An atypical inner ear barotrauma?

[Storker]

Did you experience increase in tinnitus after a dive before?

No

 

[doctormike]

Kevin,

Your condition sounds a little bit like something that I have myself. I have never had difficulty equalizing, but I started having tinnitus that was associated with going to pressure in the hyperbaric chamber. The onset was delayed, just like yours. I wouldn't notice it after the dive, I'd notice it after I woke up the next morning. My mistake, I believe, was in continuing to dive, which I think worsened the tinnitus (my ears are ringing as I type - the intensity varies but it's always there). I've since changed to a non-diving position at work. I have been worked up by some of the best ENTs and diving physicians in the business and nobody can tell me what's going on. My own theory, offered with the caveat that it's just that and not a medical diagnosis, is that there is/was an acute-on-chronic inner ear inflammatory process at work that somehow activated the tinnitus mechanism in the brain. Yours may (emphasis on the MAY) be more directly tied to non-fistulating inner ear barotrauma.

I would be very interested in hearing from any other divers who have similar symptoms. If I can get enough cases together, this may be publishable. @doctormike: your input here would be valuable.

Best regards,
DDM

Huh, just happened to see this thread.... Sorry, Eric, I don't think that "@doctormike" works here!

In any case, it certainly seems possible for sudden pressure changes in the middle ear to be transmitted to the inner ear without a fistula, and therefore without symptoms of dizziness, etc.. Tinnitus is one of the most frustrating and least understood symptoms in otology, and it's not clear if the noise is actually generated by the ears, or if it's just the brain's way of responding to an abnormal electrical signal (kind or a moot point until someone figures out how to interrupt that process). For example, vertigo is the brain's way of reacting to asymmetric inputs from the two labyrinths (the part of the inner ear involved in balance).

As far as the timing goes, since we really don't understand the pathophysiology of tinnitus, it's hard to be definitive about that either. Certainly, one could imagine a traumatic injury caused by a forceful valsalva with a shock wave going through the inner ear fluid that resulted in a progressive change in the inner ear structures. It sure seems that in the OPs case, there was some temporal relationship, even though it wasn't an immediate association.

I wish that I could be more helpful!

Mike

 

[KelvinMKLee]

Huh, just happened to see this thread.... Sorry, Eric, I don't think that "@doctormike" works here!

In any case, it certainly seems possible for sudden pressure changes in the middle ear to be transmitted to the inner ear without a fistula, and therefore without symptoms of dizziness, etc.. Tinnitus is one of the most frustrating and least understood symptoms in otology, and it's not clear if the noise is actually generated by the ears, or if it's just the brain's way of responding to an abnormal electrical signal (kind or a moot point until someone figures out how to interrupt that process). For example, vertigo is the brain's way of reacting to asymmetric inputs from the two labyrinths (the part of the inner ear involved in balance).

As far as the timing goes, since we really don't understand the pathophysiology of tinnitus, it's hard to be definitive about that either. Certainly, one could imagine a traumatic injury caused by a forceful valsalva with a shock wave going through the inner ear fluid that resulted in a progressive change in the inner ear structures. It sure seems that in the OPs case, there was some temporal relationship, even though it wasn't an immediate association.

I wish that I could be more helpful!

Mike

Mike,

Thanks for your information.

What is meant by OP?

Have you ever heard/come across a case similar to my situation (very delayed onset of tinnitus (11 days) without other symptoms)?

At this point, anything I can do to remedy my situation?

--Kelvin

 

[KelvinMKLee]

No

Having said that, did you mean the physical trauma was the cause and the dive was the straw on the camel for the increase in tinnitus?

 

[Storker]

Having said that, did you mean the physical trauma was the cause and the dive was the straw on the camel for the increase in tinnitus?

I'm not a physician, so I can't point to any cause-effect relationship.

The correlation certainly indicates that there is a causal relationship here, but not having dived since I experienced what I described, I don't know if it's a permanent or a temporary phenomenon either. It's just one single datapoint.

 

[doctormike]

Mike,

Thanks for your information.

What is meant by OP?

Have you ever heard/come across a case similar to my situation (very delayed onset of tinnitus (11 days) without other symptoms)?

At this point, anything I can do to remedy my situation?

--Kelvin

Hi, Kelvin...

OP is you (Original Poster), it refers to the person who started the thread.

I have not seen anything like this, but I'm a pediatric ENT doctor, so I don't see a lot of tinnitus in my practice. As I mentioned, tinnitus is a poorly understood phenomenon, and there aren't a lot of reliable treatments. Some people have had luck with various devices, but not something that I use in my practice. Sometimes, patient support groups like the ATA are helpful: American Tinnitus Association

 

[KelvinMKLee]

Kevin,

Your condition sounds a little bit like something that I have myself. I have never had difficulty equalizing, but I started having tinnitus that was associated with going to pressure in the hyperbaric chamber. The onset was delayed, just like yours. I wouldn't notice it after the dive, I'd notice it after I woke up the next morning. My mistake, I believe, was in continuing to dive, which I think worsened the tinnitus (my ears are ringing as I type - the intensity varies but it's always there). I've since changed to a non-diving position at work. I have been worked up by some of the best ENTs and diving physicians in the business and nobody can tell me what's going on. My own theory, offered with the caveat that it's just that and not a medical diagnosis, is that there is/was an acute-on-chronic inner ear inflammatory process at work that somehow activated the tinnitus mechanism in the brain. Yours may (emphasis on the MAY) be more directly tied to non-fistulating inner ear barotrauma.

I would be very interested in hearing from any other divers who have similar symptoms. If I can get enough cases together, this may be publishable. @doctormike: your input here would be valuable.

Best regards,
DDM

Eric,

Why you related your tinnitus to the pressure of the hyperbaric chamber instead of the dive the day before? Was there something bad happened in the hyperbaric chamber?

Kelvin

 

[Chris A H]

Kevin,

Your condition sounds a little bit like something that I have myself. I have never had difficulty equalizing, but I started having tinnitus that was associated with going to pressure in the hyperbaric chamber. The onset was delayed, just like yours. I wouldn't notice it after the dive, I'd notice it after I woke up the next morning. My mistake, I believe, was in continuing to dive, which I think worsened the tinnitus (my ears are ringing as I type - the intensity varies but it's always there). I've since changed to a non-diving position at work. I have been worked up by some of the best ENTs and diving physicians in the business and nobody can tell me what's going on. My own theory, offered with the caveat that it's just that and not a medical diagnosis, is that there is/was an acute-on-chronic inner ear inflammatory process at work that somehow activated the tinnitus mechanism in the brain. Yours may (emphasis on the MAY) be more directly tied to non-fistulating inner ear barotrauma.

I would be very interested in hearing from any other divers who have similar symptoms. If I can get enough cases together, this may be publishable. @doctormike: your input here would be valuable.

Best regards,
DDM

I will add my story with a similar situation after snorkelling for a few days when doing some free diving to around 6-8 metres depth. I had some trouble equalising on a few of the dives and had slight tinnitus in the evening though nothing that seemed worrisome. I continued snorkelling with intermittent dives with no issues equalising. I had no pain or vertigo at any moment.

When I returned home, after a couple of days I noticed bilateral tinnitus and light tugging on my right ear. The tinnitus grew to steady roar over the following days and I contacted my GP who observed fluid and though it was likely some mild middle ear trauma.

Now, that appears to have settled down as I went to see an ENT 5 days later who observed no issues with the eardrums (and wasn't very helpful as he couldn't say anything about barotrauma and was not at all receptive despite my dive history). Of course the tinnitus remains just as bad, and reading this string of blog posts has been like a light going on. Unfortunately there doesn't appear to be much literature or information out there about non-fistulative IEBt.

So I'll be getting a second opinion from an ENT with actual dive medicine experience (UK Royal Navy), and I imagine he will come to a similar conclusion.

The hardest part is the tinnitus and I'm just wondering if I can expect this to subside as the inner ear heals. I know it won't likely go away entirely, but it would be nice to hear others' experience so I can stopping the constant worry!

Thanks!