Cranial abscess

Question:
I have a very exciting case with question fit for dive or not.
First contact 15.4.97 with mild pain left ear after diving with no equalizing problems. otoskopic infected ear canal with little affection of ear drum.
Next day 1200 hour, severe pai, therefore I perforated the ear drum with lots of secretion of pus, neurological no problems, interestingly high blood pressure but low pulse!. Pat was sent to clinic, but did not really want to go. Having a bad feeling I made a phone call 1645 to see if patient went to hospital, reached him on the phone where just could state his name, but could not give answer to simple questions. Motorical Aphasia! Raising hell with suspect of absces of empyema of middle brai I called emercency transport for him to be taken in.
CT scan revealled that my diagnosis was right, same night he unterwent combo operation of ENT and Neurosurgery with implantation of ventilation tube, surgery of Mastoid and drain of the pus (subdural empyema and bakteral menigitis). Part of the skull was removed and later reimplanted.
He barely made it having one epileptical attack, treatet with Phenytoin for a while.
He was in intensive care intubated and "breathed" by machine for a while, later went to rehabilitation and now has no sequale.
The cause of the empyema was a gap in the tegmen tympany which according to the anatomists have about 25 percent of the normal population.
Every 16th of April he now appears in my clinic for celebration of additional birthday.
The latest CT (Nov 98) scan of scull base still reveals a little bone gap of 2 mm, which was glued with the first operation.
Snorkeling he has no problems with equalizing and is eager to start diving again!!! (Why do always I get those people to ask me if they can dive or not???!!!).
The MRI Scan searching for scars of NOv 98 show Glia scars left parietal and a thickening of the dura as sign of former Menigo Encephalitis and a small atropia of the left emisphere.
He and his daughter are very much into the Wasserwacht, his daughter beeing 14 starts to dive anyhow now, and I believe he is going to dive again no matter what I say.
I strongly believe that the mechanical reason for this accident, the bone gap is proof and tight and will resist equalizing, but what about the scars?
I always tell him that after epilepsia you have to wait 5 years of no medication or attack, but the late EEG show total normal activity.

Answer:
I agree with you that the bone lesion should not be a problem. I also do not think that the risk of epileptic seizures is significant, as the antiepileptic drug treatment was very brief and there is now no EEG abnormality.
This could be considered as a bad case of cranial trauma, now satisfactorily healed.
To be safe I would have a full EEG study (including sequential Furier spectro-analysis) under all kinds of possible stimulation, not only hypervantilation, but also visual stimulation, strobo, halo-lights, etc.