Vomiting and Vertigo

[Ed Hatfield]

Playa del Carmen, Mexico. I did a 2-tank dive today with my son. He is a 30 year old in good health with normal height and weight and no medical issues. He received his OW 4 years ago and did no dives after that. Today he did a 'Refresher' in the pool and then we went to the reef. We did a dive of approx 40 minutes to a max of 45 feet. During the surface interval he felt slight dizziness and nausea. He didn't mention anything because he thought it would pass. We completed a second dive of approximately 40 minutes to 40 feet. His underwater movements and control were exceptional including proper breathing and bouancy for someone on his fist OW dive since certification. He began feeling nausia at the safety stop and started vomiting on the surface. He purged for several minutes and got on the boat. The dive was at Jardines so there was a short boat ride back to shore. He had to lay down at the dive shop with severe vertigo like conditions. He had another bout of vomiting. After 45 minutes we returned to my condo where he lay down and has slept for 3 or 4 hours. He is awake now but is still suffering the vertigo. He descibes his symtoms as nausea, cold and clamy, with dizziness and the inability to stand and/or walk. If ANYONE has a comment or suggestion for a remedy please reply ASAP.

[doctormike]

Wow, that could be a lot of things... from an ENT point of view, one would worry about a perilymph fistula or inner ear DCS. Simple barotrauma would be less likely to cause such symptoms. But I wouldn't limit my investigation to just ear problems. Other forms of DCI (like DCS or AGE) can also present like that. The profile doesn't sound high risk, but who knows...?

I would have him seen by a doc, and call DAN's emergency hotline now: 1-919-684-9111

They may know someone to see in the area.

Good luck...

Mike

[TSandM]

Yeah -- vertigo on ascent can be alternobaric, but having it persist after several hours of sleep, it isn't that. I'd have him seen. (If it were just nausea and vomiting, I'd think it was Mexico. But food doesn't cause vertigo.)

[TSandM]

Ed, any word on this?

[Duke Dive Medicine]

Extremely unlikely to be decompression illness. Did he have difficulty equalizing? Hopefully by this morning he's been evaluated.

[Spd 135]

A young cave diver passed over the weekend in that area. In his case it was carbon monoxide poisoning. With the shallow depths you dived, if this is the case, luck may have been with you guys. Not being a physician, I can't say if it can cause all of the symptoms but I will throw this in just in case.

[Spd 135]

This is the incident I noted above

Cave Diver's Forum - Cave Diving Resource

[DandyDon]

A young cave diver passed over the weekend in that area. In his case it was carbon monoxide poisoning. With the shallow depths you dived, if this is the case, luck may have been with you guys. Not being a physician, I can't say if it can cause all of the symptoms but I will throw this in just in case.

Well, on one hand PDC is a long ways from Coz in terms of tank air sources. On the other, the symptoms are all too similar to a CO hit - as well as a large number of other medical possibilities I suppose. With "symtoms as nausea, cold and clamy, with dizziness and the inability to stand and/or walk" from whatever happened diving, I certainly hope that medical help was sought and DAN called - and hope the blood tests included screening for CO.

[raftingtigger]

Ed, Please let us know the outcome. We are all concerned for your son, and will learn by the ultimate diagnosis.

[Ed Hatfield]

Our internet searches with the symptoms as described revealed a condition called BPPV - Benign Paroxysmal Positioal Vertigo. It is not a diving related illness but it can be triggered by several common activities including diving. It is more commonly associated with flying and can also be triggered by something as simple as standing up quickly. It is the most common form of vertigo and can have all of the symptoms that my son experienced or just mild dizziness at the other end of the spectrum.

Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia. In patients with BPPV, the otoconia are dislodged from their usual position within the utricle and they migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris (colloquially "ear rocks") within the affected semicircular canal causes abnormal (pathological) fluid endolymph displacement and a resultant sensation of vertigo. This more common condition is known as canalithiasis

We also found a series of physiotherapy manoeuvres to releave the symptoms.

The Epley maneuver (particle repositioning) does not address the actual presence of the particles (otoconia), rather it changes their location. The maneuver aims to move these particles from areas in the inner ear which cause symptoms, such as vertigo, and repositions them to where they do not cause these problems.
The Brandt-Daroff exercises may be prescribed by the clinician as a home treatment method usually in conjunction with particle repositioning maneuvers or in lieu of the particle repositioning maneuver. The exercise is a form of habituation exercise, designed to allow the patient to become accustom to the position which causes the vertigo symptoms. The Brandt-Daroff exercises are performed in a similar fashion to the Semont maneuver; however, as the patient rolls onto the unaffected side, the head is rotated toward the affected side.^[11] The exercise is typically performed 3 times a day with 5-10 repetitions each time, until symptoms of vertigo have resolved for at least 2 days.

Yesterday afternoon after several Epley Maneuver applications the sypmtoms all but disappeared. He felt well enough that this morning we took the Tank-Ha trip to Cozumael and did two dives. The dives were no problem. The slight underlying feeling of dizziness is still there but it could persist for a couple of days according to the information we garnered. He will repeat the Epley again a couple times tonight and still plan to dive tomorrow. After the rough boat ride back from Cozumel I haven't found my land legs yet either.

He will be making an appointment to see his doctor and get referred to ENT as soon as he gets home even it the symtoms are completely gone.