EAR issue potentiel perilymph fistula ?

[Danishinstructor]

Hey Everyone


Hope that someone here can help me.


2 weeks ago I came up after a dive and felt a fullness in my ear and tinnitus. I went for another dive and was able to equalize without issue. But during the week the fullness in my ear did not subside and the tinnitus did not go away. During the week I also experienced ear pain. I went to my GP and he look at the pressure in my middle ear and that looked totally normal and he also look me in the ear and could not see are perforations of my eardrum. I went diving again and felt a slight vertigo under the dive. Later that week the dizziness start to come and got worse and worse and i got a immidiate time at the ENT. The ENT did alot of measurements and found the same as my doctor that the eardrum looked fine and pressure in my middle ear was fine.

The also did a hearing test and my hearing was totally fine even though I feel fulness of my ear and tinnitus.

The found slight vestibular abnomallaties on the effected ear and go me a appointhed to see the specialists at the hospital, that sepcialieces in balance and dizziness.


I went to the hospital and got alot of test done, the find nothing from with my hearing and they could not find any damage to my vestibular organ, eventhough I am dizzy constantly.


They concluded that I may have a very small leak in the OVAL window and that I should go home and rest in bed for 4 weeks and the come back, to see if it could heal on it's own and if it couldn't we would talk about exploratory surgery.


The reason I am writing here is to get more opinons.


I feel that it is weird my hearing test are totally fine, but I am dizzy constantly. My dizziness is at the point that all I can do is lay in bed , If I walk around I get very dizzy. I am also dizzy laying down.

The reason I think it is weird is because when I read about perilymph fistula, the symptoms alongside the dizzyness and tinnitus I almost always severe loss of hearing.


I work as an instructor, so all help about what I should do for treatment and my future prognoses are greatly appreciated.


Thanks in advance.


Best regards

Alex

 

[Duke Dive Medicine]

Hi Alex,

I'm sorry this happened to you. The only way to really diagnose perilymph fistula (the round window is actually more likely to rupture than the oval window) is through surgery, though it seems like a reasonable presumptive diagnosis in your case. Symptoms of PLF do not always include hearing loss. Our typical recommendation for suspected PLF is strict bed rest with stool softeners to reduce straining, and surgical exploration if the symptoms do not resolve or improve significantly within 24 hours. I would not second-guess a Danish otologist though. Re prognosis, the other vestibular apparatus can compensate for the damaged one, so your symptoms may improve with time, but recovery is highly individual. Also tagging @doctormike here, he is an otologist and technical diver.

Best regards,
DDM

 

[doctormike]

Yes, I agree with DDM... that pretty much sums it up! I'm actually not an otologist, but a pediatric otolaryngologist, so I do have some experience with these things but I don't do those PLF middle ear explorations myself.

What you describe sounds like inner ear symptoms which could be due to inner ear barotrauma, but not necessarily a PLF. Remember, with inner ear barotrauma, the eardrum itself and the middle ear pressure might well be normal.

Have you had a CT scan? While that probably wouldn't show a PLF, it might show if you had dehiscience of the superior semicircular canal, which can cause vestibular symptoms when pressure changes are transmitted to the inner ear. Another possibility is inner ear DCS, you didn't tell us much about your dive profile, but that is often overlooked and can cause lingering symptoms...

Did you have vestibular testing (ENG, balance testing, etc...?). It sounds like that has been done.

Sorry you have to go through this! Hopefully your symptoms will improve, even if you aren't a surgical candidate. Sometimes vestibular rehab can help people with persistent balance issues once an underlying cause has been treated or ruled out.

 

[Danishinstructor]

Thanks for the answer @doctormike .

I have not have a CT scan done.
I have had a lot of test done. The test I got at the ENT I was refered to by my GP show that my hearing was totally normal but they did find some vestibular abnormallities on the side of the left ear. The test that showed that was a test where i whore some kind of glasses and i looked at a dot while the moved my head.
The ENT send me to the hospital to se the department that deals with "dizziness and balance issues". This was around 5 days after I saw the ENT. The did several measurements for about 1 hour and the concluded that they couldn't find any vestibular damage.
Their diagnoses was that I properly had a tiny hole in the oval or round window.
I asked about why I didn't have any hearing loss on the test or vestibular damage on the test and their answer was that it was properly only a small hole.
I need to say here that I have a fullnes of the ear and tinnitus on that ear after the injury.

So the send me home and booked me for a follow up time in 1 month, because they wanted to see if the hole could heal on it's own.
I has now been a week since I have been to the hospital and around 3 weeks since the injury and the dizziness, fullness of the ear and tinnitus is still there and I has not improved.
Since Diving is my job, It is not very comforting not having a proper diagnoses or a timeframe or even a treatment plan.

Do you think it can be something other than a hole in the oval or round window ?

 

[Danishinstructor]

@doctormike I totally forgot, the symptoms came after a dive to 15 meters for 20 min.
I did on more dive that day to 25 meter for 20 min. Because I could equalize without problem and the dizziness didn't start right after the dive. The dizziness first started 1 weeke after the injury.

 

[doctormike]

@doctormike I totally forgot, the symptoms came after a dive to 15 meters for 20 min.
I did on more dive that day to 25 meter for 20 min. Because I could equalize without problem and the dizziness didn't start right after the dive. The dizziness first started 1 weeke after the injury.

OK, that pretty much rules out DCS, if you didn't get symptoms for a week (and if the profile was so shallow). I can't really diagnose anything over the Internet, and I don't really do this sort of surgery, but you get a CT scan, it won't really show a hole in the round window membrane. What it might show is if you have a congenital or acquired abnormality in the bony capsule around the inner ear, which could predispose someone to a PLF or other forms of inner ear barotrauma. It's also possible that this has nothing to do with diving at all (since it was 2 weeks after your last dive).

 

[Danishinstructor]

A little update - hope you @doctormike would comment on this and give your viewpoint on the matter.

I have now undergone intense vestibular testing on several hospitals here in Denmark, and all my vestibular measurements are completely normal, both VNG and ENG alongside TRV chair testing which have ruled out BPPV. I have also have the test done with both warm and cold water in my ears, and closed glasses on, sorry I don't know what this Is called, but that was also completely normal.
I have some tinnitus In the effected ear and a little hearing loss from the PLF surgery in the middle frequencies, but very minor and normal hearing in high and low frequencies.

The doctors now doubt if I ever had a PLF, even before the surgery, since the ENG and VNG measurements have been normal since the start and the surgery have done nothing for the dizziness.

The doctors have now due to my symptoms and the measurements, giving me the diagnoses of PPPD, previously called CSD and I have begun on VRT, but I am still dizzy to the same degree.

My question here is, once the dizziness subsides and treatment, can I dive again ?

 

[doctormike]

Hi,

Sorry, no one can really "clear" you to dive over the Internet. Unfortunately, the PLF diagnosis is always hard to be precise about. This is really a question that you need to ask your surgeon....

Wish I could be more helpful...