DAN Europe Medical Q&A

Ask DAN

DAN medical specialists and researchers answer your dive medicine questions

Little Ear Q: Can someone be certified to dive if they were born with ‘little ear’ — where the ear wasn’t fully formed in the womb and the canal didn’t open?

A: It seems like you are referencing both microtia and aural atresia. Microtia ranges from minor changes in the outer-ear shape to a very small external ear, possibly with no external canal or eardrum. Anotia is the complete lack of any ear structure, and aural atresia is the absence of an ear canal.

Your physician may not necessarily restrict diving. The concern would be making sure your anatomy allows for proper equalisation of your Eustachian tube and any potentially remaining gas in a vestigial middle ear. If equalisation is impaired with gas still in the ear, you could risk barotrauma (a pressure injury) on your functional internal ear. If this is not an issue, then the risk would be severe barotrauma on the other fully functional ear, which could cause deafness in rare cases.

A physician might suggest you avoid diving if your hearing is already unilateral, since a dive injury to the functional ear could result in bilateral hearing loss. Consult with your ear, nose and throat specialist to discuss your ear anatomy and determine if diving is possible.

Atrial fibrillation Q: I have a history of atrial fibrillation (AFib) and had a cardiac ablation to restore my heart’s normal rhythm. My recovery went well with no complications, and I have returned to normal activity. Is it safe for me to dive now?

A: Opinions vary in the dive medicine community about AFib and medical fitness for diving. Some physicians completely recommend against diving, while others are more permissive. Respected dive medicine cardiologist Dr Douglas Ebersole believes that AFib alone, with an otherwise structurally sound heart (confirmed through treadmill stress testing and an echocardiogram), should not prevent diving. As long as you control your AFib with medication and have proper exercise tolerance, you should be able to dive.

Your successful ablation has resolved the dysrhythmia issue of AFib, but it raises another concern. The ablation procedure may have required a transseptal puncture to get the catheter from the right atrium into the left atrium. This puncture results in an atrial septal defect, which will generally heal without any intervention over time. Unfortunately, there is no clinical definition of how long that time is. Although the hole is typically small, depending on the exact procedure (some catheters are larger than others), you would be at risk for bubbles shunting from the right to left atrium until the hole has completely closed.

The best recommendation is to wait for confirmation from your cardiologist that the hole is closed before you return to diving. An echocardiogram with a bubble study is usually the procedure to determine the hole closure. www.daneurope.org

Barbados

has a place for everyone, but especiallyforyou