An update on my ear question...and MORE questions...

[Rockhound]

Hi,
I visited an ENT yesterday. I told him of the "fullness" and tinnitus in my right ear after a session of free diving last week.

He gave me some sort of Vasulva treatment (inhalant under pressure, injected in my nostrils, while I held my breathe with a mouthful of water until told to swallow with my mouth tightly closed). Although I told him that on subsequent SCUBA dives, I had no trouble clearing, nor did I have trouble "popping" my ears at that time, he thought this treatment would help.

An examination of my eardrums, including a pressure test, showed them to be normal, Type A , with no pressure. After we chatted a bit (I learned he was a diver), I mentioned that I was suprised that he hadn't ordered up a hearing test for me, since I had told him earlier of my perception that there was some high freqency hearing loss in my right ear.

He seemed surprised, having missed my comment on that concern. "This changes everything", he said. I then had a series of tests, which showed a large (40-50db) loss in the high range in my right ear.

He then proceeded to inform me that my "diving concerns" threw him off track--that such a hearing loss could not be diving related, but a simple coincidence. He indicated such profound asymmetric loss was not the result of barotrauma (my term), but something esle, perhaps a tumor or a viral infection. That certainly set my mood for the rest of the day......

He then ordered an MRI, which I will have to set up today, and a series of blood tests. He started me on high dose steroids (Prednisone) and Valtrex, a powerful anti-viral drug often used against herpes.

My feeling is that the hearing loss, tinnitus and feeling of fullness were all associated with my free-dives. His feeling is that asymmetric hearing loss is nerve related and , as such, could not be part of a diving related event.

Also, when I asked about the possibility of an oval window rupture, he told me that he would have gotten "all sorts of data" confirming that, including my recollections of any vertigo at the onset (none).

Any clues? Can this be diving related, or should I really start worrying?

BTW, he told my that my "severe" hearing loss was permanent, despite the fact it was less than a week old.

 

[Bob3]

It's hard to second guess an ENT with all the diagnostic tools, plus being a diver himself sort of clinches his qualifications.
I can't see the permanent hearing loss part, especially seeing as how he's still running tests.
Keep your fingers crossed.

 

[Rockhound]

Thanks Bob, for your kind reply.

As for my physician's diagnostic skills, I was uncertain as to how to read them. He ran the tests, but failed to listen to my report of the "sudden" loss of hearing, the fullness and the ringing noted immediately after a mid-range free dive. He seemed to think this was a long term problem I just happened to notice or one that occured coincidentally with my free-dives. That is certainly possible, but from my layman's perspective, unlikely (I am not a physician, but I am an earth scientist and have learned the answers that fit ALL the data are often the best).

The last information he acquired, was the only data he noted that pointed to something other than barotrauma. This was the asymmetric high frequency hearing loss in my right ear. The does point to sensorineural hearing damage , which implies involvement of the inner ear, but ran no other tests to expand on these data. Barotrauma induced sensorineural losses outside of oval window ruptures are rare, I bet, but I wonder if they are impossible.

I could be in denial, but as the parent of a pediatric cancer patient (and bone marrow transplant survivor), I tend to be very, er, well, "cynical" isn't the word I want..... maybe "objective", when evaulauating a physician's opinion. I've dealt with many physicians, most of them top notch, but a few who were a few beers short of a six pack. Most of us, an any demanding technical field, know folks who make us wonder, "how did he get this far?".

Although he said he was a diver, my new ENT did not know what "free-diving" meant, nor was he familiar with "breath-hold". I had to explain what I was doing in better detail for him, but he still didn't seem to understand that I wasn't on scuba (but not important, I know).

So......I called DAN this morning, and talked to one of their medics. She was very helpful and gave me the name of a local ENT, suggesting a second opinion was in order.

DAN's (or her?) recommendation was that, as my doctor ordered, I needed an MRI and bloodwork to rule out other causes. She also noted that the prednisone and Valtrex he prescribed were valid and recommended treatments for sudden SNHL.

But, the medic seemed surprised that barotrauma was ruled out as the precipitating event to this sensironeural hearing loss and tinnitus. The fact that I noted these problems IMMEDIATELY after a free-dive cause her to suggest I seek the second opinion of a true ENT dive specialist. She expressed serious doubts this was a tumor, however she pointed out that she was a medic, not a general practice or ENT physician.

We'll see.

I sure hope it ain't no tumor.

I sure hope I can dive the Gardens in August.

 

[BillP]

Howdy Ricky:

Sounds like you've well on the way to a thorough evaluation. Keep us posted on the MRI results and the second ENT opinion.

Bill

 

[JamesK]

I had the same problems as you did after a weekend of diving in early February. After about 4 days, I finally went to the ENT. I would be diving again in a week and wanted to be ok. The ENT gave me the steroid, and a very strong decongestant. After a week on the medication, the hearing loss returned, and the "full" feeling was gone. Hopefully the same works for you. Good Luck.

 

[pdomen]

I would definitely seek a second and third opinion, after reading a bunch of case histories at this site:

www.cholesteatoma.org

It would seem middle ear problems are particularly tricky to diagnose, since it's hard to see very much past the eardrum.

 

[Rockhound]

Thanks for the good wishes. The ENT is now beginning to agree that it is "somewhat possible" that my loss of hearing was a "free-diving" related barotrauma and not simply a coincidental occurence. He has conferred with a number of his colleagues and more than a couple (not exactly a consensus) believe I "may" have an inner ear fistula, despite the lack of persistant associated vertigo they look for when doing their "differentials".

I have just finished taking a few days of bed-rest, post MRI (The diagnostic clinic was so busy, I was finished at midnight on Monday. I should invest.....). As of today, I am still down to a 50 db loss in the 6000hz and 8000hz bands in my right ear, which represents no change. The tinnitus is lower, but constant and the pressure in my head only builds in the presence of ambient noise (in the car, shower, etc.)

The bed rest seems a little late (as it is supposed help spontaneous closure of any fistula), but I made it through 48 of the suggested 72hrs before I went completely bonkers. If no improvement occurs, and no pathology is present on the MRI, I will be weaned of the prednisone and will be evaluated for exploratory surgery in 6 months. I was assured such a recommendation WOULD NOT be made lightly and would be made in consideration of my love of diving and flying.

Btw, I saw the MRI and confirmed that I have a brain, but the final results aren't back, yet. I was told a number of physicians and a diagnostician are reviewing them in detail.

Wish me luck. I was told that whatever is wrong, I should consider myself lucky that I retain my sense of balance and do not suffer from vertigo.

(I have also been told that my diving days are not necessarily "permanently over", which something of a relief.)

 

[bluemadness]

Guys, anybody knows what the end of this story here was? This same thing happened to me after freediving and i just wonder what the results of Rockhound's MRI was.
Please if someone knows let me know.