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My fistula - surgery or no?

Discussion in 'Diving Medicine Q&A' started by Fly Girl, Jul 13, 2009.

  1. Fly Girl

    Fly Girl Contributor

    # of Dives: 25 - 49
    Location: Alexandria, VA
    120
    0
    Two doctors have now confirmed that I most likely have a perilymph fistula in my left ear from pressure trauma from my 31 May dive. The vertigo is MUCH better, from the audiology tests my hearing has even improved from where it was right after the accident despite that I do have some hearing loss, but the tinnitus is driving me crazy, and the ear feels like I have a cone over it. I can't exert myself much without making the ringing and pressure worse, but I've had very few episodes of the vertigo again, and when I have they are mild. One ENT says surgery might be good, and another ENT says that because the hearing has gotten better, leave the ear alone. I go for a third opinion on Wednesday. The doctor I will be seeing is VERY pro-surgery, and his assistant was even going to pencil me in for surgery based on that he will probably want me to have it once he sees me.

    I don't want to feel like this the rest of my life. I want to be able to lift weights, do something strenuous, and fly again without fear I'm going to get vertigo, or worse, lose my hearing. I doubt that there is an easy answer for me, but I just don't see how the surgery can hurt. On the other hand, if I just leave my ear alone, with the pressure and ringing ever go away? Will I ever be able to do something strenuous? Dr. Mike, Dr. Lynne, or anyone that has had the surgery, what would you do? I know, this is a big decision, and there are probably no clear yes or nos here, but it isn't like I have friends around that have any experience with this except for the friends on Scubaboard. Thanks in advance!
     
  2. doctormike

    doctormike Medical Moderator Staff Member

    # of Dives: 1,000 - 2,499
    Location: New York City
    6,891
    7,042
    Hey, Fly girl..!

    There are a bunch of threads about this here (for example), and it all comes down to the difference between a traumatic and a "spontaneous" fistula. If you truly have a traumatic fistula (from external trauma or barotrauma), then the approach is much less controversial - most docs would recommend a repair. Spontaneous fistulae may or may not exist, depending on who you ask. In fact, a common question among ear specialists is "do you believe in the fistula fairy?".

    The bottom line is that the operation for fistula repair is pretty quick, straightforward and without a lot of risk in the right hands, so if I really suspected that I had a traumatic fistula, I would go ahead with it. Every medical decision is balancing risks vs. benefits, so since there isn't much risk of doing it, and a potential downside of worsening hearing loss if a true fistula is missed, I would have a pretty low threshold for surgery in such cases.

    Unfortunately, it is very difficult to predict results with this type of surgery, and while the hearing may stabilize, the tinnitus may not improve, etc...

    Good luck, and keep us posted!

    Mike
     
  3. Fly Girl

    Fly Girl Contributor

    # of Dives: 25 - 49
    Location: Alexandria, VA
    120
    0
    It is a barotrauma related fistula. Thanks for confirming what I know in my heart and what I have read from the research I have been doing (some of it from the doctor I am seeing tomorrow). I just can't see living like this anymore. I hope I can have the surgery soon.
     
  4. doctormike

    doctormike Medical Moderator Staff Member

    # of Dives: 1,000 - 2,499
    Location: New York City
    6,891
    7,042
    OK, keep us posted..!

    Mike
     

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