Diving post acoustic neuroma surgery

[Duke Dive Medicine]

Bob, my take FWIW is that it's a low-probability, high-consequence event. We advise the same for divers who've had a perilymph fistula. If a diver injures the other vestibular apparatus the disability could be severe and life-altering, e.g. permanent, profound vertigo. I thought Mike did a very eloquent job of putting it into perspective.

Best regards,
DDM

 

[doctormike]

Hey, Mike, accepting that we are talking about folks with TWO functioning auditory and vestibular systems, is there any data on the actual incidence of ONE of those systems going down? I would guess it's pretty small. Is dive-induced deafness amenable to cochlear implants?

In other words, can we estimate the risk this diver will become completely deaf, with no subsequent recourse?

Just asking, because with a sample of one, I've dived conservatively for thirty years, and still have both my ears functioning well. I was a little surprised by your comment.

Yes, permanent hearing loss with diving is rare, but it definitely can happen. Since it's not a systemic thing but rather related to local anatomy, a bilateral loss would be uncommon to the point of not being worth considering, IMHO - you probably have a greater chance of a fatal accident from something else.

So I think that your question is - if you dive, get inner ear barotrauma or a PLF and end up with a dead ear, is that treatable with a cochlear implant? I don't do CI, but technically yes - a dive injury wouldn't affect the cochlear nerve. However, a CI doesn't just "switch on" normal hearing. It's not a hearing aid, it's a way of converting sounds to electrical impulses, that you then train the patient to identify as sound.

So again, we are dealing with personal risk tolerances here, and there is no "right" answer, but I wouldn't tell the OP that he should just dive and not worry about it because if he loses all hearing in his only hearing ear, he can just get it fixed with a CI. Results with postlingually deaf adults are nowhere near as good as in children - it's a question of retraining the brain - so I wouldn't just have him rely on the fact that he can always fix any problem with technology.

 

[Spotted_Cow93]

Yes, permanent hearing loss with diving is rare, but it definitely can happen. Since it's not a systemic thing but rather related to local anatomy, a bilateral loss would be uncommon to the point of not being worth considering, IMHO - you probably have a greater chance of a fatal accident from something else.

So I think that your question is - if you dive, get inner ear barotrauma or a PLF and end up with a dead ear, is that treatable with a cochlear implant? I don't do CI, but technically yes - a dive injury wouldn't affect the cochlear nerve. However, a CI doesn't just "switch on" normal hearing. It's not a hearing aid, it's a way of converting sounds to electrical impulses, that you then train the patient to identify as sound.

So again, we are dealing with personal risk tolerances here, and there is no "right" answer, but I wouldn't tell the OP that he should just dive and not worry about it because if he loses all hearing in his only hearing ear, he can just get it fixed with a CI. Results with postlingually deaf adults are nowhere near as good as in children - it's a question of retraining the brain - so I wouldn't just have him rely on the fact that he can always fix any problem with technology.

Mike, once again, thank you for the thorough answer and analysis.


From my perceptive, even more significant than bilateral hearing loss, and quite frankly more frightening for me, would be a right PF leading to damage to my good vestibular system resulting in profound vertigo with no “good” side to compensate. Deafness would be disabling. Damage to my only good vestibular system would be catastrophic.


As a previous commenter said, it’s low probability, but high consequence. But that reads like high risk to me. Skydiving with a parachute that fails every 3,000 times fits that description as well. I’d be willing to jump a few times, but not 3,000 times. Based on that alone, I think I’ll keep my future scuba adventures to only a few times a year when on vacation and under extremely conservative dive parameters. You need to live life a little bit.

 

[doctormike]

I think that you are showing good understanding, and are making this decision with eyes wide open. We all take risks, and for some of us, those risks necessarily involve balancing factors that no doctor can give us numbers for.

Not to get into details, but I'm looking forward to this dive season after a pulmonary embolism last year. Should I do this? Can I find any doctor to give me a specific risk percentage? Can I look it up on PubMed? No. But I still have to make a choice.

Be safe, buddy, and thanks for letting us help as best as we can!