I don't know anything about the problem except what I just read on line.  It
appears to be an inner or middle ear issue which suggests that the surgery
you had opened some kind of channel into that region.  If related tissues,
your eardrum or other entry channel, are weakened to the point where they
are at risk from internal or external pressure differential, both of which
are experienced in scuba and free diving, you're probably well advised to
find another hobby.  Pressure damage to the ear could leave you permanently
and completely deaf and water entering through the ears is problematic,
sometimes fatally so.

As for snorkeling, on the surface, no freediving, the risks are considerably
less.  You might well be able to participate.  You might even find something
like the Bob, a kind of helmet arrangement that surrounds your head with
air.  It all depends on what the medical risks are.  That, you're going to
have to talk to a doctor about.

I suggest you do a search on Diver's Alert Network, locate a toll free
number for diving medical information and ask their opinion.  Also ask them
if there's a specialist in your part of the world that you might consult
with.

Lee

Thre is only one authoritative source for medical info about diving, and
that's scuba doc, a forum for hyperbaric and scuba physicians. The only
reference I could find to cholesteatoma was as follows:

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Revisiting the “Absolute Contraindications” to diving - as outlined by
various organizations such as the RSTC and NOAA and copied by most of
the certifying agencies, turns out to be a difficult project, as there
are few studies to be found that back up their recommendations. Making
the guidelines more lenient turns out to be just as difficult - again
because there are few suggestions that can be based on evidence. Expert
opinion and anecdotal evidence are generally the substantiating factors
in making decisions about fitness to dive.

The obvious reasons why a person should not be allowed to dive are as
follows:

* Disorders that lead to altered consciousness
* Disorders that inhibit the “natural evolution of Boyle’s Law”
* Disorders that may lead to erratic and irresponsible behavior.

Here is the first system that we looked into, the ear, nose and throat -
abnormalities in which can stop a person immediately from diving without
any rules having been applied. Reviewed and commented upon by Allen
Dekelboum, MD.

RSTC Absolute Contra-indications
• Monomeric TM
• Open TM perforation
• Tube myringotomy
• History of stapedectomy
• History of ossicular chain surgery
• History of inner ear surgery
• History of round window rupture
• Facial nerve paralysis secondary to barotrauma
• Inner ear disease other than presbycusis
• Uncorrected upper airway obstruction
• Laryngectomy or status post partial laryngectomy
• Tracheostomy
• Uncorrected laryngocele
• History of vestibular decompression sickness

——————————————————————————–

NOAA Absolute Contra-indications

Inability to equalize pressure in the middle ear by auto-inflation. This
may be due to a correctable problem such as polyps, nasal septal
deviation or allergic rhinitis in which case the diver can be
reevaluated after correction of the problem. In addition, this may be
purely a training problem with technique and altering the clearing
method might be all that’s necessary. Nevertheless, one cannot and
should not dive until this maneuver can be accomplished with ease.

Risks: Damaged middle and inner ear from barotrauma
Hearing loss
Severe balance problems
Drowning

Perforation of the tympanic membrane. Until fully healed or successfully
repaired with good Eustachian tube function, diving is contraindicated.
Ease of equalization should never be ignored.
Risks: Water in the middle ear
Vertigo and possible drowning
Infection, middle and inner ear
Hearing loss.
Balance problems

Open, nonhealed perforation of the TM.
Risks: Water in the middle ear
Vertigo and possible drowning
Infection, middle and inner ear
Hearing loss.
Balance problems

Monomeric TM. A thinned out ear drum. Thickness differs in individuals.
If the diver has good Eustachian tube function and can equalize easily -
diving might be allowed. ENT consultation assessing the amount of
pressure sustainable by the tympanic menbrane.
Risks: Perforation of ear drum
Water in middle ear with same risks as above.

Tympanoplasty, other than myringoplasty (Type I)
Tympanoplasty, Types II, III, IV all deal with tympanic membrane
perforations as well as damaged ossicles. Goals are to have a dry ear,
functioning Eustachian tubes, increased hearing, normal balance.
Successful surgery with these factors present would not seem to be
adverse to diving if ability to equalize is present. Discussion with
surgeon about risk factors. Most chronic middle ear disease and mastoid
disease is due to a poorly functioning Eustachian tube (ET). Correcting
the middle ear disease, might not correct the ET problem.
Risks: Water in the middle ear
Vertigo and possible drowning
Infection, middle and inner ear
Hearing loss.
Balance problems

History of stapedectomy.
Most recently there have been good studies to show that stapedectomy is
not the risk that was once thought. A study in the journal
‘Otolaryngology, Head and Neck Surgery’ in October, 2001 by Drs. House,
Toh and Perez at the House Ear Clinic in Los Angeles concluded that
stapedectomy does not appear to increase the risk of inner ear
barotrauma in scuba and sky divers. These activities may be pursued with
relative safety after stapes surgery, provided adequate eustachian tube
function has been established. There had been the fear that the stapes
implant would be pushed into the round window, damaging the inner ear.
Those that agree with Dr. House are in the minority.

Otolaryngol Head Neck Surg 2001 Oct;125(4):356-60
Diving after stapedectomy: clinical experience and recommendations.
House JW, Toh EH, Perez A.
Clinical Studies Department, House Ear Clinic and Institute, 2100 West Third
Street, Los Angeles, CA 90057, USA.

History of inner ear surgery.
There are those who do not feel that successful inner ear surgery is a
contra-indication to diving - given a functioning Eustachian tube and
easy clearing of the middle ear. There should be hearing remaining that
is normal or near normal. Not all who have repair of labyrinthine
fistulae recover their hearing.
Status post laryngectomy or partial laryngectomy
Valid recommendation

History of vestibular decompression sickness - This probably is a valid
recommendation. A study showed that only 28-32% of divers with IEDCS
completely responded to hyperbaric treatment - indicating possible
permanent damage to end organs such as the vestibule and cochlear.
Farmer et al have demonstrated a near total return to baseline hearing
if recompression is initiated immediately.
Inner Ear Decompression Sickness in Sport Compressed-Air Diving.
Laryngoscope. 111(5):851-856, May 2001.
Nachum, Zohar MD; Shupak, Avi MD; Spitzer, Orna MA; Sharoni, Zohara MA;
Doweck, Ilana MD; Gordon, Carlos R. MD, DSc

Farmer JC, Thomas WG, Youngblood DB, et al. Inner ear decompression
sickness. Laryngoscope 1976;86:1315-1327.

Radical mastoidectomy (posterior) involving the external canal is
disqualifying. (Closed childhood OK). Dr. Dekelboum describes several
commercial divers with mastoid cavities who went to work, waited for the
vertigo to cease, after a few minutes, and performed their tasks, using
prophylactic antibiotic ear drops after leaving the water.

Risks: Water in the middle ear
Vertigo and possible drowning
Infection, middle and inner ear
Hearing loss.
Balance problems

Meniere’s disease is disqualifying, as well as surgical procedures
designed to treat the condition. I can find no references backing this
up except the unsupported statement that pressure worsens the condition.
However, pressure is exerted in and on the body equally - not just on
the endolymph. Meniere’s is known to be initiated by vestibular
stimulation and stress - certainly scuba diving can cause both of these
- but so can many other things. Although risky, there are many Meniere’s
sufferers who dive. Diving is not recommended - unless one has a very
reliable buddy who understands the risks.

Labyrinthitis This would be a situation that would not be permanent.
Diving should certainly not be allowed in the acute phase.

Inner ear barotrauma and Perilymph fistula. No evidence that returning
to diving is contra-indicated. http://tinyurl.com/4p468 . A repaired,
asymptomatic fistula from round window rupture is not an automatic
contra-indication to some diving medicine specialists. Parell et al have
shown that if proper precautions are taken to maintain proper eustachian
tube function, no further deterioration takes place in hearing if a
patient returns to diving after experiencing cochlear IEBT.

Parell GJ, Becker GD. Inner ear barotrauma in scuba divers. A long-term
follow-up after continued diving. Arch Otolaryngol Head Neck Surg
1993;119:455-457.

Dr. Allen Dekelboum states that he has the same feelings about this as
to inner ear surgery. Although not published,he did an informal survey
many years ago, involving the two largest series of those who treated
inner ear barotrauma. All agreed that if there was usable hearing
remaining in the ear and the patient took precautions to adequately
equalize, aborting any dive when equalization failed, they would allow
their patients to dive. Before I agreed with those surgeons, I always
recommended that they not dive. They all did anyway and no one was hurt.

Cholesteatoma is disqualifying.

Cerumen impactions - remove before allowing to dive. This causes
barotrauma of the external ear canal between the cerumen plug and the
ear drum. Just remove the impactions. There is no need to remove
non-impacted cerumen. Being too aggressive could lead to external otitis.

Stenosis or atresia of the ear canal- disqualifying. Narrowing of the
external ear canal without blockage would be less risky and probably not
adverse to diving.

Facial paralysis secondary to barotrauma. It is assumed that further
diving would increase the risk of further barotrauma to the ear (the
facial nerve passes through the wall of the ME.). http://tinyurl.com/4wle8 .
This does not seem acceptable that barotrauma will occur every time a
person dives. Given ease of equalization this might be a situation that
is not absolute and these patients could dive.

Tracheostomy, tracheostoma . Endotracheal tubes can be rigged to accept
respirators - so it’s possible that a scuba regulator could also be
fitted to a tracheostomy. However, this is extremely risky and possibly
fatal. It is not recommended that anyone with an external connection to
the trachea dive.

Incompetent larynx due to surgery (Cannot close for valsalva maneuver).
However, it might be possible to do other maneuvers that will open the ET.

Laryngocoele. This is an extremely rare occurrence and effects of the
condition are variable. A large, fluid or pus filled sac obstructing the
airway would certainly be a contra indication to scuba diving. An air
filled sac with a narrow neck would be risky for obstruction and rupture
due to barotrauma. A small asymptomatic laryngocoele would probably not
cause a problem.

Congenital or Acquired hearing loss. It is assumed that this is because
of the possibility of further hearing loss from a scuba diving accident.
Whether or not to dive would depend upon the degree of hearing loss of
each case. Total hearing loss in one ear confers the risk of complete
deafness should the other ear be damaged due to a diving accident. When
the risks are explained to the patient, they will make their own choice.

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Note they state cholesteatoma is disqualifying, without any discussion
or qualifications. That pretty much says it all.

m