Tinnitus and diving

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Jamie_r

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Halifax nova scotia
Hello,

Well ive been diving for about 5 or 6 months, My ears have been ringing for about 2 years now probally from playing drums in bar bands every week, I normally dont hear it throughout the day because the sourounding sound is usually greater, but if i walk into a quiet room or area, or if im driving then I get to my destination and stop then I can hear it again. When I get out of the shower at night time it seems to be greater and (almost) unbearable when I lay down to goto sleep, but ive been able to deal with it most of the time.

Okay, sorry for the long post,
when I started diving, I would surface and BAM that ringing noise was louder again, just like when I come out of the shower or lay down to goto sleep. Ive heard that ringing after diving is bad, but I cant tell if this is normal for me or not.

About a month ago I moved to a new province (PEI) and I havent played drums or with a band since then except for a few weeks ago, the ringing never let up and I didnet expect it to, But I went diving the other week and when I came back my right ear seems to feel swolen (spelling?) and seems to feel like its still pressureized.

Anyway, thats the background, so really I guess my questions are , Since my right ear seems to ring more is this from diving? Ive always had alittle bit of equalizing troubles but that weekend of diving went fine.
Will the ringing get worse as I dive more often?
Last I heard, theres no known treatment to stop the ringing, is this true?

Thank you so much for your time anyone,
-Jamie
 
We have not seen anything in the diving medical literature that would be helpful. There are several articles that talk about tinnitus as a symptom, a couple that describe similar stories to yours but nothing that really discusses treatment.

An ENT specializing in tinnitus with a diving background is always a good thing. Joe Farmer would be my first pick in the US. Most of what he treats currently is tinnitus and similar hearing problems. Helps that he holds most of the chapters on ears and diving in the diving medical books.

Treatment of clinical tinnitus information can be found with the following:

Best info out there will be on UpToDate.
http://www.patients.uptodate.com/topic.asp?file=genr_med/5223#1

The American Tinnitus Association may be of more help and does not require a subscription. (Keep in mind, UHMS members get access to the Duke Library resources so joining UHMS is really worth while, just for the added research capabilities.)
http://www.ata.org/

Sorry I can't offer any other suggestions.
Take care,
G
 
Thanks for the info,
I actaully live in a little island called PEI in canada, Theres one ENT on the island I dont beleve hes got much to do with diving but should probly be helpful or know who would be here


Thanks,
Jamie
 
Your right ear was probably closest to your loudest crash cymbal.

Ask me how I know. Haha!

Thomjinx
 
An audiology eval is probably what you need. They do frequency testing, conduction, and eval of the drum. As far as I understand, tinnitus points to the inner ear or the cochclear organ. I do not believe this organ is affected by barotrauma, but I could be wrong.
 
Oh, this article can be very helpful. Apparently barotrauma can affect the innerear also

www.bcm.edu/oto/grand/32395.html

Short quote:

Barotrauma of the Middle and Inner Ear
March 23, 1995
Willard C. Harrill, M.D.

The most common causes of barotrauma today are from the use of the Self-Contained Underwater Breathing Apparatus (i.e. SCUBA gear), commercial air travel, and from hyperbaric oxygen chambers. In fact, hyperbaric oxygen therapy has been found to produce over a 50% incidence of barotrauma. Well over 50% of the medical problems that are related to barotrauma are referred to an Otolaryngologist. Over 90% of these complaints involve the ear.

The noncompressible middle ear cavity makes the ear susceptible to damage from these ambient pressure changes. Middle ear pressure is governed by a law of physics known as Boyle's Law, which states that at a constant temperature, the volume of a body of gas is inversely related to the pressure to which it is subjected. Applying this law to diving, demonstrates that if a diver descends 33 feet (or the equivalent of 1 atmosphere of pressure), the ambient pressure will double from 1 atmosphere to 2 atmospheres. This will cause the volume of gas to be cut in half in the middle ear, resulting in a 50% increase in negative middle ear pressure if the eustachian tube is closed. The first 33 feet of descent represents the largest change in the volume of the middle ear while diving or during hyperbaric decompression. A diver must dive to greater than 150 feet in depth to equal the total volume change produced during the first 33 feet. This explains why the majority of otologic diving and hyperbaric injuries occur during shallow dives and not during deep water dives as one might expect. In fact, MEBT and IEBT have been reported to occur in as little as 8 ft of water.
 
They added:

If the eustachian tube is blocked, a valsalva maneuver will cause an elevation of CSF pressure which will be transmitted through a patent cochlear aqueduct or internal auditory canal causing a rise in the intracochlear pressure. If the difference between the perilymphatic space is sufficiently greater than the middle ear pressure, an explosive rupture of the round or oval window ligament will occur.

Both the implosive and explosive forces generated by a force valsalva are theorized to cause a perilymphatic fistulae or dislocation and rupture of Reissner's membrane, as well as the basilar membrane, the saccule, the utricle, or the semicircular canals. Antonelli and Paparella have studied the temporal bone pathology in scuba diving deaths and confirmed the presence of these pathologic findings. Simmons et al have demonstrated through experimental models that pressure differentials of less than 2 cm of water can cause labyrinthine ruptures.
 
Wow, this is scary stuff. I am going to be very hesitant diving when my allergy is active. Last year I had bad ear squeeze that resulting in crepitus around the ear, and blood out of one of my nostril. I never figured out the source of the blood - whether it was from a concurrent sinus squeeze.

Anyhow, my hearing is back to normal... But I try to us an Afrin spray before each dive now along with a claritin tablet. Claritin doesn't work well for others, but it dries me out in a hurry.
 
Here's a quote from an article in the American association for family medicine:

Inner ear barotrauma also can develop in patients with middle ear barotrauma.2-5,7 A pressure gradient between the perilymph of the inner ear and the middle ear cavity can occur, causing rupture of the labyrinthine windows (round and oval) and leakage of perilymph into the middle ear (i.e., fistula). Symptoms include the acute onset of vertigo, sensorineural hearing loss, tinnitus, nausea and emesis. The Weber's test will lateralize to the unaffected side in this group of patients. Reducing intracranial and perilymphatic pressures through bed rest, head elevation and with stool softeners can help. Surgical exploration may be necessary for repair of the fistula if conservative treatment is ineffective within five to 10 days (i.e., the symptoms persist or worsen).

They noted that tinnitus can be caused by innerear barotrauma.
 

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