Dizziness and vertigo

[Spray25]

Hello everyone. I appologize in advance for the long post. I wanted to share an experience and solicit some feedback...

I got my OW a couple of months ago and have done about 10 dives. During the OW part of my class I became quite dizzy during an ascent (within 5-10 feet of the surface). I informed my instructor and he said it happens fairly often and not to worry too much. He has even had people vomit after surfacing. That releaved me a bit and I went on diving. Since then I have experienced it a few times. It has never really unnerved me at all. My big fear would be passing out underwater. To get through it I have always just prepared myself to push my inflate button and told myself that I am so close to the surface that at least with a little air in the BC I would float even if passed out. I know it's amazing what I tell myself to calm down, but hey it was working.

So then I go diving this weekend. All of my dives have been pretty shallow up to this point (30 ffw). So this weekend I go to an altitude of 6250ft and a depth of 48 feet. Everything was fine, but I did notice my right ear, the one that somtimes is dificult, didn't clear real easy. It wasn't extremely difficult and was not painful at all, it just didn't clear right away.

So everything was going fine I was having a blast. Then I noticed that my bouyancy wasn't quite right so I added a little air (I was at 48'). The combination of adding air and finning caused me to rise a couple of feet. No big deal normally, except I became VERY dizzy. the differnece this time is I'm at nearly 48' not less than 10'. I panicked a bit thinking that if I passed out I was a gonner. I decided in the confusion to surface. Problem was with the disorintation I was having a difficult time. To make a long story short I ended up surfacing WAY to fast and dragging my buddy up with me. The whole experience really freaked me out. After building a little courage back up I went on asecond dive (to 24') and experienced no problems.

Some of the things that I have pieced together...

I had a slightly stuffy nose when I woke up that morning, but I thought it was pretty much cleared up by dive time. If memory serves me correctly I was a tiny bit stuffy the day of my OW dives that I first experienced the dizziness. Both times I experienced at least some difficulty clearing my right ear. The water temp was cold, 45 degrees. Trying to remember back I had a dive in cold water to 30 ffw, with no clearing problems and I don't think I got dizzy on that dive at all.

I have read other posts on here about dizziness and Virtigo, and I think I may call DAN and see if I can find an ENT with dive experience in my area. I would like feedback from you guys as well. There is definately a wealth of knowledge on here.

 

[BillP]

Howdy Spray25:

Sorry about all your trouble. When one ear clears slower than the other it causes different pressures- or alternobaric conditions (everything in medicine has to be in Latin or Greek, doesn't it?)- in the ears. This pressure differential causes the delicate balance mechanism in each ear to be stimulated differently and leads to vertigo. It most typically happens on ascent, but can happen any time there's a pressure differential.

Checking with an ENT referred by DAN is a good idea, because vertigo at depth with its associated disorientation and/or nausea can be hazardous. I guess from what you've said, to save us from re-inventing the wheel here you've already read the many threads about alternobaric vertigo at:

http://www.scubaboard.com/search.ph...id=74192&sortby=lastpost&sortorder=descending

Do you have any specific questions?

HTH,

Bill

The above information is intended for discussion purposes only and is not meant as specific medical advice for any individual.

 

[BillP]

BTW, since you mentioned cold water diving I should mention that having different temperatures in each ear can cause different stimulation of the balance mechanisms and vertigo too. This might happen when cold water enters one ear while the other is being kept nice and toasty by your hood. You'll find info about caloric stimulation on-site too.

HTH,

Bill

 

[Spray25]

Bill,

I did do a search for "dizzy" before posting, but your search turned other articles that I had not seen. It sounds like most just live with the problem. I saw you and others suggest several times to work on clearing. I was disapointed that no one really reported back with reults, good or bad.

One person said he normaly has the problem when ascending in a vertical postition and not when in a horizontal postition. Any merit to this? If yes how does one go up a ascent line and stay horizontal?

Why did I not have difficulty on my second dive? I was in a horizontal position on the second dive as I was follow the bottom back to shore. I didn't go as deep either, although depth doesn't seem to be the trigger.

Is this a problem that a ProEar mask might help with. Does the ProEar work in general? What are the trade offs with it?

Is it likely that as I dive more and get better at clearing this situation may coorect itself?

If it is temperature related involving the hood what is the cure? One person suggested poking holes in their hood is that a good solution.

Most important to me is it likely that I could pass out? I know anything is possible, but is it likely? Also what happens if I vomit? Can a regulator handle that and not get plugged etc?

The rapid ascent I went through was not a good experience either. If ever faced with that again what signs of DCS or CAGE should I watch for? I hate to admit that I didn't know what to watch for. How much risk did I expose my buddy and I too? In what time frame would a persom notice the symptoms?

I'm not sure how I forgot to mention this in my first post. After surfacing my computer was signaling for a mandatory safety stop because of the rapid ascent. My buddy and I returned to about 13' and swam around for 5 minutes and resurfaced. As we started our surface swim I went to spit what I thought was normal throat junk and it was blood. I later figured out it was coming from my sinus'. I determined that because I could inhale/snort through my nose and get some blood. No blood ever came from my nostrels. I assumed this was from my ascent. It also contributed greatly to my being freaked out by this dive, and caused me to wonder about DCS.

 

[BillP]

Originally posted by Spray25
One person said he normaly has the problem when ascending in a vertical postition and not when in a horizontal postition. Any merit to this? If yes how does one go up a ascent line and stay horizontal?

Well, it does seem to have merit for the person you quoted. Everybody is different, and it's impossible to guess whether it would have merit for someone else. I believe that most people find it easier to clear when vertical, but that's not true for everyone. With practice you will be able to maintain any attitude in the water you wish- vertical, horizontal, on your back, head down, whatever.

Originally posted by Spray25
Why did I not have difficulty on my second dive? I was in a horizontal position on the second dive as I was follow the bottom back to shore. I didn't go as deep either, although depth doesn't seem to be the trigger.

The problem doesn't occur when the ears equalize together or the temperature is the same in both ears. I'm not at all surprised when the problem is intermittent.

Originally posted by Spray25
Is this a problem that a ProEar mask might help with. Does the ProEar work in general? What are the trade offs with it?

The people that sell the ProEar masks and the Doc's Proplug vented ear plugs will tell you that they help, but I don't really understand how they help and I've not seen independent verification that they really work. There are lots of anecdotal reports of benefits, however.

Originally posted by Spray25
Is it likely that as I dive more and get better at clearing this situation may coorect itself?

The spirits are distant and my crystal ball is fogged at the moment, so I can't tell you specifically what will happen to you. (grin) When a problem is related to technique, the problem improves when technique improves. When it's due to inflammation and congestion, it gets better when the inflammation and congestion get better. When it's due to anatomy, it goes away when the anatomy is corrected.

Originally posted by Spray25
If it is temperature related involving the hood what is the cure? One person suggested poking holes in their hood is that a good solution.

When the problem is related to temperature it is because the temperature of the water in the ears is different. The solution is to keep both ears equally warm or cold. That might involve adjusting technique, or getting a better or worse insulating hood (letting in less or more cold water.) I suppose that poking holes in the hood would be one way of ensuring that it insulates less well and cold water gets to each ear.

Originally posted by Spray25
Most important to me is it likely that I could pass out? I know anything is possible, but is it likely? Also what happens if I vomit? Can a regulator handle that and not get plugged etc?

The crystal is still clouded... Sorry, just kidding. In order to say how likely an occurence is, you need to know how often it happens. Unfortuanately when you pass out when diving, you frequently die. No one knows how frequently vertigo occurs when diving, even in divers who survive. One Swedish study questioning 2053 divers indicated that 453 had experienced vertigo at some point when diving, and of those 343 had likely had alternobaric vertigo. None had lost consciousness and all were alive when they were questioned. Divers who had lost consciousness and drowned prior to the study refused to complete the questionaire and tell the researchers whether they were dizzy before losing consciousness. Be that as it may, you can be assured that passing out when diving is a very bad thing.

Vomiting is quite common when suffering from vertigo. It is possible to vomit into a regulator, and it is quite likely that the regulator will continue to function. If you go to the Basic Scuba Discussions forum and ask about vomiting into a regulator, I bet you'll find people that have had it happen to them and instructors that have helped students deal with it.

Because of the potential hazards posed by vertigo while diving with its associated disorientation, panic, vomiting, or even loss of consiousness some diving medicine authorities would tell people prone to alternobaric vertigo that they should not dive- ever. Others might say that diving should be avoided when conditions that bring on the vertigo are present (congestion, irritation from multiple dives, etc.) At other times when conditions seem "right" and the diver elects to dive, their well trained and skilled buddy should always be made aware of potential problems (to be ready to assist), depth changes should be avoided when there's the slightest ear fullness until the feeling subsides, the diver should reverse direction until the problem clears when vertigo does appear on ascent or descent, and ascents should be made with adequate gas supply to handle delays in the ascent from needing to address problems.

Originally posted by Spray25
The rapid ascent I went through was not a good experience either. If ever faced with that again what signs of DCS or CAGE should I watch for? I hate to admit that I didn't know what to watch for. How much risk did I expose my buddy and I too? In what time frame would a persom notice the symptoms?

Signs and symptoms of DCS and AGE can be found on Scubadoc's site at:

http://www.scuba-doc.com/dcsprbs.html

and

http://www.scuba-doc.com/ageprbs.html

Rapid ascents can be dangerous on occasion. You can die from a rapid ascent. They should be avoided when there is a viable alternative.

In recreational diving 50% of people with DCS show signs or symptoms within 60 minutes and 95% will have problems within 39 hours. For AGE 50% show evidence in less than 2 minutes and 95% have difficulty within 75 minutes.

Originally posted by Spray25
I'm not sure how I forgot to mention this in my first post. After surfacing my computer was signaling for a mandatory safety stop because of the rapid ascent. My buddy and I returned to about 13' and swam around for 5 minutes and resurfaced. As we started our surface swim I went to spit what I thought was normal throat junk and it was blood. I later figured out it was coming from my sinus'. I determined that because I could inhale/snort through my nose and get some blood. No blood ever came from my nostrels. I assumed this was from my ascent. It also contributed greatly to my being freaked out by this dive, and caused me to wonder about DCS.

Blood is often a sign of barotrauma. The injury from the barotrauma can be very mild and self limiting (usually the case) or in some circumstances it can be severe and life threatening. It is rarely seen with DCS, but can be seen with AGE.

Originally posted by Spray25

I was disapointed that no one really reported back with reults, good or bad.

Then I'm sure that you'll be reporting back to us.

HTH,

Bill

The above information is intended for discussion purposes only and is not meant as specific medical advice for any individual.

 

[Spray25]

Thanks for all the info. I called DAN for an ENT referral and they have none listed in my area. There was only one dive related doc at all in my area. The good news is that I know him pretty well. I spoke with him and he set me up with an ENT that I am going to go see tomorrow. He has seen a fair amount of this and is an instructor as well. He said in most cases he has seen that there has been improvement in the virtigo with better clearing and bouyancy control. He echoed all of the same possibilities that you did. I am going to Jamacia next week so he was interested to see how I did in warm water vs. the cold stuff I've been diving in.

What's up with the Swedish study? Why did the people that had passed out and drowned not participate in the study? Rather selfish isn't it? Do they not care that many people could benefit from there experiences?

My buddy and I have already worked out a system of signals and actions to take if this should happen again.

I will let you know how my appointment goes with the ENT and how I progress. Thank you very much for all of your help.

 

[BillP]

BTW, I guess I should tell you that the numbers from the Swedish study are real. Only the part about the dead divers not participating was tongue-in-cheek.

Lundgren C., et al: Alternobaric vertigo and hearing disturbances in connection with diving: An epidemiologic study. Undersea Biomed Res 1:251-258, 1974.

 

[Spray25]

I went to the ENT this week. I wasn't very impressed by him. He clearly knew little if anything about diving. He said he could see blood behind both eardrums, a sign of barotrauma. Which I already figured on. As far as the vertigo, he said he wanted to run more tests. When I said I was leaving in a week to go on a dive vacation he said "don't go". He gave no real reason for that response. He was very short and seemed in to big of a hurry to really comunicate with me. I brought up some of the things I had learned on here, ie. cold water exposure, not clearing properly etc. and he just kind of said yes that could be it. :upset:

They gave me a hearing test and a pressure test. I have some hearing lloss in my left ear which the person giving the test speculated was from shooting firearms. I am scheduled for more tests this Wednesday, the day before I leave. The good news is the doc will be out of town so I get to discuss the results with one of his associates.

I decided to order a set of Proplugs. There are a lot of mixed reviews and it seems most medical proffesionals doubt the positive claims, but they aren't very expensive and I figured they are worth a try.

I also plan to work on my clearing a lot more. In the past I have cleared when I felt pressure. I am going to try to clear more often and before I feel any pressure.

I will give an update after my next appointment.

 

[art.chick]

I have deafness in my left ear (due to a virus when I was 19) & have noticed that I don't clear evenly EVER! It takes me SOOooo long to clear 'em both compared to some people. But here was my education: we went to visit a hyperbaric chamber for fun, & they put us in to feel the effects of pressure change. We REALLY needed to clear our ears. The chamber attendant said he had only dropped us 3'! He said that in the ocean, there are so many sounds & distractions that we don't notice how much we need to clear or how often. He said that waiting to feel the sensations that make us want to clear is inadequate; we need to clear BEFORE we feel the discomfort.

I had one instructor who told us to clear while we were on the surface, before we ever went down. When I do all of these things, the dive goes quite well. Vertigo on dry land was once a problem for me, so I can imagine the fear underwater! I hope things can be resolved so you can go on your vacation, but here's my thought: if you are well enough to go on a plane, would you not also be well enough to dive? Does the ENT have an issue just with the diving (because it is not his bag) or does he, without the question of diving in play, also worry about you on the plane?

 

[Spray25]

I went to the ENT again yesterday. They did some tests (ENG) and found nothing wrong. One of the tests was blowing cold and warm air into my ears. I thought it was interesting that cold air in my right ear mad me slightly dizzy after a while warm air did nothing. Blowing cold air in my left ear made me extremeley dizzzy, basically the same as the virtigo I am experiencing. Warm air was almost as bad in the left ear. I thought it odd that the Doc didn't take issue with this.

So I'm left thinking I need to work on my clearing. Need to clear before I think I need to as both of you suggest.

Art.Chick, I think the Doc's reaction to diving is because he knows little or nothing about it. If he simply says don't go he has no chance of liability if I am injured. He had no concern about me flying.

Thanks guys for your help. I leave in a few hours for Jamacia!! I will give an update when I return. We'll see how I do with better clearing and some warm water!!