High frequency hearing loss (past 3khz), tinnitus, and vertigo after first dive

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timnswede

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Hello, I saw some people get some very good advice on these boards and wanted to try my luck.

Some background: I went scuba diving for the first time last Monday (10/4/21) and had troubles equalizing on the way down. I performed the vasalva maneuver rather forcefully (wasn't aware that this is dangerous...) and the pain went away so I thought it worked. I got a bloody nose midway through my dive (about 20 minutes after descending) and after I got out of the water I had no hearing what so ever in my left ear and had bad vertigo. At this point I had no ringing. The instructor said it was probably just water in my ear and it'll be fine.
The day after I got some of my hearing back in my left ear, but also have some pretty bad tinnitus. I also had some off-and-on vertigo several times a day that has since gone away. Since that day I have complete hearing loss past 3khz in that ear and the ringing has not gone away. I have seen two ENTs (neither specialized in diving) who put me on 60mg of prednisone and also steroid injections in my ear, but no improvements as of now. The ENTs said there is signs of trauma to my ear, some redness and blood. I found one diving experienced ENT in Irvine, CA, but his earliest appointment is December 8th... They're also having an MRI done on my ear in case it's not related to diving, which seems like it would be a massive coincidence.

I was wondering if anyone has experienced anything similar or could give me some advice on what to do. As of now it seems like my hearing loss and ringing is most likely permanent, but definitely looking for other opinions.

I appreciate any response.
 

rsingler

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@doctormike

With the blood that was observed, your forceful Valsalva may have given you a ruptured tympanic membrane. The cooler water in the middle ear on one side may then have caused your vertigo.

It's too early to say the changes are permanent. My only advice is to refrain from diving until you're tympanic membrane is fully healed. An early December appointment sounds about right for your ENT to see how it has healed.

@doctormike certainly has more experience and may have better advice for you pending that visit, but we'd all say: don't depend upon Internet advice from someone who hasn't examined you.

Diving Doc
 

doctormike

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@doctormike certainly has more experience and may have better advice for you pending that visit, but we'd all say: don't depend upon Internet advice from someone who hasn't examined you.

Diving Doc
Yup, I sure agree with that! But I will say that this doesn't sound like a ruptured TM. The fact that you have gotten intratympanic and systemic steroids, and an MRI, tells me that this is a sensorineural hearing loss, not a conductive hearing loss. And the story makes it sound like inner ear barotrauma.

You might not want to wait that long. It's not clear that surgery helps in all cases, but if there is a leak of inner ear fluid (like a perilymph fistula), the longer you wait the less likely the hearing is to stabilize. Hard to say much scientifically since these cases are relatively rare, so there aren't big series' and you can't really do double blinded studies.

But I would forget about finding a "diving" doc, and find a good otologist (ear specialist) to see if you are a candidate for a middle ear exploration. I don't know anyone in San Diego, but the House Institute in Los Angeles is very well known.
 

Ukmc

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There are several neurootologists in SD. Rick Friedman for one. I think he trained at House.
 
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timnswede

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Thank you for the responses! The specialist in Irvine actually bumped up my appointment to tomorrow, and from what I spoke to him on the phone about it seems like they may indeed be suspecting a perilymphatic fistula. There is apparently a somewhat experimental procedure of drawing some of my blood and injecting it into my ear (not too excited about that..) in order to stop the leakage if there is any. So I'm glad that I found some other opinions.

I will update this thread if there's any progress. As of now my hearing loss is stable at least. For now no more diving, no sneezing, no blowing my nose, etc.
 

Ukmc

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Good luck! I hope the procedure works.
There is also a guy by the name Dr. Michael O’Leary, whom I do not know, but is a retired Navy guy who used to be a chief neuro-otologist at the Navy hospital in San Diego. Looking at his bio, he spent 24 years in the Navy serving as an ENT specialist.
I suspect he knows a thing or two about diving related ear injuries… In case, you will want to seek a second opinion. I think he is in private practice in your area.
 

doctormike

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Thank you for the responses! The specialist in Irvine actually bumped up my appointment to tomorrow, and from what I spoke to him on the phone about it seems like they may indeed be suspecting a perilymphatic fistula. There is apparently a somewhat experimental procedure of drawing some of my blood and injecting it into my ear (not too excited about that..) in order to stop the leakage if there is any. So I'm glad that I found some other opinions.

I will update this thread if there's any progress. As of now my hearing loss is stable at least. For now no more diving, no sneezing, no blowing my nose, etc.

Glad you are going to be seen sooner. I'm always reluctant to give any specific advice over the Internet, but hopefully you will get help. Please keep us posted.
 
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timnswede

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Hey guys, just a minor update. I saw Dr. Harrison Lin at UC Irvine who performed the blood patch in my ear yesterday (drew some of my blood and injected it into my ear). The hope is that if there is perilymphatic fistula then my blood will coagulate with it and seal it up. I'm sure there's a fancier way to describe that, but I'm not a doctor :)

It's mainly to prevent any further vertigo, but may also help with the tinnitus and hearing loss if I'm lucky. There's very little research into this, so basically just a wait and see thing. Next steps are to do a hearing test next week and most likely further steroid injections. If still no improvement then I would be going in for surgery where they manually patch up the fistula (at least that's my understanding).

On the bright side, my hearing loss is not getting worse as of now. If it starts getting worse then they'd want to do surgery right away.
 
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