Me neither. I first learned about them on scubaboard. I thought all the agencies had removed it from their curriculum. Apparently not. I certified with NAUI. My daughter with SSI. Neither of us had to do a CESA.
Inner Ear Barotrauma - seeking opinions
- Thread starter Ken Fischer
- Start date
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OP
Ken Fischer
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I purposely posted this in "Accidents and Incidents" because I wanted to highlight and discuss the sequence of events that lead to my injury. As in most incidents, a cascade of failures resulted - any one of which could have prevented this. All of the below were factors:
1. Miscommunication between me and the resort, where I thought the resort was going to provide a dive computer - or I would have rented one elsewhere and brought it with me. (No dive computer on the dives.)
2. The CESA followed by a descent - the cycle from 20' to 0' to 30'. (Sure wish we had done the CESA at the END of dives #2 or #3.)
3. I didn't practice equalization as a muscle memory skill. I knew the Valsalva maneuver, and nothing more than that. Undereducated on the dangers of a failed equalization. I was also ignorant as to how relatively painless an inner ear injury could be.
I respectfully submit that this isn't a "Dive Medicine" discussion? Or is "Accidents and Incidents" solely for discussing dives that result in a death?
OP
Ken Fischer
Registered
Diving accelerating an underlying condition and an injury due to diving aren't necessarily the same thing
And I'm saying that it doesn't matter....the problem sounds like SSNHL rather than barotrauma. What did your hearing and ear doctors say?
Just following up on item 2, regarding your preference of performing a CESA at end of the dive rather than the beginning.
Realistically, the before or after would have no tangible effect on the resulting barotrauma as, in essence, both involve a descent and ascent. In some respects the standard ascent will have less potential for damage as this would be slower and easier to manage without the additional stress of completing a performance required skill.
My personal preference is to carry out the CESA at the beginning of dive 3. My rationale is two-fold. Firstly, in our centre, dive 3 is always the first dive of day 2, therefore staff and students have had a good night's sleep and have sufficiently 'off-gassed' since the previous day. Secondly, from an instructors perspective, we may be required to conduct a number of student CESA's, one after the other, which is not ideal for managing the controlled release of inert gas in our bodies. Therefore if I carry out this skill at the beginning of the day, at least my poor old body isn't managing repeated 'bounces' after having already completed a dive with resulting residual nitrogen.
I know this was only one of your concerns, but thought it may be helpful to provide a reason why the skills may have been structured this way.
Anyway, sorry to learn things did not go as planned. Hopefully your ears will mend soon.
One of my young colleagues at work (he is 28) suffered of this neurological problem while driving his car to home. Strange sounds "like birds" and immediate hearing loss. It was promptly threated with cortisol, and a number of hyperbaric oxygen treatments. Unfortunately he recovered only partially.
The explanation given to him was that some sort of embolism or thrombosis occurred, depriving the auditorial nerve of blood flux. The hyperbaric oxygen therapy provides some oxygen to the nerve cells which become under-oxygenated due to the embolism. My colleague is not a scuba diver, and was doing nothing strange. It is the second one I have seen, the first one was 65, and at that age a small thrombosis or embolism is more "natural".
So this kind of hearing damage has nothing to do with equalization while going down. Instead, the embolism could have been caused by the CESA.
And this is well possible in people suffering of the open oval foramen in their heart. Approximately 20% of population have it...
I am not an ear doctor. It appears that I used an incorrect term in my original description. The water entered my middle ear, not my inner ear. Thank you for catching my mistake & thank you for the additional useful information that you provided.
By the way, how are things in Parma these days?
That seems unfortunate.
Obtaining better training might be another option to consider.
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