An atypical inner ear barotrauma?

[KelvinMKLee]

Hope someone can shed some light on this!
Here is my story – maybe an atypical inner ear barotrauma?
Day 1 – I did one introductory (scuba) dive, when descended my ears felt some pain and ascended a little bit and equalize OK. Anyway, I think my valsalva maybe forceful. No abnormality (no vertigo, no hearing loss and no tinnitus) after surfacing.
Day 2 – I did another introductory dive, when descended my ears felt some pain and ascended a little bit and equalize OK. Anyway, I think my valsalva maybe forceful again. No abnormality (no vertigo, no hearing loss and no tinnitus) after surfacing.
Day 13 – I heard a loud (but not very loud) but not very loud tinnitus in my left ear and then it is gone.
Day 20 – I first noticed a slight tinnitus in both years. I could only hear it when I lied down on my bed before sleep or in very quiet place.
Day 28 – I visited an ENT. Hearing test was normal (the test was up to 8K only). The ENT found no problem with my ears and said that any dive related problem will arise with 2-3 days and therefore he excluded my tinnitus was diving induced. His diagnosis was unknown cause or early aging of hair cells.
And then around 4 months passed, my tinnitus was almost the same, maybe with very little increase in intensity.
Day 130 – I did 3 dives in one day. During the 2nd dive, my ears felt painful during descent. Ascended a little bit and equalize OK. Not long after I surfaced, my right year was muffled. I think my valsalva maybe forceful. Again, no other symptoms – no vertigo, no tinnitus. I did the 3rd dive – night dive. Went home and notice my tinnitus was louder.
Day 131 – After I woke up, my right ear was not muffled and tinnitus returned to normal (maybe a little bit increase in loudness but barely noticeable)
Day 133- Visited another ENT (he himself used to be diving instructor). He checked my ears and diagnosed middle-ear barotrauma with bruise in both eardrums. Again, he said my tinnitus was not caused by diving. Prescribed me decongestant, neurobine and betaserc. No improvement of tinnitus after I took the medicines for one month and actually my tinnitus has gradually become louder.
And then another 3 months has passed, my tinnitus has gradually increased in intensity with left ear louder and I have visited a couple of ENTs during this period. Did several hearing tests and all were normal. Almost all ENTs said my tinnitus was not diving induced because one or two of the reason below: 1) No vertigo 2) no hearing loss 3) symptom should arise within 72 hours. The last ENT (he is a scuba diver) said it it likely I shocked my tiny hair cells by forceful valsalva.
Anybody have any ideas if it is likely an inner ear barotrauma?

 

[Duke Dive Medicine]

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

 

[KelvinMKLee]

Kevin,

Your condition sounds a little bit like something that I have myself (my ears are ringing as I type). 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

What would be the possible non-fistulating inner ear barotrauma? And is it possible tinnitus arise 11 days after diving? And anything I can do now?

 

[Duke Dive Medicine]

Kelvin (sorry about the misspelling in my earlier post),

Inner ear barotrauma often involves a tear, or fistula, in either the round or oval window (parts of the vestibular apparatus), but it can occur in the absence of a fistula. Re the very late onset: I really don't know. Speculation follows: given your stated history of difficulty equalizing, your initial symptoms could have been related to chronic otitis media, but if that was the case they should have resolved. The chronic inflammatory process is only a theory and I do not have any proof of it in either myself or anyone else. I went through a course of prednisone that didn't help and had some unpleasant side effects. I will PM you with some other treatment modalities that I've used.

Best regards,
DDM

 

[KelvinMKLee]

Kelvin (sorry about the misspelling in my earlier post),

Inner ear barotrauma often involves a tear, or fistula, in either the round or oval window (parts of the vestibular apparatus), but it can occur in the absence of a fistula. Re the very late onset: I really don't know. Speculation follows: given your stated history of difficulty equalizing, your initial symptoms could have been related to chronic otitis media, but if that was the case they should have resolved. The chronic inflammatory process is only a theory and I do not have any proof of it in either myself or anyone else. I went through a course of prednisone that didn't help and had some unpleasant side effects. I will PM you with some other treatment modalities that I've used.

Best regards,
DDM

Thanks DDM,

One of the ENT I saw thought that forceful valsalva will shake and damage the hair cells in inner ear without damaging the oval or round window. Is it possible and have you heard of any similar case before?

 

[Duke Dive Medicine]

Thanks DDM,

One of the ENT I saw thought that forceful valsalva will shake and damage the hair cells in inner ear without damaging the oval or round window. Is it possible and have you heard of any similar case before?

Kelvin,

Absolutely. That is non-fistulating inner ear barotrauma. The shaking the hair cells part is oversimplifying the pathophysiology but that is the gist.

Best regards,
DDM

 

[Duke Dive Medicine]

PM sent.

 

[clownfishsydney]

PM sent about my 1998 incident.

 

[Storker]

I would be very interested in hearing from any other divers who have similar symptoms.

FWIW: I have chronic tinnitus. Not constant and not particularly debilitating, but rather annoying and a bit distracting at times. Recently, I experienced a physical trauma to one of my ears (the one where my tinnitus usually manifests, and where my slight hearing disability is most prominent) and had a bit of ear pain for a couple of days. A few days later, when my symptoms were almost back to normal, I went diving. The next day was the worst I've ever had WRT my tinnitus. It had increased from just annoying to mentally debilitating, and the only thing that kept me from going slightly mad was to play loud music with earphones on. These day's I'm back to normal, and I'm just hoping that my next dive won't exacerbate my symptoms once again.

 

[KelvinMKLee]

FWIW: I have chronic tinnitus. Not constant and not particularly debilitating, but rather annoying and a bit distracting at times. Recently, I experienced a physical trauma to one of my ears (the one where my tinnitus usually manifests, and where my slight hearing disability is most prominent) and had a bit of ear pain for a couple of days. A few days later, when my symptoms were almost back to normal, I went diving. The next day was the worst I've ever had WRT my tinnitus. It had increased from just annoying to mentally debilitating, and the only thing that kept me from going slightly mad was to play loud music with earphones on. These day's I'm back to normal, and I'm just hoping that my next dive won't exacerbate my symptoms once again.

Hi Stroker,

Did you experience increase in tinnitus after a dive before?