dizzyness after diving?

[BillP]

ASCENDING TO ALTITUDE AFTER DIVING

Since ascending to altitude after diving has been brought up, now might be a good time to mention Dr. Edward Kay's webpage at http://faculty.washington.edu/ekay/altitude.html . Dr. Kay is a Family Practice and NOAA trained diving physician in Seattle on the clinical faculty of the University of Washington. He is the Dive Physician for the University of Washington Diving Safety Program, and also serves as Diving Medical Examiner for the Health and Safety Executive (HSE) of the United Kingdom. On his webpage, Dr. Kay gives his recommendations for "time-to-fly" before ascending to altitude. He also references Dr. Campbell's excellent Scubadoc site on his webpage and even has a specific link to Dr. Deco's forum here- so he must be a good guy (grin)! FWIW, the air pressure at 1500m is about 0.83ATA.

MIDDLE AND INNER EAR BAROTRAUMA AND DIVING

Middle ear barotrauma is the number one most common dive related injury reported to diving physicians and DAN. Unfortunately it is quite common and seems to be widely under recognized and under reported by many divers and even diving instructors. Many divers complain of fullness or hearing loss like "water in the ears" after diving and try all kinds of drops and potions when the problem is not actually in the outer ear canal. Of course you often can have water in your ears that can be relieved by eardrops or simply a short span of time, but often the problem is in the middle ear. Inexpensive otoscopes (those "ear-lookers" doctors use) are sold at drugstores now for parents to look in their kids' ears. It might be a good investment for those who frequently run into divers (particularly students) with "water" or "wax" in their ears after diving to learn to use one of these to see if that's actually the problem or if the divers have barotrauma. You can read more about middle ear barotrauma on DAN's website at http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=13 . You can also read a "case history" about middle and inner ear barotrauma in the FAQ on DAN's website (that is similar to, but much more severe than viceroy's description of symptoms) at http://www.diversalertnetwork.org/medical/faq/faq.asp?faqid=19 .

Middle ear barotrauma can be associated with inner ear barotrauma and a feeling of "dizziness". The dizziness can be quite severe and disabling if due to rupture of the delicate round or oval windows of the inner ear, but inner ear barotrauma does not have to be associated with a round or oval window rupture and the symptoms can be mild to moderate. (Note in the DAN FAQ link how the diver experienced "trouble with his balance" but DAN felt he "was fortunate he didn't rupture his eardrum or one of the internal membranes of the ear".)

Another good source to read about middle ear barotrauma is the website for The Center for Sensory and Communication Disorders at Northwestern University. It can be found at http://www.cscd.nwu.edu/public/ears/barotrauma.html#middle . Dr. Kay also has a page on middle ear barotrauma at http://faculty.washington.edu/ekay/MEbaro.html .

Decompression sickness after a post-dive ascent to altitude can be associated with dizziness, but it would be exceedingly unlikely that 5 divers would all develop identical neurological DCS. As Dr. Deco has already pointed out elsewhere on this board, DCS of the inner ear is generally associated with deep decompression dives and not recreational diving. It would be unheard of for 5 recreational divers to all develop labyrinthine DCS from their open water training dives. It would also be unlikely for all to develop identical symptoms of CAGE after going home. It wouldn't be unlikely for 5 new divers to develop symptoms of barotrauma.

Food-borne pathogens can cause dizziness. They will generally do this by making you soooo ill from nausea, vomiting, and diarrhea that you get dizzy from being horribly sick and dehydrated. Viceroy did not describe such symptoms. I suppose it's possible that all 5 divers developed a viral labyrinthitis like octodiver says she was misdiagnosed with after diving, but isolated labyrinthitis particularly associated with the feeling of blocked ears that viceroy mentioned would be a very unusual presentation of an infection with a food borne pathogen. Given the symptoms associated with the illness that seem to closely fit a dive related middle/ inner ear barotrauma injury and that seem unusual for a food borne pathogen, I believe a dive related injury more likely.

I guess that I agree with John Reinertson's assessment.

HTH,

Bill

 

[Rick Murchison]

OK Docs, let me ask y'all a question... have any of you ever *seen* "most" divers in a group come down with the same or very similar pressure related symptoms?
I haven't - but I've only been at this (and flying) a bit over three decades, (well, three and a half for the flying) and I get surprised from time to time. The only times I've seen similar symptoms in any group it has always been traceable to the food or the water or to a "bug going around." Howzabout a good old fashioned rhinovirus?
If this group were indeed all having some sort of mild DCS or barotrauma then I'd expect at least one severe case among 'em (wouldn't you?).
Too bad we weren't all there for a look through the otoscope and a little blood work at the time... then we wouldn't be dealing in probabilities and conjecture.
Rick (still bettin' on a non decompression cause)

 

[viceroy]

Just to clarrify.

We all drove back home after a 3 hour wait after our last dive.

 

[BillP]

Thanks for the clarification viceroy. After you left the coast, how long did it take to get to altitude? Did your instructor mention anything about an ascent to altitude after your checkout dives? Now, another bit of clarification if you would please. Did the five of you have disabling, falling-down-drunk, can't-walk-a-straight-line, throwin'-up-my-toes dizzines, just some fuzzy that-doesn't-feel-right when your eyes were closed in the shower dizziness, or something in between? Did you and the other students tell your instructor about your dizziness?

You're right Rick, 5 people could all come down with a virus that causes labyrinthitis (or vestibular neuronitis- inflammation of the nerve to the inner ear). The symptoms are typically dramatic with marked and sometimes incapacitating vertigo associated with intractable nausea and vomiting, but don't have to be. It is not generally associated with the ringing in the ears, slight loss of hearing, or feeling of blocked ears that viceroy described.

And 5 new divers all on their open water checkout dives could also all suffer from the most common injury in diving, particulary among new divers- middle ear barotrauma. Middle ear barotrauma is often associated with ringing in the ears, slight loss of hearing, and a feeling of blocked ears- and sometimes a feeling of dizziness.

 

[viceroy]

BillP.

Our instructor did warn us to leave at least 2 hours after our last drive and to take it easy on the way back home. Trip of 550km took myself 7hrs (similar times for the othr divers.

Nope, none of us felt that bad. the ringing ears sensation was similar to having been sitting next to a loud speaker all night and then moving somewhere quiet. The blocked ear sensation was like having something blocking the ear...

The nausea wasnt disabling in any way, and we were all back at work the next day...just so long as I didnt shake my head around too much. It was just an irritation.

If I could also ask one more question about a dive I did this weekend. I went to a local inland divesite and did 2 dives, the first being fine. the second dive seemed fine. Basically to describe the second dive, we swam on the surface to a bouy marking an interesting spot where we descended to about 12m for 5 mins, then surfaced and swam to the next bouy where we repeated the dive. After surfacing again and swimming to the next bouy we tried to descend but when I reached 3m I had a pain start in my left nostral and would shoot up to my eyeball. At that point I aborted my dive. I think it might have been my sinuses, but I'd like to check, and to see if there is anyway I can get around this. I've never experienced it before.

One thing I did notice was that before my nose was clear, but later on in the day (3 hours or so after the dive) my nose was blocked, if that helps you any

Thanks so much for all the info you've provided so far everyone...greatly appreciated

ps. no dizzyness, blocked ears, or ringing this time round

 

[BillP]

Hi viceroy:

Thanks for the additional info. I'm not giving you a hard time, but I think it interesting that you didn't mention your symptoms to your instructor. New (and even seasoned) divers frequently ask about symptoms of middle ear barotrauma on these scuba forums and it's the most frequent dive injury question that DAN answers, but people seem to rarely go back and tell their instructor about the problem. I can see where instructors might get the idea that the problem is uncommon. You might be doing your instructor a favor to drop him a line about it. I can't vouch for the numbers (although I have no reason to doubt them), but you might mention Dr. Kay's website on ascent to altitude after diving to him too.

Pain in the face below the eye on descent or ascent can be due to sinus squeeze. There is a sinus in the cheek between the lower part of the eye socket and upper teeth that can be difficult to clear sometimes. There are some tips for clearing aids in a thread on alternobaric vertigo at http://www.scubaboard.com/showthread.php?threadid=718 . Another possible cause for pain around the cheek could be tooth squeeze with an air bubble under a cap or filling, but this is less likely.

Sinus squeeze can be associated with pain but sometimes the only way a diver knows they've had a sinus squeeze is when they find blood in their mask after a dive. Sinus squeeze uncommonly leads to problems and many divers continue diving after a squeeze, but the blockage with blood and mucus in the sinus can lead to infection. Also the boney wall between the sinus in the cheek and the eye socket is quite thin and on rare occasions can break under pressure. If the wall between the sinus and the eye breaks it can lead to a serious eye infection. If the pain persists after the dive, particularly with redness, swelling, and/ or fever the diver should seek medical attention.

HTH,

Bill