Ok RedyTedy, how about you posting next week what your doctor diagnosed you with, and what the the long term prognosis is going to be?
Michael
Michael
Chance of permanent hearing damage? Should I see a doctor?
- Thread starter RedyTedy
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Very hard to say much without an exam and an audiogram, or knowing much about the dive profiles. Tinnitus is poorly understood in general, but if it suddenly started while diving, that suggests some connection. Is there any hearing loss? It sounds like there might be, so an audiogram can distinguish between a conductive hearing loss and a sensorineural hearing loss, which have different implications. Here is some background reading on these issues.
Inner ear DCS is certainly treatable, but you may be beyond the time frame for that. Barotrauma of the middle ear can result in an inner ear injury, especially in cases of a perilymph fistula. In such cases, surgical exploration can help, but this is a complex decision tree. Middle ear effusion from barotrauma alone would rarely cause tinnitus. If there is a sensorineural hearing loss that is not related to diving, then steroids are occasionally helpful (although not a lot of support in the literature when you look at meta-analyses).
I think that it might be a good idea to call DAN and describe the details.
Good luck!
Inner ear DCS is certainly treatable, but you may be beyond the time frame for that. Barotrauma of the middle ear can result in an inner ear injury, especially in cases of a perilymph fistula. In such cases, surgical exploration can help, but this is a complex decision tree. Middle ear effusion from barotrauma alone would rarely cause tinnitus. If there is a sensorineural hearing loss that is not related to diving, then steroids are occasionally helpful (although not a lot of support in the literature when you look at meta-analyses).
I think that it might be a good idea to call DAN and describe the details.
Good luck!
Diver below 83
Contributor
This is completely false on so many levels. Planes are not pressured to sub sea levels when at cruising altitudes. Most modern jet liners will have the cabin pressure typically to the equivalent of 5000-8000 ft ABOVE sea level while at cruising altitude 32-35k ish. Even the newest a380 and 787 while using lower levels of pressure are still rated well above sea level when cruising. Using your logic our ears wouldn’t pop while flying nor would there be any issues with flying after diving. That’s simply not true In any shape or form.
Check your facts. Commercial flights are pressurized to 8000 ft, even if at 35,000 ft.
Thought I'd post a detailed update:
After making this thread I first called DAN. They said it sounded like baurotrauma despite the fact that I didn't feel pain and that I should see an ENT. They said it should be safe to fly. Interestingly the person I spoke with said that my symptoms wouldn't go away naturally and I would need to see an ENT at some point. My insurance also has a medical phone service in conjunction with a medical school so I talked to them. They seemed to think it was very mild baurotrauma that would go away on its own, and they recommended waiting to see an ENT until I got back in the US and it was safe to fly.
The next morning (I made this thread at like midnight), I ran to the only ENT I could find in Cartagena, Colombia. My #1 concern was making sure it would be safe to fly. He didn't see anything physically wrong with my ear, held a tuning fork in front of both ears and seemed to think my hearing was fine. Im not sure what he was saying, but he seemed to think that my symptoms were caused by a mild baurotrauma caused by equalizing with a deviated septum (apparently it blocks the earway to my left ear? But I've equalized fine before?) and that I was safe to fly. He also prescribed a drug called deflazacort as an anti-inflammatory.
I flew back to the US and on Friday (earlier today) saw another ENT. Physically my eardrums seemed fine (no signs of liquid or blood), and as a precaution he referred me to a hearing test.
I took a hearing test half an hour later. It showed sudden sensorineural hearing loss in the upper frequencies. I ran back to the ENT, got a prescription for prednisone (steroid) and also opted to have him poke a hole in my eardrum and inject a steroid because I wanted to do everything possible to maximize chances of recovery.
Does anyone know what my chances of recovery look like? I'm also looking online and see stories about hyperbaric oxygen chambers helping recovery. Is that worth trying out? (Looking for anything that will maximize chances of recovery)
By the way, below is a timeline of any possibly relevant events. I'm very curious still what triggered the sudden loss of hearing, as I've had equalization issues when I started diving that were much worse and painful than this, but didn't result in tinnitus or hearing loss.
May 16: Possible issues with my middle ear that I convinced myself was dehydration. For 1-2 hours my sense of balance was weird; I would be walking and it would randomly seem like I was floating or tilting to the side.
May 22: I flew on a really small plane in Colombia that had a super loud engine. Didn't use earplugs.
May 23: First day scuba diving and also first night I noticed high-pitched ringing and feeling like ear had water stuck in it (which I now believe was just the sensation from partial hearing loss).
May 30: Saw doctor in Colombia and took deflazacort.
June 1: Saw ENT in US, diagnosed with hearing loss, switched to prednisone + got ear injection.
Attachments
Oops, 2 more things:
1. Should I get an MRI? I was reading that in some cases a tumor can cause these exact symptoms.
2. I'm only 19, which may make the tumor option less likely? I heard that's mainly in older people. (but then again, sudden hearing loss is also primarily in older people and I still got it)
1. Should I get an MRI? I was reading that in some cases a tumor can cause these exact symptoms.
2. I'm only 19, which may make the tumor option less likely? I heard that's mainly in older people. (but then again, sudden hearing loss is also primarily in older people and I still got it)
I am not a physician, but: isn't the May 16 event before you even went diving? If so, then the root cause also has to be outside diving, no? To me, what you describe happened on this day sounds like what I heard from a friend who had inner ear ischemia. This can result in acute vertigo, and also some hearing loss.
Now what I say here is purely an idea, but just for you to judge: may it be that your ear was damaged already this day, but only after you had an unrelated case of mild barotrauma from the dive (which in itself did not really cause damage) you started focussing on this ear and then noticed the slight tinnitus? Which may have been there all the time, but not noticed?
I think doctormike is an expert on this, so he for sure will be your source of info here. For my friend, it was suggested that these infarctions in the inner ear are not really understood, and it is not clear if any treatment will really help. She improved on her own.
Now what I say here is purely an idea, but just for you to judge: may it be that your ear was damaged already this day, but only after you had an unrelated case of mild barotrauma from the dive (which in itself did not really cause damage) you started focussing on this ear and then noticed the slight tinnitus? Which may have been there all the time, but not noticed?
I think doctormike is an expert on this, so he for sure will be your source of info here. For my friend, it was suggested that these infarctions in the inner ear are not really understood, and it is not clear if any treatment will really help. She improved on her own.
HBO used to be an approved treatment for tinnitus in Germany that was covered by the standard health insurance. 4 or 5 years ago things changed and the standard health insurance no longer covers it (probably because not every tinnitus is cured by it and certainly because multiple HBO treatment sessions end up costing a lot). Additional health insurances continue to cover HBO treatment for tinnitus, but only a small fraction of Germans have additional (Private) health insurance.
Don't know what to tell you, I assume that your doctors are competent and have your best interests at heart, so talk to them and do everything they say you should do.
Michael
Who is not a doctor, not even a doctor of divinity.
Don't know what to tell you, I assume that your doctors are competent and have your best interests at heart, so talk to them and do everything they say you should do.
Michael
Who is not a doctor, not even a doctor of divinity.
Thanks for posting the update! Fortunately, your hearing loss is only on one side and limited to the very high frequencies, and that's a good thing. I'm assuming that your tympanogram was normal also (Type A? Not on the posted image), which means no residual middle ear ventilation issues. You can have inner ear barotrauma due to poor equalization during a dive when that pressure wave is transmitted to the inner ear without any residual middle ear fluid or blood.
I can't really give you specific advice over the Internet, but I guess the main question for your docs to figure out is - is this a typical sudden sensorineural hearing loss (SSNHL) or related to diving (e.g. inner ear barotrauma or IEDCS)?
SSNHL is a real thing that most people haven't heard of, but it does happen and it is not clear why. The current thinking is that it is an autoimmune phenomenon, which is why there are reports of steroids helping (oral and injected). The large combined studies (meta-analyses) hasn't shown steroids to be overall effective, but there are plenty of cases where it seems to have worked anecdotally or in small series. Of course, without doing a rigorous study, you don't know if those people would have recovered without steroids, of if those who received steroids and did not recover would have gotten worse without them. It's hard (both ethically and from a study design point of view) to do the most statistically sound investigation, which is a double blinded prospective randomized trial. If it was me, I would probably take the steroids. SSNHL can absolutely happen in young people - I have seen it in kids. Acoustic neuroma is less common in younger patients.
If it was related to diving, the question is do you have an anatomic abnormality of the ear that predisposed you to that, which might mean worsening hearing in the future. That's a hard question to answer, and imaging might help. At this point, if it was IEDCS it is probably too late for recompression to be helpful - what was your profile?
The bottom line is that you might want to see an otologist (ear specialist) as opposed to a general ENT doc. If you PM me with where you are now, I may be able to give you a local referral.
I can't really give you specific advice over the Internet, but I guess the main question for your docs to figure out is - is this a typical sudden sensorineural hearing loss (SSNHL) or related to diving (e.g. inner ear barotrauma or IEDCS)?
SSNHL is a real thing that most people haven't heard of, but it does happen and it is not clear why. The current thinking is that it is an autoimmune phenomenon, which is why there are reports of steroids helping (oral and injected). The large combined studies (meta-analyses) hasn't shown steroids to be overall effective, but there are plenty of cases where it seems to have worked anecdotally or in small series. Of course, without doing a rigorous study, you don't know if those people would have recovered without steroids, of if those who received steroids and did not recover would have gotten worse without them. It's hard (both ethically and from a study design point of view) to do the most statistically sound investigation, which is a double blinded prospective randomized trial. If it was me, I would probably take the steroids. SSNHL can absolutely happen in young people - I have seen it in kids. Acoustic neuroma is less common in younger patients.
If it was related to diving, the question is do you have an anatomic abnormality of the ear that predisposed you to that, which might mean worsening hearing in the future. That's a hard question to answer, and imaging might help. At this point, if it was IEDCS it is probably too late for recompression to be helpful - what was your profile?
The bottom line is that you might want to see an otologist (ear specialist) as opposed to a general ENT doc. If you PM me with where you are now, I may be able to give you a local referral.
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