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Ear Trauma at 15 metres = Never Dive Again

Discussion in 'Diving Medicine' started by Fried Fritz, Mar 23, 2012.

  1. Fried Fritz

    Fried Fritz Angel Fish

    # of Dives: 25 - 49
    Location: Adelaide South Australia
    5
    2
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    Can anyone help

    On the 26th Feb 2012 I made a dive in good weather but there was a bit of current on.

    I descended to 15 metres when I heard a pop in my left ear followed by the sound of bubbles.+
    The descent took 75 seconds.

    There was no pain or vertigo but thought it a good idea to surface and check out the situation topside.
    I got out of the water and onto the boat. I took my gear off and felt OK.
    I waited 15 minutes and felt great. I then put my gear back on and went back into the water.
    I only made it down a metre or so before the pain set in and I aborted the dive completely.
    I went straight to the doctors and was advised my ear drum was very red and to come back in two days for reassessment after the administration of antibiotics.
    My ear was ringing and still is to this day with the same intensity.
    I went back as advised and was told there was a small pin hole in my ear drum and to rest and continue with the antibiotics.
    I went back to the doctor a week later and asked for a referral to the ENT surgeon who did my sinuses in 2004.
    He was not available for a month plus so I saw another Doctor.
    He stated there was a small scab on my ear drum which he tried to vacuum off but it would not budge.
    He said it was probably the scab covering a perforation in my ear drum.
    I then did an audio test which showed a loss in my high frequency hearing.
    Doc was not sure if this was due to the high pitched whistle in my ear causing me not to be able to hear the high frequency tones during the test.
    I went back a week later, being yesterday, for another check and the scab was still the same but there was a slight improvement in my hearing. The ringing had not changed
    Doc could not be sure exactly what had happened but advised I never dive again. He was concerned I had punctured my inner ear and had some fluid loss but could not confirm.
    He wasnt sure if it had been damaged from the external water pressure or by my equalisation.
    Due to this he had to err on the side of caution and advise I never dive again. He was concerned if I dived again I might experience further fluid loss, experience vertigo and possibly die.
    I am booked in for further testing on April 24th for ENG, Caloric and Pure Tone and Speech testing. I would like a second opinion before then if possible.
    Can anyone advise on best plan of attack here. I will go crazy if I cant dive again. I have heard of people with much worse injuries who are still diving. I dont want this to be a case of the doctor covering his ass at the expense of my future diving enjoyment.
    My intentions are to not dive til next season and see what happens. The ringing is still there and if I equalise, which I can do without any problems, there is no pain at all.

    Any advice will be greatly appreciated
     
  2. RickyF

    RickyF Manta Ray

    # of Dives: 500 - 999
    Location: Oahu
    611
    187
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    I would suggest you call DAN and ask for a specialist in your area that has dive injury experience.
     
  3. Davemohio

    Davemohio Divemaster

    # of Dives: 200 - 499
    Location: Columbus OH USA
    424
    89
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    Fritz,

    + 1 on the call to DAN. And I empathize with your frustration. Big time.

    SOME physicians do not "get" how serious some folks are about diving. They don't understand.

    Note, I have NO medical training. But I have had 2 sinus surgeries and experienced ear issues. The testing you have gone thru is similar to what I went thru after a middle ear barotrauma. I had the tinnitus before the ear issue. I see my ENT regularly.

    So far you have done all the right things.

    But a second opinion is a great idea.

    Obviously, you have to follow your physicians' mandates.

    Good luck and hope you can keep diving.

    Dave.
     
  4. Duke Dive Medicine

    Duke Dive Medicine Scuba Media & Publications

    1,367
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    Fritz,

    It sounds like your ENT physician suspects a perilymph fistula, which is a rupture of either the round or oval window. Your symptoms (persistent tinnitus and high-frequency hearing loss) are consistent with inner ear barotrauma. The ENG and other tests will help determine if there is permanent damage to the vestibular apparatus. If there is, then you've only got one set of intact vestibular apparatus left. If you dive again, there is a risk of damaging that one as well.

    It looks as if you've just started diving. Is this the first time you've had difficulty equalizing, or has it been a consistent problem?

    Best,
    DDM
     
  5. DivingOtter

    DivingOtter Nassau Grouper

    # of Dives: 500 - 999
    Location: Toms River NJ
    126
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    I was having problems after a bad squeeze, my tender dropped me and I had pain for about 3 days. After that I had trouble equilizing. Since I dive hard hat, my dr placed PE tubes in my tympanic membrane which last about 3 years at a time. This means I dont equilize. Air naturally passes through my ear drums and I feel no change in pressue. However, for scuba operations while working, I have to wear a mask that covers my ears and keeps them dry since I cant submerge them. I will say a good test was being slammed in the chamer to 187 FSW, and while everyone else was racing to clear, I was able to sit back and relax. Its got its pros and cons but I did what I had to do to keep diving commercial.
     
  6. gkwalt

    gkwalt Instructor, Scuba

    # of Dives: 500 - 999
    Location: Fallston,MD
    69
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    This sounds like something that happened to be a number of years ago. My ENT diagnosed a perilymph fistula (PLF) and did surgery. Almost 25 years later I have hearing loss in my ear, but no significant tinnitus or vertigo. Twenty five years ago I was advised to stop diving. Since that time, I have done extensive research on this problem. This is my take on the subject...LET ME REINFORCE...this is only my opinion!!!! The risk of the same thing happening to my other ear is small. Some may argue that. My condition has been stable for >25 years and I love diving. So...I have rolled the dice and started diving again. After some 200+ dives I have had no new problems. The medical literature is mixed about recommendations about diving after PLF. I think DAN would say don't dive or at least leave it up to your ENT. I have been lucky so far and have enjoyed some amazing dives since I went back in the water.
    Please remember, this is only my take on the subject. Am I risking bilateral hearing loss?...maybe. But this was an educated, researched and informed chance I am willing to take. I would be interested in hearing the expert's opinion and the analogy to recommending diving "a conservative profile" in a divers with a known PFO.
     
    clownfishsydney and Davemohio like this.
  7. Fried Fritz

    Fried Fritz Angel Fish

    # of Dives: 25 - 49
    Location: Adelaide South Australia
    5
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    Hello and thank you all for replying so quickly.

    I have contacted DAN as I am a member. They have put me in contact with the head of the Hyperbaric Unit in the Royal Adelaide Hospital in Adelaide South Australia. He is organising a visit to a secong ENT for a second opinion.
    I had a sinus surgeryinn 1994 and another in 2004 but have never had any ear issues and have never had a issue equalising. I was not having trouble equalising when this injury occurred
    The tinnitus I currently have is due to the current injury. I have never had it before.
    The diving season is over and I will not enter the water until I have a second opinion and researched the subject further.
    I hope this will be rosolved by next summer. I want to thank you all for your advice. I will keep you all up to date with my progress.
    Any further advice is welcome.

    FF
     
    RickyF and DandyDon like this.
  8. Duke Dive Medicine

    Duke Dive Medicine Scuba Media & Publications

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    Hi gkwalt,

    A few notes, in no particular order. You've already done your research so this may be a duplicate of what you've read, but I'll try.

    Background:
    The vestibular apparatus in the inner ear consists of two organs: the cochlea, which is the organ of hearing, and the semicircular canals, which are responsible for balance. Either of these can be damaged by inner ear barotrauma. Damage to the cochlea may result in hearing loss and/or tinnitus, while damage to the semicircular canals results in vertigo.

    Inner ear barotrauma vs. PLF:
    Inner ear barotrauma does not necessarily mean perilymph fistula. The inner ear can be damaged by pressure without actually incurring a fistula. A fistula, or tear, typically happens in either the round or oval window. The only way to definitively diagnose perilymph fistula is to surgically explore the inner ear.

    Treatment:
    If a diver presents with symptoms of inner ear barotrauma, we'll put him/her on strict bed rest and give stool softeners to prevent straining and subsequent leakage of fluid if there's a fistula present. If symptoms do not resolve or improve significantly within 24 hours, surgery is typically indicated.

    Followup:
    After symptoms stabilize and any surgical sites have healed, a diver will usually undergo testing to determine the extent of damage. This may include audiogram, electronystagmogram (ENG), and other tests.

    Resuming activity:
    The conservative approach, and the advice you'll hear from most practitioners, is to stop diving after a perilymph fistula. If a diver chooses not to follow this advice, there are a few things that he/she will need to consider:
    1. How did the injury happen? Was it a one-time event due to congestion and inability to equalize, or does the diver consistently have a difficult time equalizing because of his/her individual anatomy? The chances of re-injury or injury to the opposite ear are much higher if anatomical variances or other issues make it difficult to equalize.
    2. What were the original symptoms? If vertigo was present but has resolved, it's possible that the brain has compensated for the damage to the injured semicircular canals. If the intact semicircular canals are damaged by a subsequent injury, the diver will suffer from permanent, possibly debilitating vertigo. If hearing loss and/or tinnitus are present, injury to the other cochlea could result in further hearing loss and tinnitus, which could cause a significant lifestyle alteration. Severe tinnitus can be maddening, as anyone who suffers from it can attest.

    This is by no means an endorsement, but if a diver decides to return to diving, he/she should conduct a very honest risk/benefit analysis, taking into account the likelihood of further injury and the amount of disability that he/she is willing to endure.

    The PFO irony:
    Normally, a PFO is only discovered in a diver if he/she is tested for one following an incident of decompression illness. PFO is associated with sudden-onset severe neurological DCS, inner ear DCS, and loosely with cutis marmorata (skin marbling). Our index of suspicion is raised if the diver has any of these symptoms following a moderatly provocative no-stop dive and, if neurological symptoms are present, there is no evidence of AGE. If we suspect a PFO, we'll order an echocardiogram with bubble contrast. If a PFO is discovered, it's assumed that the DCS incident was due to the PFO. This is a bit of a logical fallacy, but it's the most conservative approach. We'll advise a diver in this situation not to dive again; if the diver chooses to continue diving, we recommend that he/she dive conservatively to keep venous bubbling to an absolute minimum. This includes staying shallow (<60') and well within the no-stop limits, and using nitrox on either air tables or the air setting on a dive computer.

    I guess the analogy between diving with PFO and diving after inner ear barotrauma would be that both involve an honest assessment of the risks, determining if the benefit of diving is worth those risks, and taking every possible step to mitigate them.

    Best regards,
    DDM
     
  9. Fried Fritz

    Fried Fritz Angel Fish

    # of Dives: 25 - 49
    Location: Adelaide South Australia
    5
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    Thanks Duke

    Is the Tinnitus permanent. You are quite correct about it being madening.
     
  10. aussie82

    aussie82 DIR Practitioner

    # of Dives: 50 - 99
    Location: Idaho
    51
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    Let me first say I hope that you make a full recovery. I suffer from bilateral high frequency hearing loss and tinnitus. My tinnitus never really goes away but does seem to be worse when it's completely quiet. It doesn't stop me from diving. I should also mention that my hearing was not damaged diving, I served in Iraq in 2003-2004 and it was damaged then. Good luck.
     

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