Anyone ever had these symptoms?

[DocVikingo]

I don't know about BPPV -- can you relate your symptoms to any changes in position or head movements? I'm worried about the possibility of inner ear damage during your dives. Persistent vertigo is pretty odd. Especially if the meclizine is not helping,....

Hi TSandM,

I, too, have such a concern. The timing of events certainly lines up.

However, as mentioned in my initial reply, if this is a bona fide case of BPPV antihistamine and anticholinergic-based preparations such as meclizine often are not very effective, e.g., Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review)--]—“ There is no evidence to support a recommendation of any medication in the routine treatment for BPPV; Disconnect between charted vestibular diagnos... [Acad Emerg Med. 2009] - PubMed - NCBI--"Most patients diagnosed with BPPV are given meclizine, which is not indicated."

A neuro consult certainly would be prudent, with a possible subsequent visit to a neuro-otologist if indicated.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[flots am]

I struggled a tiny bit with swallowing issues before diving so it will remain its own thing. That said, I think most of my diving-related symptoms are starting to head in the right direction.

I'm not a doctor, but lost one of my parents to a misdiagnosis, so take this for what it's worth.

If you get a diagnosis that is mostly a complicated name that just describes some of your symptoms, but doesn't explain why they studdenly started after a dive, you might want to get a second or third opinion.

flots.

 

[marineman]

Everything I've read about BPPV makes it seem like it is come and go. Mine was and still is persistent, though at a much lighter level now than a week ago. I'm not convinced BPPV is correct, but maybe another form of inner ear trauma. I've seen 6 doctors to date, none of which were truly an ENT. I think I may make that the next step. I don't know how familiar family practice docs are with ear injuries, so maybe BPPV is a bucket diagnosis that covers anything inner ear? All have told me not to be surprised if it takes a while to heal...

I've also heard about and have been worried about an undiagnosed bout of DCS. It seems treatment would be pointless at this point, but for those that know, what does this mean for me? Will all symptoms (and bubbles) eventually go away on their own? Is it going to resurface whenever I fly or dive again? Nobody bothered to put me on 100% 02, though I did ask and they said it was pointless. Everyone, not just DAN, has been very quick to rule out DCS.

 

[TSandM]

I think, given the profiles you posted, DCS should be at the very bottom of the differential diagnosis, if not entirely off it. Inner ear trauma, however, is possible even with very shallow dives, and inner ear trauma would be persistent, as you have described. From your description of the balance disturbance and the visual problems, it really sounds as though something in the vestibular apparatus is awry -- either that, or you have something affecting the central nervous system component of proprioception processing.

Benign positional vertigo is precisely as described -- it is POSITIONAL. It occurs with changes of position or head movements, and almost always, the symptoms are self-limited and have a duration of minutes. Meniere's disease, which is an malfunction of fluid balance in the inner ear, can also present as vertigo and be persistent, but it is not treated with meclizine.

At present, I think we are stuck with a set of symptoms which can have either a peripheral (ear) source, or a central source. Given the onset after diving, I would vote first for an ear-related issue, and seek out a really good, diving-savvy ENT doc for a consultation. DAN may be able to help you find one in your area.

Doc Vikingo, I was not trying to imply that lack of response to meclizine suggested a non-BPPV etiology. Rather, I was saying that if symptoms are not adequately controlled on his present regimen -- whatever the etiology -- further evaluation was merited.

 

[DocVikingo]

Hi Marineman,

I don't know how familiar family practice docs are with ear injuries,...

The chances are quite small that the average family practice physician has much knowledge of SCUBA-related ear injuries.

I've seen 6 doctors to date, none of which were truly an ENT. I think I may make that the next step.

I wasn't clear whether or not you had seen a board certified ENT. If not, then that's a very good place to start.

I've also heard about and have been worried about an undiagnosed bout of DCS. It seems treatment would be pointless at this point, but for those that know, what does this mean for me? Will all symptoms (and bubbles) eventually go away on their own?

Inner ear DCS seems unlikely, but not entirely out of the question, given the reported dive profiles. This is an injury typically associated with deep/saturation/mixed gas including helium diving, although it has on rare occasion been reported in shallow recreational dives. In addition, the condition typically involves vertigo and nystagmus accompanied by a hearing abnormality such as tinnitus or hearing loss.

Inner ear barotrauma, which can have signs and symptoms much like those of inner ear DCS, appears more likely given your report of equalization difficulty on one the dives, although the absence of “fast ascents, darts, rapid depth adjustments, etc” and onset delayed until 3-4 hours after the last dive does somewhat leave one pondering.

You can read more about inner ear DCS and inner ear barotrauma in Shupak A et al. Inner ear decompression sickness and inner ear barotrauma in recreational divers: a long-term follow-up. Laryngoscope. 2003 Dec;113(12):2141-7.

If your injury was related to inert gas bubbles, recompression treatment at this stage (~3 wks post-onset) is very unlikely to be of any benefit. Any offending bubbles have long, long since been eliminated from your body.

In any event, the advice from TSandM and myself above remains in force.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[marineman]

If your injury was related to inert gas bubbles, recompression treatment at this stage (~3 wks post-onset) is very unlikely to be of any benefit. Any offending bubbles have long, long since been eliminated from your body.

I agree with everyone else given the dive profile and lack of rapid ascent that DCS is not the cause, but for future readers, I'd like to clarify. In short, any permanent damage IF it were DCS is already done and there is no point doing anything at this point? What does this mean long-term? If I dive in 6 months, assuming all symptoms reside and I'm cleared medically, am I at risk? What about flying?

Inner ear barotrauma of some form seems to make more sense, especially since I can justify it with a reason (ie, the dive where I swam down instead of letting myself sink, which caused me hours of pretty intense pain). Both ears were killing me after that. I am surprised I finished the other three dives after that, and I'm sure they didn't help. Especially since they kept getting deeper and deeper. I feel like that is the main lesson to be learned for me and for others.

Diving 101: Failure to properly equalize...

At this point, I feel much more with it mentally, played left side outfield at softball Thursday (and even pulled in a couple catches where I surprised myself), and driving is easier. I had a 4-day weekend and felt little vertigo. However, I returned to work today where I look at a PC all day, and the vertigo has increased a lot. Maybe the brightness? Maybe the fact that my eyes move a lot across the screen? I am even able to lay down without the room spinning, which was the worst trigger not a week ago, as noted in previous post.

All gastro symptoms are also long gone, in terms of lower chest/ab pressure. The antacid/anti-gas chipped away at it. However, I am still struggling with my seemingly ongoing swallowing issue which led me to ER last weekend due to a feeling of food being stuck high up in my throat (above my Adams apple), possibly even upward into the nasal/sinus passage. It's actually very hard to tell. I'd imagine it will lead to an ENT trip anyways. I do tend to be highly energetic and a bit high strung, as much as I hate to admit it, so I'm hoping it is maybe anxiety or something not critical that will go away on its own. Plus, I really don't like doctors. No offense to you docs out there, I just don't like being poked and prodded, and needles are about my only fear in life. Depending on how long it takes me to get in (and when/if I break down as go), it seems to only make sense to ask about the ears as well.

 

[shorediver66]

I have had problems with shallow water diving in the past when my right ear did not equalize as fast as the left ear on the ascent to the surface. If both of my ears did not fully equalize it left me feeling unsteady on my feet, nauseous, a bit dizzy, pressure in my head, and a feeling of being very tired. The first couple of times it lasted for several days. I have learned a few things that help me in shallow water (30 feet or less). Once you start your dive stay on the bottom and do not go to the surface until your dive is over. Make sure both of your ears fully equalized before you reach the surface of the water by rising very slowly. And whenever possible dive deeper and avoid shallow diving. When you dive deeper you get a better clear and I do not suffer any of the above mentioned symptoms.

 

[DocVikingo]

Hi Marineman,

I agree with everyone else given the dive profile and lack of rapid ascent that DCS is the cause,.... Inner ear barotrauma of some form seems to make more sense,….

You mean DCS is NOT the cause, correct?

I'd like to clarify. In short, any permanent damage IF it were DCS is already done and there is no point doing anything at this point? What does this mean long-term? If I dive in 6 months, assuming all symptoms reside and I'm cleared medically, am I at risk? What about flying?

At this point, it is unclear what had/is causing your vertigo, nystagmus, lightheadedness and brain fog. Until this is determined, arriving at a credible prognosis is going to be quite a feat. This is why you have been advised to see a board certified ENT, then possibly a neurologist, then possibly a neuro-otologist.

If there is permanent damage, whether the cause is IEDCS, IEBT or there is some other etiology, you well may have continuing symptomatology.

I do tend to be highly energetic and a bit high strung, as much as I hate to admit it, so I'm hoping it is maybe anxiety….?

It appears to me that you are showing some anxiety and this indeed may be clouding or complicating the clinical picture.

BTW, early on you mentioned drainage from the ear despite reporting that the several doctors who examined your ears observed saw nothing of concern. Whatever became of that situation?

It is positive that many of your complaints seem to be resolving. However, a return to diving does not seem wise until your medical situation has been more definitively sorted out.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[marineman]

Sorry to disappear, for all that were following this. After many weeks, I've had the gauntlet of tests but the vertigo and symmetrical weakness in my lower legs occur constantly, and occasional bloating still occurs after I eat at times. So far, nothing has turned over a culprit. I do know, after very extensive ear examinations with an ENT, that my ears are perfectly fine. I just finished a 6-day run of Prednisole and I'm on my last couple days of a Septra antibiotic run.

I've wondered if the strong pain I had in my "ears" could have actually been my jaws. I've gone to the doc expecting an ear infection before to be diagnosed with TMJ. After researching similar cases to mine, I've learned that TMJ is quite capable of causing vertigo and swallowing difficulties - my two main symptoms, though the swallowing problems are pretty well gone as of the last week. I continue to feel bloated, especially after eating. My ENT also has me running some food avoidance tests (milk and egg) to check for food-based allergies. He thinks the symptoms - chest fullness, dizziness, fatigue, and throat swelling could very well point to that. I have always been a fan of milk, yogurt, eggs, etc. Time will tell, but at this point, I just want someone to tell me what is wrong with me.

Any chance anyone has experience with allergies or TMJ? I don't get how all vascular, ear, nervous system, and blood tests show nothing but this is still continuing.

 

[Easdem]

Marineman:

Have you consiedered anxiety as the cause of your symptoms? Chest tightness, gastro discomfort, dizzines, "head in space," muscle tightnes can all be related to general anxiety.