Vertigo, nausea and vomiting after diving

[Vmax8]

Any answers and/or input to my questions/case would be highly appreciated.

I am a 48 year old male diver with better than average fitness for my age, who started diving 5 month ago. Qualification: Padi Advanced Open Water/Deep Diver. Experience: 27 logged dives all in tropical waters.

I am on a dive holiday (tropical water) and during a textbook dive on Nitrox to 18m with the majority at about 12m, during the descent at about 14m I realised a slight, almost unnoticeable hissing in my left ear. I did not feel any pain or discomfort in the ear. At the end of the dive we ascended slowly and had the usual safety stop.
Once I was on the boat, serious vertigo, nausea and vomiting started. I was so incapacitated with vertigo, that I stayed in bed the whole afternoon. I hardly could walk without assistance and there were not many times in my live when I felt so miserable. I still had the almost unnoticeable hissing in my left ear and hearing is very slightly muffled on the left. Every move caused the world to spin. Only staying motionless made me feel better after a few minutes. After calling DAN they told me I have some kind of ear barotrauma and they strongly advised me not to dive before I saw a doctor. I saw the hotel doctor and he told me, it might be just the exhaustion of the journey coming here and I could dive again to an easy dive once I feel ok. This was actually what I wanted to hear.
After one complete day rest of diving I felt 98% ok and went for my 2nd dive, this time on Air. Exactly the same problem again and the symptoms were even worse. Now, after two full days I am almost ok again, but definitely will not dive during this trip and get myself checked out by an ENT specialist once I am back home.

I would like to emphasize, that I felt ok during both dives and did not have any problems equalizing. I did not have a cold and I did not notice any ear/nose congestion whatsoever. Due to the shallow profile I absolutely rule out any DCI.

1. What could actually have caused the problem?
2. What might have been damaged in my ear?
3. Is there a good chance, that I will be fit for diving again, because I do not want to give up the sport I feel in love with?

 

[TSandM]

With the trio of tinnitus, muffled hearing, and vertigo, I would be worried about damage to inner ear structures. I hope it is not long before you will be home and can get examined. Hopefully, our resident ENT doc, Dr. Mike, will see this and chime in with a fuller response.

 

[Saturation]

This reads like your ED is perforated, the hissing could be air escaping through the ear, and water entering the middle ear. That it occurred with the second dive suggest this strongly after what reads like a full recovery. Alas, you should not dive without an ENT exam.

Any answers and/or input to my questions/case would be highly appreciated.

I am a 48 year old male diver with better than average fitness for my age, who started diving 5 month ago. Qualification: Padi Advanced Open Water/Deep Diver. Experience: 27 logged dives all in tropical waters.

I am on a dive holiday (tropical water) and during a textbook dive on Nitrox to 18m with the majority at about 12m, during the descent at about 14m I realised a slight, almost unnoticeable hissing in my left ear. I did not feel any pain or discomfort in the ear. At the end of the dive we ascended slowly and had the usual safety stop.
Once I was on the boat, serious vertigo, nausea and vomiting started. I was so incapacitated with vertigo, that I stayed in bed the whole afternoon. I hardly could walk without assistance and there were not many times in my live when I felt so miserable. I still had the almost unnoticeable hissing in my left ear and hearing is very slightly muffled on the left. Every move caused the world to spin. Only staying motionless made me feel better after a few minutes. After calling DAN they told me I have some kind of ear barotrauma and they strongly advised me not to dive before I saw a doctor. I saw the hotel doctor and he told me, it might be just the exhaustion of the journey coming here and I could dive again to an easy dive once I feel ok. This was actually what I wanted to hear.
After one complete day rest of diving I felt 98% ok and went for my 2nd dive, this time on Air. Exactly the same problem again and the symptoms were even worse. Now, after two full days I am almost ok again, but definitely will not dive during this trip and get myself checked out by an ENT specialist once I am back home.

I would like to emphasize, that I felt ok during both dives and did not have any problems equalizing. I did not have a cold and I did not notice any ear/nose congestion whatsoever. Due to the shallow profile I absolutely rule out any DCI.

1. What could actually have caused the problem?
2. What might have been damaged in my ear?
3. Is there a good chance, that I will be fit for diving again, because I do not want to give up the sport I feel in love with?

 

[Vmax8]

Got checked up at home by a ENT doctor. Diagnose: BPPV = Benign Paroxysmal Positional Vertigo, which is not directly related to diving or the associated pressure change.
I still doubt a little if this is really the "only" thing what happened to me. I might get another opinion.

 

[dschonbrun]

Sounds like the Vertigo is only one part of the diagnosis. It doesn't explain the hissing... which suggests a perforated eardrum, as the docs surmise. Consider getting a second opinion from an ENT with specialization in diving related injuries/Barotrauma.

DAN can hep you find a specialist in your area, suggest you call the hotline.

Cheers,
D

 

[TSandM]

The "hissing" can also be tinnitus, which is a common symptom of damage to the inner ear.

I agree that the diagnosis seems a little odd. Was the ENT doc you saw dive-savvy?

 

[Vmax8]

No, the ENT was not dive savvy.
Today, however I saw another doctor who is specialised in Dive Medicine.
After his examination he said he believes I had a reverse block twice.
He suggested, that I descent head up, and not head down as I usual do, but in general I'm perfectly fit to dive.
Will have a short break for diving in early February and try again.

 

[headsqueeze]

You might consider asking your physician for a prescription for scopolamine 0.4 mg tablets (not the patch); 1 tab 30 minutes prior to diving and start w/ easy dives. This may help with several problems; dry the nasal mucosa and help prevent squeezes and reduce the vertigo and nausea. At least you won't have to suffer after the dive as you did before.

Although less likely, migrains can present like this sometimes too, if the hissing was indeed tinnitus.

 

[divemedic1316]

I have to chime in on the head down descent. I strongly discourage head down descents. It is one of the main factors in blockage of the eustachian tube I would ask how often you equalize during a descent? I would have to say that you suffered some form of inner ear barotruama. Middle ear is most common medical problem encountered in divers. The tube opens between 10 and 30 mmHg Middle ear barotruama is graded from 0 to 5 by otoscopy. So First look at the middle ear but your signs and symptoms indicate inner ear barotruama.

 

[Vmax8]

After geting a all clear from a ENT and a dive physician, I dived again today and ... everyhting was ok.
I'm so happy I don't have to give up diving. Thanks for all the input.
By the way I made a head up descent and equalized very often like divemedic1316 recommended.