Inner Ear Barotrauma - seeking opinions

[PBcatfish]

I wanted to share here an injury that I sustained on Feb 16. I'll try to be as succinct as possible.

I conducted a CESA during my 4th Open Water certification dive, ascending from 20' to 0'.

At the surface, my instructor and I rested for no more than 30 seconds. (Ocean swells made the surface unpleasant.) We descended back down to 30' to complete the rest of the dive.

My recollection of the subsequent descent is extremely foggy - but I recall feeling "euphoric" and having some difficulty equalizing. But, I did not perceive the pressure as dangerous - I even recall smiling during the descent. I heard a few "tones" during the descent in my right ear, but nothing that I perceived as dangerous. [I will re-emphasize that this was my 5th descent ever in open water - total novice.]

I sustained inner ear barotrauma in my right ear (formally diagnosed 4 days later on Feb 20.) 2 months later, I have lost hearing for frequencies between 1600 Hz and 2300 Hz, and for frequencies > 3200 Hz. [In other words, normal hearing from 250 Hz to 2500 Hz, and for a small region from 2400-3100 Hz] My left ear is completely unaffected and normal.

The "euphoric" feelings, poor recollection, etc. - I speculate that the rapid cycle of 20' to 0' to 30' acted as a pump, pushing off-gassed Nitrogen back into my body during the descent?

Perhaps it was just adrenaline. In any case : the "CESA followed by an immediate descent" was a really bad combination for this newbie diver.

I had a situation in only 10 feet of water where I did not clear my ears correctly & water was then forced into my inner ear when my jaw cocked to the side. That water in my ear cause me to be dizzy & gave me a significant case of "the spins" when I changed the position of my head. This lasted for a few weeks, until the water in my ear had dissipated. Sitting up to get out of bed in the morning was a real challenge for a while.

The moral of this story is equalize early & equalize often.

I do not know if my experience was related to yours, but it seemed close enough to warrant a comparison.

Narcosis hits different people at different depths. I do not know anyone who gets hit in 30 feet, but that doesn't mean that it can't happen. In the distant past, I would normally start to feel it around 75 or 80 feet. These days, it's usually more like 110 or 115 before I notice it. Tolerance varies from diver to diver & can vary from day to day for a specific diver.

Since this was an OW check out dive, I'll assume that you were diving on air & not mixed gasses. If you have reason to believe that you may not have had straight air in your tank, for whatever reason, then that possibility may warrant further investigation.

Adrenaline most certainly is a possible cause of euphoria in that situation. I think that it actually seems likely. The dizzy feeling was probably from the ear problem.

 

[Angelo Farina]

I had a situation in only 10 feet of water where I did not clear my ears correctly & water was then forced into my inner ear when my jaw cocked to the side. That water in my ear cause me to be dizzy & gave me a significant case of "the spins" when I changed the position of my head.

So, water penetrated in medium ear after rupturing the tympanic membrane? There is no other way water can penetrate inside...
And it cannot go to inner ear, as inner ear is already full of liquid, so it cannot be flooded...
Have you been visited by a doctor after the accident? What treatment was prescribed?
Usually water penetration in the medium ear following rupture of the tympanic membrane, if treated promptly and appropriately, recovers in a few days without permanent consequences. If not treated properly, the membrane can regrown ticker, causing a permanent hearing loss. In extreme cases of large lacerations, the membrane does not heal and an open communication remains, resulting in severe hearing loss and a number of problems related to the fact that water will continue to flow in.

 

[Ken Fischer]

Narcosis hits different people at different depths. I do not know anyone who gets hit in 30 feet, but that doesn't mean that it can't happen. In the distant past, I would normally start to feel it around 75 or 80 feet. These days, it's usually more like 110 or 115 before I notice it. Tolerance varies from diver to diver & can vary from day to day for a specific diver.

Since this was an OW check out dive, I'll assume that you were diving on air & not mixed gasses. If you have reason to believe that you may not have had straight air in your tank, for whatever reason, then that possibility may warrant further investigation.

Adrenaline most certainly is a possible cause of euphoria in that situation. I think that it actually seems likely. The dizzy feeling was probably from the ear problem.

It was definitely a "drunk" type of sensation. I was diving on air, not mixed gases. I think the 20' to 0' to 30' cycle in just a couple of minutes affected both my mind and inner ear. My ear drum never ruptured. My equalization was sloppy and I had a forced / overdone Valsalva. I wish my training had practiced equalization as much as we drilled on mask clearing, breathing off of a buddy's air supply, etc. The one clear and present danger present on EVERY dive (pressure) was given the least amount of time in the skills training.

 

[Ken Fischer]

Fixed it for you.

CESAs can be really hard on instructors, especially if some students need to redo them (which is not uncommon).

Yes, I don't see the point in the CESA. A diver who allows his/her tank to run out of air, and separates from his buddy, is suddenly going to be a prepared boy scout and ascend properly while gently exhaling?

So sorry to hear about your injury and I wish you a speedy and, hopefully, full recovery

As others have said, at this depth Narcosis almost certainly not a factor.

Question is whether the barotrauma occurred on ascent due to a reverse block (unlikely unless you had some sort of cold or congestion) or on the descent due to incomplete equalization, but the decent after 30 seconds on the surface for a training dive is not uncommon. How was the rest of the dive, did you complete the dive or abort?

Best wishes for your recovery

The injury definitely happened on descent. I heard distinct "tones" on descent - which at the time, I took as being just some under water tinnitus.

Shortly after reaching 30', I realized I was focusing on my instructor's fins and not really enjoying the dive. I swam up alongside my instructor, and signaled to him to abort the dive. We did a safety stop at 15'-20' while signaling the boat.

That evening, I felt completely exhausted. I went to bed shortly after 7pm and slept the entire evening.

 

[Ken Fischer]

When you get better and start diving again.

I won't be returning to diving. My first/last dives were on that weekend in February. Losing hearing in one ear for 2 months, and maybe permanently. Just too much for me to enjoy this sport in the future, even if I somehow have a miraculous recovery at this point.

 

[Steve_C]

I see this more often on descent with new divers not trained to equalize often enough on descent and the instructor (or experienced diver) drops like a rock. I've watched people ditch me on descent as a result after I stopped being overweighted. My ears can handle it typically. But now I prefer slower descents being more in control.

So, I'm not surprised if this happens quite often. Too many divers are not properly trained and many divers, instructors included, have bad buddy habits.

In my case I was properly trained and can usually drop fast and if it clears slowly I usually go slow or back up. Around dive 350 clearing did not go as quickly as usual and I was almost to the wreck and I pushed it a bit since it did not hurt.
No real pain but was left with a full feeling in ear. Good ENT did tests and said I did not have anything ruptured but some inner ear trauma. Went away after the two months. No significant hearing loss long term. I am now more careful about descents.

Good old haste makes waste.

 

[Angelo Farina]

I won't be returning to diving. My first/last dives were on that weekend in February. Losing hearing in one ear for 2 months, and maybe permanently. Just too much for me to enjoy this sport in the future, even if I somehow have a miraculous recovery at this point.

Sorry to hear that, but I understand entirely. Enough is enough...

 

[Angelo Farina]

Yes, I don't see the point in the CESA. A diver who allows his/her tank to run out of air, and separates from his buddy, is suddenly going to be a prepared boy scout and ascend properly while gently exhaling?

I agree entirely. CESA was a required exercise when I was teaching at Maldives, in the eighties (I am a CMAS instructor). After some bad experiences, when back home, I did fight strongly (together with many other instructors), and in the end the requirement to perform a CESA for being certified was removed.
It is entirely anachronistic that some agencies today still require an inexperienced diver to perform a CESA in the sea.

 

[Steve_C]

Still good to remind students not to hold their breath on an emergency assent. I know some DM/instructors that repeat that for every dive they lead/instruct

 

[tursiops]

@Ken Fischer Your hearing issue sounds more like SSNHL than anything related to the diving. See for example, The Diagnostic and Treatment Dilemma of Sudden Sensorineural.... It could be quite unrelated to your diving; it happened to me while walking to my car one day.
Good luck to you.