Diving induced Tinnitus ?

[Corrado]

Hi,

Did 10 dives in sulawesi to make a total of 20. after about 2nd dive noted ringing in ear (mostly left) and dizzy spells in evening. 14 days later have loud TV sound in left ear. Medical showed clear MRI and audio test suggested some high frequency hearing loss left ear. No other damage noted in ear drum and while diving had no problem equalizing etc and no pain or bleeding etc. Not getting any dizzy spells or other problems with coord or balance but loud noise continosly in ear distracting and definitiely bothers me if I am going to have to live with it !

First dive went to 33 m and noted afterwards from Suunto Stinger that was within 3 minutes of decompression. Not good 5 m stop as blew down tank in 20 minutes (subsequent dives 45-55 minutes. On second dive remember chsing down fish with camera and getting pain above eye and maybe ear.

Any other experience of this and any suggestions as to what testing would be relevant or drugs etc.

Also looking for good ENT in Singapore, Edinburgh or Houston for further look !

Any advice comment appreciated..

Corrado

 

[Laurence Stein DDS]

Hi Corrado,

Your symptoms suggest an injury to the inner ear. You did multiple dives and had no other symptoms to suggest worsening DCS. Did you experience any difficulty clearing during the dive(s), pain on ascent or descent, vertigo during or immediately following a particular dive?

As for experience, I have had tinnitus (ringing in ears) for 20 years now. It started following a wave crashing into the side of my head, effectively "boxing" my right ear. I noticed immediate ringing that has never stopped.

Audiometry showed a high frequency loss. It was attributed to trauma that resulted in the breakage of the little hairs withing the auditory apparatus. Each hair is responsible for detecting a specific sound frequency and sending a signal to the brain. You break the hair and you lose some hearing in the corresponding range.

My tinnitus is like a high pitched whistle. Sometimes it is louder and sometimes lower but always there. It seems worse in noisy rooms or when my wife is yelling at me. :11: I find that the ringing seems to mask sibilant sounds (high pitched sounds generated when saying the intial parts of "S", "T" and "soft "C") and the beginning sounds of "D", "Z", "P". Wind noise in my good left ear also creates a greater hearing problem in the right ear when listening to a passenger in the car while the windows are open. I often find myself thinking I heard an S when it was a P. The mind fills in the blank...usually wrong. To this day I don't understand what my wife means when she is sissed off!

The tinnitus also seems worse when there are loud, high pitched sound in the environment...music in a club or concert. No matter how loud the outside sound, the tinnitus is always louder.

Another problem is the localization of certain sounds like a chirping bird or even the whine of a jet aircraft. I can hear it but cannot find it easily if at all.

Ruptured oval or round windows can also result in this type of injury and may affect your qualification to dive in the future.

There are also other causes of tinnitus such as ear wax touching the eardrum and listening to loud sounds over a long period of time.

You should have it checked out to rule out causes. There isn't going to be any treatment if the cause is damage to the inner ear. Earwax can be removed.

Don't suppose this really helped, huh?

Larry Stein

 

[MO Diver]

I have heard tinnitus a possible condition due to flattening of cones (nerve endings) in ears during deep dives. The more deep diving you do, more possible hearing damaged. Don't think this has been proven though.

 

[Saturation]

I fully concur with Larry Stein's analysis. It does sound like a middle ear injury, typically a peri-lymph fistula or a round or oval window rupture. Audiograms are very sensitive to injury, such as your high frequency hearing loss, but the extent of what could have happened can be reinforced by having typanometry. It may be treatable the sooner your seek care, so its prudent to see an ENT soon or the tinnitus can be permanent. Luckily, in very many cases, it recovers slowly on its own after several months. Alas, if it persists, it can be as you now experience, quite disturbing.

 

[Saturation]

I have heard tinnitus a possible condition due to flattening of cones (nerve endings) in ears during deep dives. The more deep diving you do, more possible hearing damaged. Don't think this has been proven though.

Hello MO Diver:

Hearing is potentially damaged during the equalization phase, when done incorrectly. But there is good news: many studies in saturation deep divers, submerged for days on end, [1000' +] show few to no issues with hearing.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11011799.

 

[Laurence Stein DDS]

I have heard tinnitus a possible condition due to flattening of cones (nerve endings) in ears during deep dives. The more deep diving you do, more possible hearing damaged. Don't think this has been proven though.

Hi MO Diver,

Well, either Saturation is going to correct me or correct you...

To my knowledge, cones are associated with color vision rather than hearing.

Donno...could be wrong...unless you are into that old LDS and sounds appear as colors. Maybe it's a symptom of ciguatera poisioning....Hey, Saturation!

Regards,

Larry Stein

 

[Saturation]

Yes, you are right again Larry. I think MO Diver may have gotten his facts mixed up, but the spirit of his question is what I hope to answer. On the side, he may have also been considering the issue of increase hearing loss associated with diving in general. While depth is not a consideration repeated small injuries, or risk of a major injury to the ear, is high among divers ... because of equalization. So hearing loss, in general, is a risk for all of us, if not all other issues with our ears.

90% of divers mention issues with their ears after a dive, and 99% do their own treatments, so experienced divers begin to forget about their post dive issues or treat the problem before it worsens. Maybe all those small problems add up.

Finally, with so many dives racked up, its just a matter of time when something won't resolve with self treatment and cause an ear issue that requires professional help.

http://www.scuba-doc.com/LTE.htm

 

[NOVIZWHIZ]

I have had this problem in both ears for 15 years (left is my worse), also diagnosed with high frequency hearing loss. I know it's something you don't want to have to think about living with, but...guess you could look at it as at least not having worse problems. I usually don't even think about it most of the time...kinda something you adapt to. Mine is usually a high pitched sound, like a mosquito right in my ear. Sometimes if I sleep in a funny position it's a roaring sound - that's uncomfortable, will wake me up. I finally gave up going to Dr.'s, got no advice that reallly helped.

 

[Corrado]

Laurence,

Thx for the feedback. No doubt asa beginner I may not have done a good job of equalization but did not experience any pain. I did have vertigo in the evenings particularly if I raised my head back and attributed it to pressure from the BCD or tank valve on my upper back. But was also close to decompression limits on first dive. My suunto shows a few minutes away at depths of around 30 m. So I wonder if I had some DCS effect like nitrogen bubbles damaging inner ear !

I had a hearing test in Singapore which shows high frequency loss in the left ear. Also had an MRI to check for tumor but was OK. I had a general medical in Houston and hearing test but was not done as thoroughly and showed up nothing.

Certainly I am amazed at the volume of noise in my left ear when I wake up in the mornings and cannot experience silence ! Balance and coordination seems OK and I can hear but seem to say what more often - probably more because of the 'noise' distraction more than the hearing loss.

I am seeking out more ENT expertise and testing from diving aware doctors to better define the source. The ENT in Singapre did not seem to think it was a burst oval window or middle ear problem. No wax and ear drum test suggesting no fluid behind. Likely inner ear problem as you suggest.

I am interested in any ideas regarding diagnosis or tests to isolate the source of damage. seems a good place to start.

Then I would like to hear more about what to do or not to do to help improvement or reduce teh risk of further deterioration. For example some say you should not take ear danmaging 'otoxic\' ?? drugs such as anadin/aspirin. etc

I have also come across a site run my Neuromincs who claim to have a treatment for Tinnitus although only available in Australia.

Anyway, looks like I will be around for a while on this subject and will post an update !

Regards
Corrado

Hi Corrado,

Your symptoms suggest an injury to the inner ear. You did multiple dives and had no other symptoms to suggest worsening DCS. Did you experience any difficulty clearing during the dive(s), pain on ascent or descent, vertigo during or immediately following a particular dive?

As for experience, I have had tinnitus (ringing in ears) for 20 years now. It started following a wave crashing into the side of my head, effectively "boxing" my right ear. I noticed immediate ringing that has never stopped.

Audiometry showed a high frequency loss. It was attributed to trauma that resulted in the breakage of the little hairs withing the auditory apparatus. Each hair is responsible for detecting a specific sound frequency and sending a signal to the brain. You break the hair and you lose some hearing in the corresponding range.

My tinnitus is like a high pitched whistle. Sometimes it is louder and sometimes lower but always there. It seems worse in noisy rooms or when my wife is yelling at me. :11: I find that the ringing seems to mask sibilant sounds (high pitched sounds generated when saying the intial parts of "S", "T" and "soft "C") and the beginning sounds of "D", "Z", "P". Wind noise in my good left ear also creates a greater hearing problem in the right ear when listening to a passenger in the car while the windows are open. I often find myself thinking I heard an S when it was a P. The mind fills in the blank...usually wrong. To this day I don't understand what my wife means when she is sissed off!

The tinnitus also seems worse when there are loud, high pitched sound in the environment...music in a club or concert. No matter how loud the outside sound, the tinnitus is always louder.

Another problem is the localization of certain sounds like a chirping bird or even the whine of a jet aircraft. I can hear it but cannot find it easily if at all.

Ruptured oval or round windows can also result in this type of injury and may affect your qualification to dive in the future.

There are also other causes of tinnitus such as ear wax touching the eardrum and listening to loud sounds over a long period of time.

You should have it checked out to rule out causes. There isn't going to be any treatment if the cause is damage to the inner ear. Earwax can be removed.

Don't suppose this really helped, huh?

Larry Stein

 

[crpntr133]

I suffer from the same thing in my left ear all the time. Had a ENT last year tell me that it isn't uncommon especially with people that fought in a war, gun fire.

I guess I get to be the weird one because I have the ringing in my right ear sometimes when diving. It usually happens at around 10' and stops fairly quickly. My left ear was worse but after my first pool dive after my sinus surgery it lessened. I told the ENT about it and he figured it was because of a immature estachion (sp) tube.
I have scrubbed one dive because I ended up with vertigo. It wasn't bad but wasn't something that I want to deal with in 30' of water. It was also towards the end of the dive and we were headed back anyway.
So far nothing I have tried has worked on helping any of it and the ENT doesn't seem to be worried about me diving.