Perilymph Fistula and FLYING on a commercial plane - I am stranded on an Island

[doctormike]

Thanks for the detail...! I responded to you by PM with the specifics about the docs, etc... but for other people following thread, here is the redacted version of what I wrote:



It seems that DDM doesn't think that this sounds like DCS (especially given the time frame and the acute onset of symptoms on the surface with air pressure, etc.. Also, it looks like you did relatively short dives to relatively shallow depths on nitrox - that doesn't rule it out, and I'm not an expert, but I think that DCS is pretty unlikely. [DDM, am I over my pay grade here?]

Am I correct in assuming that you have no middle ear fluid, and that the tympanograms were normal? And that the hearing loss is a sensorineural hearing loss, not a conductive hearing loss?

The acute vertigo really does sound more like a fistula than other things, and if you do have a PLF you should NOT valsalva (or lift weights, dive or fly at this point, for that matter). Fistulas may heal spontaneously, but it doesn't sound like things are settling down. Don't know if they put you on stool softeners, but that's often done as well.

The bottom line is that there really is no test that will rule in or rule out a PLF ahead of time, it really is a surgical diagnosis. And you aren't risking much with the surgery if the person doing it is comfortable with ear procedures. It's just a middle ear exploration (where they lift up the eardrum), and look where the fluid might be pooling, and stick some fat or other material there if they see a leak. I really can't diagnose or treat anything over the Internet, but I think that if I was you I would certainly consider the operation.

I don't know these docs, but you could ask them about their otology training, if they had done this surgery before, and how many times and how recently... Like I said, the fact that they are practicing in paradise doesn't mean that they are not competent! If it doesn't sound like this is something that they really do, you could always come back to the US and go to an ear center.

Keep me posted...

Mike

 

[DocVikingo]

You might ask them how many of these they have done, where they trained in otology, etc… The operation is not a very technically demanding procedure, but it should be done by someone with good ear surgery training.

Indeed, doctormike. Otologic surgery that goes awry never is a good thing, and inner ear surgery that does so can drive patients mad.

Regards,

DocV

 

[Duke Dive Medicine]

[DDM, am I over my pay grade here?]

Heck no. This is your area of expertise. I'm second fiddle here

 

[dowmartens]

Thanks for all of the great advice. I had a full work up yesterday, although I can't quite remember all of the acronyms. I had positional vertigo, infrared goggles, air blown into my ears (which didn't work because apparently I have abnormally small ear canals and they could not stimulate my ears drums) as well as some tests with clicking noises and making sure my ear "hairs" were working. Everything that they could conduct was within the range of normal EXCEPT that I did have excess fluid in my affected ear.

After talking with the ENT today and verifying that he does quite a few of the surgeries, as I do live on an island and many people's livelihoods depend on diving here, I am leaning towards getting the surgery done. As to whether I will dive again, I am not ready to make that decision yet. I am a little bit perturbed by the fairly constant headaches I have had over the past week or so, but I think that is probably due to some anxiety over this whole issue. My vertigo symptoms seem to have subsided a little in terms of frequency, but I can't quite put my finger on why I get vertigo some days and other days not, and it seems like most of the attacks are fairly short lived, but at this point, I am not sure if I want to go on wondering if (or when) something else will happen to make this worse or do more damage.

I'll update when I make a definitive decision.

 

[doctormike]

Everything that they could conduct was within the range of normal EXCEPT that I did have excess fluid in my affected ear.

Thanks for the update! This one sentence doesn't make sense to me.... when you say "excess fluid", what does that mean? Because inner ear stuff like a PLF is different from middle ear stuff like barotrauma. With barotrauma (or with an acute middle ear infection), you would have fluid behind the eardrum, which would cause a conductive hearing loss. With a PLF, even though there is technically fluid leaking into the middle ear from the inner ear, it is generally such a tiny amount that it wouldn't be seen through the eardrum, or picked up on tympanometry. The symptoms come from the fact that fluid is coming out of the inner ear, not from that fluid going into the middle ear.

Best,

Mike

 

[dowmartens]

Just wanted to update the thread on my condition. I ended up having the PLF surgery last Thursday. I want to give my honest account of the surgery and how I have felt since then, but this is certainly not meant to scare anyone, as I am sure everyone is different.

The surgery itself was fine. I don't remember much as I was under light general anesthetic and was "drowsy" but my ear was numb. The surgeon had me "bear down" a few times during the surgery to see if he could verify leakage, which he was able to from the oval window. That makes me feel a little bit better, as I feel that the surgery was now not unnecessary. The surgeon said that every thing went well and that it turned out as well as it could have.

What I was not prepared for was how I would feel after the surgery. The doctor told me that I do have small ear canals and could be in some pain for a few days, but "some" pain ended up being a tremendous amount of pain. I am now on day 8 and am still having some fairly extreme headaches at night, balance issues, a little bit of fuzzy vision in my right eye, soar throat, extreme tinnitus and hearing loss (as to be expected in my affected ear), and some interesting taste sensations. I spoke to the doctor this weekend and the other day and he said that all of these symptoms were to be expected as swelling can press on different things.

I have been bed-ridden and taking it very easy just hoping that everyday I will feel a little better, which I have, it has just been a longer process than I thought.

My middle ear was packed with self-dissolving sponges, as was my outer ear (I believe) and I imagine as that dissolves, and my eardrum heals, the tinnitus and other issues will also get better.

I must say that this procedure has most definitely scared me from thinking about diving again. I realize that the chances of this happening again are slim and I realize that there would be risks to dive again, and right now, a week after surgery, these are risks that I am not willing to take. I guess only time will tell if my feelings change.

I really appreciate all the advice, support, and weigh-in that different people provided me with and I will post another update when I am feeling better.

 

[doctormike]

Thanks for the update... those all sounds like common postoperative issues, and you should be feeling better as time goes on! Of course, check with your surgeon, and don't make any decisions this week...

 

[TSandM]

Glad to hear that the diagnosis was correct, which means there's a good chance the problem is corrected. Sorry to hear that your post-op course is rocky, but I'm glad doctormike thinks everything will resolve.

 

[DocVikingo]

Today:

"DocVikingo,

Well, it has been quite a journey, I guess. I must say, I am feeling much better than I did the 10 days or so after surgery. I thought I had a high threshold for pain, but I have never had inner ear surgery I guess. I think that it was day 12 when I finally felt ok enough to go out and walk a little bit. Now, almost 4 weeks after surgery, I am seeing some improvements, but some things still aren't right, and some have me worried. There is a lot of sound (like crinkling paper) in my ear that occurs spontaneously throughout the day, and I get very sharp pains inside my ear when I burp and sometimes yawn, although that seems to be going away. I still have tinnitus, but it only is there about 75% of the time, although sometimes I also hear what sounds like a tv tuned to white noise instead of ringing. The thing that has me a little worried though is that I am still getting vertigo attacks. They are short, an usually only last 5-10 seconds, but they occur at least 2-3 times
a day, and sometimes more.

I saw my ENT last week and he said the surgery went well and everything looks like it is healing, so I hope these attacks are a result of things healing and shifting and not of something else.

Justin"

Regards,

DocVikingo