Can't hear after diving

[Corky Leadhogger]

OK Todd the Cat.... I confess. Last time I was in Aztec, NM was 1971. I apologize if it's nicer now. Corky

 

[sprklep]

Another question for doctormike and DukeMedicine....or anyone else...these two have been so helpful.

OK, the hearing loss was 12/26. I returned to Dallas 12/31 and saw the ENT just as soon as I could 1/2. So his examination was a week later. He did not see Oval, Round Window trauma or fistula. I know it is very hard to detect damages to these areas unless you have surgery. Is it possible I healed up and that is why he thinks there was no barotrauma?

If you have had this trauma, you can continue to dive once you are healed correct?

 

[doctormike]

Well, diving after fistula repair (surgical or spontaneous healing) is controversial, and no one (otologist, dive guru or otherwise) is ever going to be able to "clear" you to dive. It's always going to be a risk taken with very little real data. Unlike decompression sickness, there are just not enough of these operations to be able to do any sort of real science and give you number that you can use in calculating that personal risk. More likely, you will not get a final definitive "diagnosis", and you will be stuck making that hard choice on your own.

Just to be clear, a fistula is generally not something that you can see with imaging. There is something called a "fistula test", where you push on the tragus (the little flap of cartilage in front of the ear hole) and the eyes demonstrate nystagmus - check out this video.


Now this patient had a fistula from a cholesteatoma, which is something big that erodes through bone, so you would see it on the CT. Unless you had a congenital abnormality of your ear, you wouldn't see anything with a diving related PLF on imaging.

Even at surgery, the surgeon sometimes has to convince him or herself that there really is a leak. More often, the surgeon just puts some fat in the area where it looks like fluid is welling up, and calls it a day. If the hearing gets better, it's a success. If the hearing stays the same, it's a success because it might have gotten worse. If the hearing gets a little bit worse, it's a success because it might have been lost completely (you see how it's hard to do real science with this stuff?).

Remember, the trauma in this case is barotrauma - pressure injury causing a leak across a membrane. It's not like blunt trauma from an assault or a motor vehicle accident where you would have a fracture of the temporal bone, which would be visible on x-ray (CT). So it's important to keep these terms clear...

 

[sprklep]

Thanks, no the doc did not do this test. I guess I could do it myself in front of a mirror. He said he did some tests I was unaware of and he thinks no barotrauma. 2nd opinion on Monday.

Now I do know I have congenital abnormalty. I was born with a hearing loss. Docs called it otoscolosis. My hearing was checked every six months while I was a child and never changed. Thus we quit testing. I believe it was 45 decibel loss then and that is what the right, good ear had Thursday. I guess I need to discuss this with the doc on the MRI findings. I know I did not have an MRI as a child..not sure they had MRIs 40 yrs ago. I do not know how they diagnosed the bone deformities or whatever it was...maybe some sort of xray.

 

[doctormike]

Thanks, no the doc did not do this test. I guess I could do it myself in front of a mirror. He said he did some tests I was unaware of and he thinks no barotrauma. 2nd opinion on Monday.

Now I do know I have congenital abnormalty. I was born with a hearing loss. Docs called it otoscolosis. My hearing was checked every six months while I was a child and never changed. Thus we quit testing. I believe it was 45 decibel loss then and that is what the right, good ear had Thursday. I guess I need to discuss this with the doc on the MRI findings. I know I did not have an MRI as a child..not sure they had MRIs 40 yrs ago. I do not know how they diagnosed the bone deformities or whatever it was...maybe some sort of xray.

Interesting... so do you have a baseline conductive hearing loss?


Otosclerosis is a genetic (not congenital) condition that causes a progressive conductive hearing loss due to stiffening of the chain of bones that conduct sound from the eardrum to the inner ear. It usually presents in the early 20s, and is fixed by an operation where you replace the third bone (the stapes) with a prosthesis, with excellent results. There is a condition caused congenital fixation of the stapes, which is from a mechanical perspective similar to otosclerosis, but is present at birth. This is less commonly operated on, because unlike with otosclerosis, there is more of a chance of causing permanent, complete deafness due to a leakage of inner ear fluid (a "gusher").


MRI is only done to look for soft tissue problems like that benign tumor of the nerve of hearing (acoustic neuroma). It is no good for looking at congenital structural problems with the ear, since they are primarily bony abnormalities and MRI isn't good for looking at bone - you need a CT scan for that. If you have a congenital stapes fixation, that would not necessarily show up on a CT (although other congenital abnormalities of the ear bones would).


This information makes your case seem even more complicated, especially since that's your good ear! I really think that you should see an otologist, although I guess there is no harm in going to your appointment for Monday - I’ll owe you $40 the next time we dive together if it doesn’t turn out to be worthwhile..!


I spent a little time looking at the websites for those doctors on the list who had claimed expertise in otology, and not all of them are actual otologists. The ones who are actual otologists are: Cristobal, Isaacon, Kurtz, Peters and Roland. In addition, there is something called the Dallas Ear Institute, which is Dr. Peters and his associate Dr. Hahn (not on the original list). Maybe see if any of those are in your plan and see what they say. If it's your good ear, and if you have congenital ear abnormalities, and if you are hoping to dive again, I would do what you can to make sure that you have covered all your bases...

Mike


Good luck, hope that things get better soon…

 

[sprklep]

Thanks...Dr Hahn was of my first phone calls but he could not see me right away. That is who my mother uses. He took over the practice of a Dr Mayberry who died and he was my doc when I was a child. Now, it has been so long since my childhood tests, I am really not sure what it was. I just know I would not turn my head when called when I was a baby and the checked me every six months until I was maybe 10-12 yrs old and nothing changed. From what I remember, it was a bone issue or so they thought. Since nothing had changed in that amount of time, I quit going in for tests. Been meaning to go in here lately for a test before this trip as I thought I might have dropped off some just over the last couple of years. I am now 48. No worries on the apt Monday, 2nd opinions are not going to hurt. I really did not like the first doc anyways. I will pursue Dr Hahn on down the line since my Mom thought they still had my old file microfilmed somewhere. Thanks for your time. Oh yeah...if I continue to dive and prob will...I think Prednisone will be a staple in my dive bag. Doc really thought it would have helped to be on it right away. But with no vertigo or anything else...I just did not think it was serious and just gave it a few days. Thanks for your time!!

 

[doctormike]

You are a mystery! If you can't see Dr. Hahn, maybe one of the other Otologists (Cristobal, Isaacon, Kurtz, Peters or Roland).


Keep us posted, we are all rooting for you...

 

[sprklep]

I loved Dr.Admire, thank you for finding her for me doctor Mike. She was trained under Dr Newberry who has passed & who was my childhood doctor. She is going to go get all of my old hearing records. She does not see any ear trauma so this may not be dive related at all. Sorry if it was not and I wasted everyone's time. We may never know. I never had vertigo which is odd if it was dive related or DCS. I have bad and weird ears so she will get all the old records and try and piece it all together. I will go back in for retesting after I finish the Prednisone. Thanks gang. I may just need to start wearing hearing aids but if I can just keep diving, I can live with that.

 

[doctormike]

Great, so glad that she turned out to be good for you! Yes, having the old records is important - for example, if there really was no change in your hearing level at all, but you just have some baseline issues and then had some transient symptoms that made you more aware of them, that might explain everything. Hearing aids are good if you need them, fortunately you won't need them underwater, if everything turns out OK...

Keep us posted...

Mike

 

[gkwalt]

I suffered a PLF in the early 80's while diving. It was repaired, but the ENT at the time advised that I should give up diving. I was left with a moderate hearing loss but no other symptoms. I stopped diving, but years later, my son got into diving and I wanted to dive with him. After a great deal of research of the scientific literature I could find no good reason not to dive. Some of the published rational not to dive suggested that it could happen to the other ear resulting in bilateral hearing loss. PLF is a rare diving related injury and I did not find any evidence based data to suggest that if it occurred in one ear it was more likely to affect the contralateral ear. Yes, if at the outside chance I sustain a PLF in the other ear it would affect hearing in both ears, but it won't kill me. How many divers with a PFO continue to dive a conservative profile thinking it would prevent them from getting a potentially fatal case of DCS. I am curious as to why an ENT would disqualify someone from diving just on the basis of a previous PLF but not a DCS hit. Diving is a sport that carries a lot of inherent risk. Divers accept that risk and do all they can to minimize it. Why then should a diver be prohibited from diving after a PLF just because it "may" happen in the other ear? IMHO, there is not scientific evidence to support this Draconian prohibition in a diver who gets great enjoyment from their sport.