Inner Ear Barotrauma - seeking opinions

[Angelo Farina]

By the way, how are things in Parma these days?

Still locked at home till 4th May. But my colleagues at the hospital report a significant reduction in the number of bad cases. The ICU units are not anymore saturated. So we are slowly coming out from the emergency.
It will be necessary to reopen everything very progressively, for avoiding a second wave.
The problem is that we have people with mild or no symptoms who are still positive after 5 weeks. And we have probably approximately more than 1 million of people actually carrying the virus, but we are not yet capable of performing massive tests and insulating them. So it is early for saying that the crisis is over...

 

[ToneNQ]

I won't be returning to diving............

That is a shame, but completely understandable. Many hobbies can have consequences and if its not paying the bills, discretion is often the better part of valour. Even as a dive professional it can fail to cover the bills.

A point to consider is that as a qualified diver you now have complete control of your dive. Your certification doesn't expire so you can change your mind. Do a skills refresher, find a good buddy in your local area, talk through your history and plan your dives accordingly. It is possible to manage this without missing out altogether, if the want returns.

 

[Duke Dive Medicine]

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?

Do you mean idiopathic SSNHL? The OP has a stated history of a forced Valsalva maneuver followed by tinnitus and hearing loss, and a formal diagnosis of inner ear barotrauma. What led you to the conclusion that this is not related to barotrauma?

Best regards,
DDM

 

[PBcatfish]

Still locked at home till 4th May. But my colleagues at the hospital report a significant reduction in the number of bad cases. The ICU units are not anymore saturated. So we are slowly coming out from the emergency.
It will be necessary to reopen everything very progressively, for avoiding a second wave.
The problem is that we have people with mild or no symptoms who are still positive after 5 weeks. And we have probably approximately more than 1 million of people actually carrying the virus, but we are not yet capable of performing massive tests and insulating them. So it is early for saying that the crisis is over...

Thank you. It's good to have first hand information. Buono fortuna

 

[tursiops]

Do you mean idiopathic SSNHL?

Yes

The OP has a stated history of a forced Valsalva maneuver followed by tinnitus and hearing loss

Perhaps.....he seems both uncertain and quite sure

a formal diagnosis of inner ear barotrauma

Perhaps. Given how few doctors seem to be comfortable with barotrauma, and that it was not stated that an ear doctor gave him the diagnosis, I am not yet convinced.
I agree, circumstantially barotrauma is the easiest conclusion. The easiest answer is not always the correct answer.

 

[Duke Dive Medicine]

The easiest answer is not always the correct answer.

Not always, but Occam's razor does have a way of proving itself.

Best regards,
DDM

 

[Ken Fischer]

Yes

Perhaps.....he seems both uncertain and quite sure

Perhaps. Given how few doctors seem to be comfortable with barotrauma, and that it was not stated that an ear doctor gave him the diagnosis, I am not yet convinced.
I agree, circumstantially barotrauma is the easiest conclusion. The easiest answer is not always the correct answer.

Symptoms started on Sun Feb 16.

I returned home on Wed Feb 19. I saw an ENT on Thu Feb 20. Audiogram conducted with virtually no air or bone conduction hearing. The ENT saw no obvious perforation of the eardrum.

I saw a 2nd ENT for a 2nd opinion on Fri Feb 21. I had a 2nd audiogram conducted - same results.

Both ENTs gave me a diagnosis of "SSHL due to inner ear barotrauma" - based on my audiogram results and my report of the symptoms occurring while scuba diving on Sun Feb 16.

Treatments consisted of a tapered dose of Prednisone (oral steroids), intraympanic steroids delivered via a tube inserted in my right ear, and 20 hyperbaric oxygen sessions over 4 weeks.

I quickly regained hearing from 250 Hz to 1 kHz in the first week. Return of hearing at the higher frequencies has been slower.

I did have an MRI performed to rule out a coincident acoustic neuroma.

I had no cold symptoms, no stuffy nose or allergies, etc. at the time of the dive.

 

[tursiops]

Symptoms started on Sun Feb 16.

I returned home on Wed Feb 19. I saw an ENT on Thu Feb 20. Audiogram conducted with virtually no air or bone conduction hearing. The ENT saw no obvious perforation of the eardrum.

I saw a 2nd ENT for a 2nd opinion on Fri Feb 21. I had a 2nd audiogram conducted - same results.

Both ENTs gave me a diagnosis of "SSHL due to inner ear barotrauma" - based on my audiogram results and my report of the symptoms occurring while scuba diving on Sun Feb 16.

Treatments consisted of a tapered dose of Prednisone (oral steroids), intraympanic steroids delivered via a tube inserted in my right ear, and 20 hyperbaric oxygen sessions over 4 weeks.

I quickly regained hearing from 250 Hz to 1 kHz in the first week. Return of hearing at the higher frequencies has been slower.

I did have an MRI performed to rule out a coincident acoustic neuroma.

I had no cold symptoms, no stuffy nose or allergies, etc. at the time of the dive.

Thank you for the additional information.

 

[Ken Fischer]

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.

I submit for consideration that the 20' to 0' to 30' cycle with only seconds on the surface at 0' had a definite effect. The symptoms I felt on the descent (A "foggy dream-like thinking state" that I had to push through) certainly sound like descriptions I read elsewhere of nitrogen narcosis.

Whether it was nitrogen on the brain, or adrenaline, or just being 43-years-old - Whatever it was, that post-CESA descent was dramatically different from the other 4 descents I did that weekend. I suspect it had something to do with attempting to descend ALMOST IMMEDIATELY after the CESA ascent.

If I had a dive computer on my wrist, that would have helped. If I had drilled equalization to the point that it was a muscle memory skill, that would have helped. (It's one thing to answer a question correctly on a quiz, or to show your instructor that you can pinch your nose and exhale. It's another to do the right thing while descending from 10' to 15' in a matter of seconds while something else is going wrong. Hindsight being 20/20, I wish I had a prepared descent routine for equalization that I had actively practiced.)

I submit that a 2-3 minute rest on the surface after my CESA would have helped also. For instance, I knew that one should always ascend if there's an issue with equalization - but again, the "foggy dream-like state" interfered with my ability to conduct the descent correctly.

And that's been my main objective in posting here. A chain of unfortunate events lined up to result in a significant injury. I contend that a rest period on the surface after my CESA would have broken one of the links in the chain leading up to the injury.

 

[tursiops]

Didn't you need to equalize several times during your confined water sessions? How did that go?