some of the things that can mess with the way your tubes work.  The lining of the tubes gets irritated or inflamed and even though the tubes may be trying to stretch open, because of that swelling, they can't really open.

There's not a whole lot they can do about this.  The best treatment is decongestants/antihistamines, nasal sprays, and steroids, all of which are supposed to help reduce inflammation and congestion so that the tubes will relax and open again.

I went to the doctor, and he gave me prescriptions for all three of these things.  He said to try the decongestant/antihistamine and the nasal spray for a week and if those didn't work, try the steroids.  It hasn't been a week yet, but the pills and the spray aren't doing much, though the pills are making me pretty speedy.  It looks like I will be trying the steroids soon.  Cross your fingers that those work!


But all this is not the point of this entry.  While reading about how to equalize the pressure in my ears, I read that a burst eardrum will heal on its own.  I did not know this.  I always thought it was an enormously bad thing to break your eardrum.  But maybe it's not.  So that's my question:  how bad is it if you perforate your eardrum?


Drawing of a perforated or ruptured eardrum.
(Drawing from Eon Meditech)


CAUSES
Lots of things can poke a hole in your eardrum.

• Ear infection
• Explosions
• Sharp slap to the side of the head, for example, from a hard, slapping fall onto water
• Inability to equalize air pressure during flying, diving, or driving in the mountains
• Inserting Q-tips or other sharp objects into the ear
• Other foreign objects in the ear

SYMPTOMS
Most of the time, people who've ruptured their eardrums experience severe pain.  But sometimes it subsides right away, if the rupture has been caused by an infection or a slow build-up in pressure against the drum.

• Severe pain.
• Severe and sudden pain followed by a sudden decrease in pain.
• Moisture draining from the ear. May be clear, or yellow like pus, or bloody.
• Changes in hearing, which could include buzzing or ringing or clicking
• Partial hearing loss
• Dizziness or vertigo

Sometimes there are additional problems which can have severe symptoms:

• Constant spinning sensation
• Difficulty walking due to problems with balance
• A change in the ability to taste foods (?!)
• Stiff neck
• High fever
• "The worst headache of your life"
• Continued vomiting
• Abrupt change in vision
• Difficulty staying awake

Pretty much any time there's continuous vomiting, high fevers, or abrupt changes in any of your senses, you're going to want  to get yourself to that ER.


TREATMENT
Most of the time, a ruptured eardrum will heal on its own.  Healing make take a few weeks to two months.

During that time, it's important to keep the interior of your ear clean and dry.  Without the eardrum, the inner ear will be exposed to more viruses and bacteria that could cause infection.  So you need to do what the eardrum can't and shield the inner ear as much as possible.

• Place cotton balls in the entry to the ear -- don't shove them in there, just place them over the opening -- while showering or bathing or shampooing

• Avoid swimming or immersing your head in water

• Your doctor may prescribe antibiotics, especially if it was an infection that perforated the eardrum in the first place.

• You'll probably also take some sort pain killer to reduce discomfort.  

• You may also want to put a heating pad over the ear to soothe and reduce the pain.

• If the eardrum doesn't heal, or if the hole is especially large, surgery may be necessary to close up the hole.

• If surgery is necessary, the surgeon may use any number of materials -- a skin graft, a bit of muscle or fat, or even a piece of paper.  This material will be work like a patch, and it will also act as a base on which the tympanic membrane can grow and eventually close up the hole.

HEARING LOSS
Any hearing loss suffered during the rupture is usually not permanent.  It is possible that scar tissue may develop on the eardrum, which would result in some minor loss of hearing.

If an infection occurs while the eardrum is healing, and if the infection is allowed to spread more deeply into the ear toward the brain, then hearing loss may be permanent.  But that's a lot of if's.


So, to sum up, rupturing your eardrum is really painful when it happens.  But it will heal and probably you won't suffer any permanent hearing loss.  Good to know.

Sources

Edmond Kay, M.D., Prevention of Middle Ear Barotrauma
Baylor College of Medicine, Eustachian Tube Dysfunction 
Timothy C. Hain, M.D., Dizziness-and-balance.com, Eustachian Tube Dysfunction (ETD)
Medline Plus, Ruptured Eardrum
Medline Plus, Ear Emergencies
emedicinehealth, Perforated Eardrum
Mayo Clinic, Ruptured Eardrum
The New York Times Health Guide, Ruptured Eardrum