Help!!! Dive Buddy has ear problems

[KerriHMI]

I hope there is someone on here who can help me out here.

My partner and I were diving on Tuesday (4 days ago) and had an uneventful dive to 9.2m.

No ascent rates were exceeded and my partner had nil problems equalising. He had the cold the week before but had no symptoms left over and had not taken any decongestants.

He had a slight muffled feeling in his ear on Wednesday but felt that it was just water. He then went to band practice on Thursday and ringing started. On Friday he was deaf in his right ear.

He went to hospital this morning and they have admitted him, The Doctors have no diving experience and they heard the words scuba diving and have just said well thats what has done it. They have now put him on CO2 every 2 hours plus steriods to 'increase the blood flow to the ear' they have told him he has nerve damage and will permantely deaf and never dive again.

Now this all seems a little hasty to me. My partner says he has the constant feeling he needs to equalise his right ear but yet can't (although I think a little bit of ear fear is setting in). The doctors are now just treating me like a pain but I have questioned their treatment and suggested that it is a reverse block and possibly an infection but they have dissmissed this as 'we are in denial'.

Please can someone give any advice whatsoever. I am worried sick that he is not receiving the best treatment and this may make it worse. He is devestated by the diagnosis both from a musical and diving point of view. The ear drum is not perforated and there is no blood. Seeing as how the Doctor stated that 'I didn't know you could dive over hear' (Northern Ireland) I don't really trust his judgement on diving related injuries and can not contact our own diving doctor till Monday.
Thanks In advance Kerri

 

[shakeybrainsurgeon]

Not a lot of info to go on...what is the age of this person, his previous health, etc and also, did they scan his head or involve an ENT (ear specialist)?

Barotrauma to the middle or inner ear might be the culprit, but the story seems wrong. Normally, the symptoms occur quickly, with pain, vertigo or ringing noticed immediately or at least soon after the dive. Hearing loss with such barotrauma can occur, but is not usually complete. Both may produce evidence on inspecting the eardrum. Even if not perforated, redness or fluid (suggesting inflammation or round window rupture) should be evident. Inner ear barotrauma is unusual for such a benign dive. There is a separate illness, ear DCS, which apparently is found mostly in very deep diving. This condition is treated with a chamber, but it would be too late for that now. In this case, the delayed onset seems odd for a diving injury...but in medicine, odd presentations of common things are more likely than rare diseases. Given that ear trauma is common in diving, that still seems the likely culprit.

The prohibition against diving and the use of steroids seem reasonable... i don't know what CO2 treatment is (do you mean O2?).

I would get an MRI of the brain and internal ear canals. If that is negative, and the ear exam suggests no fluid in the middle ear, it doesn't seem like much else could be done right now.

 

[KerriHMI]

Hi thanks for the reply.

He is 31, no previous health problems, no ear problems, the Doctor was an ENT junior doctor who tested hearing with a tuning fork and examined the ear with an otoscope, however no MRI and the Consultant ENT doctor is not on untill Monday. He is on CO2 and I have no idea what it is for and I am a nurse.

 

[shakeybrainsurgeon]

The flow of blood to the brain is regulated by blood CO2, the higher the CO2 the higher the blood flow, and vice versa. The main determinant of blood CO2 is respiratory rate. Unless someone is on a ventilator, it is difficult to impossible to raise blood CO2 and affect blood flow consistently.

In brain swelling, a patient on a respirator can be hyperventilated to reduce brain blood flow (which reduces brain swelling). Conversely, C02 retention by hypoventilating increases brain blood flow and blood volume, hence the CO2 retention headache. I suspect some form of CO2 manipulation is being done to increase brain blood flow, but this seems odd in a young person.

Testing hearing at the bedside in one ear is notoriously unreliable. Only formal audiometry and/or brain stem evoked potentials can establish total hearing loss in one ear.

Where I come from, neurological loss of any kind doesn't wait for Monday to be evaluated by experts. Of course, when the US socializes its health care system, it will...

 

[Tigerman]

Where I come from, neurological loss of any kind doesn't wait for Monday to be evaluated by experts. Of course, when the US socializes its health care system, it will...

If you really believe that, you should go have a look at how healthcare actually work around the world instead of listening to propaganda.

As far as the case goes, I just hope the OPs partner get well soon and I think, if this is a case of a clueless doc (which yes, can happen anywhere, "socialiesed health care" or not) I think you might also be allowed to get a second opinion from a different doctor or even a different hospital?
To me it sounds like a case of arrogant doc if hes not a specialist on this field and just blow off concerns as "denial" without even really listening to them..

 

[TSandM]

The time course of this doesn't sound like barotrauma. But another possibility is a viral infection of the inner ear, attaching the cilia in the cochlea. One of the nurses I work with (who is not a diver) contracted this about six months ago, and her course was very similar; tinnitus, followed by loss of hearing. She was also treated with steroids, and has had a little return of sound perception in the ear. The fact that your friend had recently had an upper respiratory infection goes along with this hypothesis.

Severe barotrauma presented with an appearance on examination very similar to a rampant middle ear infection (see THIS presentation on barotruma -- warning, it's long) and such signs shouldn't be missed, even by a rather junior person in the ENT world.

 

[shakeybrainsurgeon]

If you really believe that, you should go have a look at how healthcare actually work around the world instead of listening to propaganda.

As far as the case goes, I just hope the OPs partner get well soon and I think, if this is a case of a clueless doc (which yes, can happen anywhere, "socialiesed health care" or not) I think you might also be allowed to get a second opinion from a different doctor or even a different hospital?
To me it sounds like a case of arrogant doc if hes not a specialist on this field and just blow off concerns as "denial" without even really listening to them..

There are good aspects to socialized or single pay systems, such as better primary care. Our primary care lags behind, I admit. As for specialty care, that's another matter. On my last trip to Canada, one of the lobster fisherman was waiting for a hip replacement. The waiting list was almost two years. And I spent time in the UK ssystem,,, it was awful, but that was twenty years ago, so it may have improved. Scandinavian medicine, from what I know, is superior to UK and Canadian systems.

The problem isn't that we don't understand other systems, it is that others are clueless about our system. Last week, I scheduled several people for MRIs who had the worst insurance coverage or none at all...the scans were done THE NEXT DAY. The wait for a visit with our neurosurgical practice is one week, and the wait for surgery is a week or two at most. Patients complain if we don't account for their son's little league schedule or prom date. A staff surgeon sees all consults that day, regardless of holidays or weekends.

Let's not get side tracked into whose system is better. The US way may be TOO accessible and too costly. My only point was: a young man with sudden deafness should be jumped on, but, to be fair, there are many hospitals here who would do a crummy job AND this particular patient may be getting excellent care. My only beef was that a specialist must work on weekends too, here or in Antarctica. In this case, the relevant data may have been conveyed by phone and the appropriate decisions made. I too hope all turns out well.

 

[KerriHMI]

Thanks for all your advice and support. The time scale between the dive and the complete hearing loss is what is making me believe it is not barotrauma either. After much debate between myself and the Doctor last night he was commenced on Augementian 625mg TID so at least the antibiotics have now started.

I guess i'm just a little upset by the way the whole thing was handled and even if he will be left permanently affected by this I think there are more sympathetic ways of breaking news to a person than they did, especially when it involves the two things they enjoy most out of life. I guess where I work in adult psychiatry are just a little more senstitive to the emotions of fellow human beings. I'll post later when I been back to the hospital and thanks again.

 

[ZenDiver.3D]

Okay, my husband had what sounds like the same symptoms, but he did not go quite completely deaf. He did have a viral infection in his inner ear. It felt like fluid was pushed all the way down into his jawline and ringing and pain was pretty bad. Always felt like he needed to equalize (yep, just walking around, felt like it). He finally had three different ENT's tell him varying diagnoses, but a general practitioner sorted him out. antibiotics, steriods, and a certain eardrop. Two weeks later, he was diving deep wrecks and has been fine since...

I'm not saying that it is the same problem, just that ya'll should really check around..

Get that second, third, or fourth opinion. It's your health and happiness after all.

 

[KerriHMI]

Thanks, I just think they jumped in too quickly with treatment and diagnosis. In my experience sometimes specialists become blinkered to problems and miss the obvious.