ACOUSTIC NEUROMA - still diving.....

[Melphrodite]

Hello,
I wonder if there are any medical professionals who have an opinion on scuba diving with an acoustin neuroma. I was diagnosed a few years ago in my mid twenties with a unilateral "medium sized" AN. I decided not to have surgery and had radiation treatment instead.

I've been unbale to find anyone who can tell me if diving is dangerous. My consultant said that there was no reason why it should be a problem, but he wasn't too sure. I have recently qualified as a diver (PADI OW advanced) and experienced no problems, even at depths of 30m. I'm very careful with equalizing, as I only have one good ear left!

Mel

 

[fisherdvm]

shakeybrainsurgeon is a neurosurgeon, why don't you pop him a PM:

http://www.scubaboard.com/forums/diving-medicine/217648-acoustic-neuroma-diving-2.html

 

[shakeybrainsurgeon]

AN's are benign lesions usually affecting only the inner ear (auditory nerve, or internal acoustic meatus). They usually cause mild to total hearing loss and, unless they are very large, nothing else. Specifically, unless there is brain stem distortion or hydrocephalus, they do not cause headache, weakness, balance problems or incoordination. Even though they usually arise on the vestibular portion of the nerve, not the auditory portion, vertigo or dysequlibrium are rare.

Because they are in the cerebellar region of the brain, not the cerebral area, seizures virtually never occur. They rarely, if ever, hemorrhage, either. There is virtually no chance of an AN patient acutely "decompensating" underwater. The only rapid deficit that may occur is increased hearing loss which, if already complete, is not much of an issue. Facial weakness can occur, but it is rarely abrupt and is not disabling. Thus, the typical small to medium AN produces unilateral hearing loss which should not be an impediment to diving although, as noted, you have to be careful with the one good ear.

If the tumor is treated surgically, that is another matter entirely. Posterior approaches open the mastoid and also disrupt the IAC (which can have air cells too). The translab approach favored by ENT destroys the middle ear anatomy entirely. Whether someone can dive after such surgery, I don't know. It would likely depend on the person and their unique anatomy and surgical approach.

In this case, radiation alone was used, so surgical disruption of the ear/sinuses is not an issue, apparently.

The only dliemma in AN patients is how much risk one wants to assume to the remaining good ear. If someone has no problems equalizing and dives carefully, that shouldn't be a problem, but that's a personal decision, like playing contact sports with only one good eye.

But an otherwise aymptomatic AN with no history of surgery should not pose an increased risk otherwise to the diver or his/her buddies.

This is just a general opinion and not intended, of course, as official medical advice, which can only be rendered by your personal treating physicians. There may be factors affecting your unique case that have not been conveyed here that may affect your diving risk.

 

[vtascuba10s]

Hey Mel,

I am three years post-op from Acoustic Neuroma Surgery (Middle Fossa Approach). Besides some hearing loss, I had so many other symptoms. I was actually diagnosed the day before leaving on my honeymoon to Cozumel. My doctor said that diving would not be a problem. I got down to about 60 feet at Santa Rosa Wall and experienced the worse vertigo imaginable. Upon surfacing I had a terrible headache, ringing in my head, and I lost the rest of my hearing in my left ear. My buddy Kyle, another instructor, has a friend Michael Emmerman. He was one of the co-founders of DAN. I contacted him a while ago, and he did not have a real opinion on diving pre or post op. That was three years ago, so maybe there is more research now. I had a lot of post op difficulties, and probably won't return to diving. My recommendation is to be careful. You just never know when pressure can cause a shift of the tumor...and like my experience, all hell broke loose. I also have a doctor friend who is one of the department heads at one of the NY area hospitals...he's a very good neurologist, and an old dive buddy of mine. I can put you in touch with him if you like. Also, House Ear Institute in LA is where I had my surgery. Even though I had a bad experience based upon their recommendation of diving, there may be somebody else there who is more knowledgeable about diving with an AN. Drop me a line anytime.

Matt

 

[vtascuba10s]

AN's are benign lesions usually affecting only the inner ear (auditory nerve, or internal acoustic meatus). They usually cause mild to total hearing loss and, unless they are very large, nothing else. Specifically, unless there is brain stem distortion or hydrocephalus, they do not cause headache, weakness, balance problems or incoordination. Even though they usually arise on the vestibular portion of the nerve, not the auditory portion, vertigo or dysequlibrium are rare.

Because they are in the cerebellar region of the brain, not the cerebral area, seizures virtually never occur. They rarely, if ever, hemorrhage, either. There is virtually no chance of an AN patient acutely "decompensating" underwater. The only rapid deficit that may occur is increased hearing loss which, if already complete, is not much of an issue. Facial weakness can occur, but it is rarely abrupt and is not disabling. Thus, the typical small to medium AN produces unilateral hearing loss which should not be an impediment to diving although, as noted, you have to be careful with the one good ear.

If the tumor is treated surgically, that is another matter entirely. Posterior approaches open the mastoid and also disrupt the IAC (which can have air cells too). The translab approach favored by ENT destroys the middle ear anatomy entirely. Whether someone can dive after such surgery, I don't know. It would likely depend on the person and their unique anatomy and surgical approach.

In this case, radiation alone was used, so surgical disruption of the ear/sinuses is not an issue, apparently.

The only dliemma in AN patients is how much risk one wants to assume to the remaining good ear. If someone has no problems equalizing and dives carefully, that shouldn't be a problem, but that's a personal decision, like playing contact sports with only one good eye.

But an otherwise aymptomatic AN with no history of surgery should not pose an increased risk otherwise to the diver or his/her buddies.

This is just a general opinion and not intended, of course, as official medical advice, which can only be rendered by your personal treating physicians. There may be factors affecting your unique case that have not been conveyed here that may affect your diving risk.

Hi there,

I had a small (8mm) left sided AN. Like you, my surgeon from the House Clinic said there would be no problem with diving. During my last dive I experienced the worst vertigo possible...terrible headaches, dizziness, and ringing in the ear. I opted for the Middle Fossa Surgical Approach, and have not returned to diving....and that was over three years ago. My recommendation to anyone with an AN and scuba diving is be careful, don't push it. The greatest volume change on an ear space happens within the first atmosphere of water (33 ft).

 

[AdivingDawg]

Hello, not really a question as I was nderstand that should answered between team of doctors and then myself. Recently had mri due to a slow developing unilateral hearing loss. The radiologist report shows 6 mm enhancing lesion laterally within the right internal auditory canal. This is most likely a vestibular schwannoma.
Since I’m 66 and good health I believe I will elect to have some type of radiation treatment
I have been diving with this an probably for a couple of years as my hearing has slowly worsened to about 50% of normal. I last dove several 2 months ago.
I really don’t want to stop diving as it has been my favorite hobby for 40 years and just recently got to dive with my third generation grandson and all my four children and their spouses.
Meeting with h treatment team in august with another dive planned for September so I’ll probably schedule treatment after that dive. I hope it’s not my last.
I guess I just needed to write and add comment on this his topic.