Inner Ear Decompression Sickness on recreational dive

[Kathryn_Rob]

I have recently been diagnosed with Inner Ear Decompression sickness after a live aboard dive trip on the Great Barrier Reef. I had been diving for 5 days on Nitrox - doing 3 dives per day. I had all modest dive profiles, did all recommended safety stops and recommended surface intervals. My deepest dive was 24m with most time on dives spent between 10-15m. Approximately 5 minutes after I surfaced from my 15th dive (bottom time 50mins, max depth 12m) I had a sudden onset of blurred vision, dizziness, vertigo, nausea, fatigue and ringing in my right ear. The dive crew recommended I go to bed and rest. After 18 hours and with symptoms still persistent they gave me oxygen for 2 hours. This did not relieve symptoms. I arrived at the hospital another 18 hours later again and was diagnosed by doctors with IEDC. By this stage I was unable to stand or walk unassisted as the dizziness was so severe. I was also checked by an ENT specialist and Inner Ear Barotrauma was ruled out. It was a total of 50 hours from the onset of symptoms to when I had my first hyperbaric decompression treatment. I had 12 treatments in the chamber. Doctors were frustrated by my slow recovery and have said that I was just "unlucky" as there was no specific incident that seemed to have caused my IEDS.

It has now been 6 weeks since my accident and I am still suffering from dizziness, nausea and fatigue. I am undergoing balance rehabilitation with my physiotherapist, but am still unable to move my head from side to side, or look up without feeling dizzy and nausea sick in the stomach. I have done 45 dives in total and have suffered from minor dizziness after some of my earlier dives. This dizziness was only mild and lasted only a few hours. I'm wondering if it could be related...

I am frustrated that some of my symptoms still persist and also that doctors seem to be so baffled by why it happened. It has been suggested I may have a PFO. It is difficult finding in-depth information specifically on IEDS as it is so rare in recreational diving. I would really appreciate any recommendations from any one that has experienced something similar, to help make sense of why it may have happened and what I can now do to help the remaining symptoms. Thanks

 

[Griffo]

Hi Kathryn.

I'd suggest asking a mod to move this to the medical forum. There's a whole bunch of smart doctor types that could provide some more informed opinion.
Out of curiosity, what chamber did you go to, and what did the hyperbaric specialists say aout recovery?

 

[Cave Diver]

I'd suggest asking a mod to move this to the medical forum.

Done.

 

[Kathryn_Rob]

I was airlifted by the Royal Flying Doctors to Townsville Hospital. The hyperbaric doctors down there said they believed they had got me as far as they could with hyperbaric treatment and the rest would just take time. They didn't say how long. They said it could be weeks, months or years...

Do you know how I more my query to the medical forum? I'm new to the forum and how it all works.

 

[wedivebc]

Wow, I don't have any answers for you but I hope you get better soon. I had always thought IEDCS was usually a result of isobaric counter diffusion following really deep dives with high helium mixes. This is the first time I have ever heard of it after shallow dives.
Please keep us posted and get well.

 

[vladimir]

It's disappointing that they waited 18 hours to give precautionary O2 to a symptomatic diver. When did bed rest become an indicated treatment for DCS?

 

[Duke Dive Medicine]

Hi Kathryn,

I'm sorry to hear about your accident. Ditto Vladimir; I am at a loss as to why the crew did not give you oxygen and evacuate you immediately given your symptoms.

PFO is associated with sudden-onset severe neurologic DCS, inner ear DCS, and cutis marmorata. Your dives were mildly provocative but within no-decompression limits. Also, your symptoms were out of proportion to the dives that you did and came on very soon after surfacing. Given those two points, I think that a test for PFO would be very reasonable. Going by the information you've given, we would have you tested if you had been treated in our clinic.

The one thing that CAN'T be established is a causative relationship, i.e. if you're found to have a PFO, there is no direct evidence that it played a role in your decompression sickness. It's reasonable to assume that it did, but it can't be proven.

It's not surprising that you have residual symptoms given your long delay in treatment. It's very likely that you will continue to get better over time, but it's impossible to predict whether you'll recover completely. It would be a good idea to see an ENT physican if you haven't already. Once your recovery plateaus, i.e. your symptoms are either gone or stable over time, you'll need to be examined by an ENT again to determine the extent of damage, if any.

I highly recommend that you refrain from diving until you have recovered and been cleared by a diving physician.

Best regards,
DDM

 

[Kathryn_Rob]

I am also struggling to understand why the crew did not recognise my symptoms and give me treatment earlier. They kept telling me I was probably just tired and my middle ear was inflamed from equalising. I think they were inexperienced with recognising the symptoms of IEDCS and did not want to concern the other divers...

I have an appointment with an ENT today, so hopefully that will shed some light on what is going on with my balance.

I am a bit confused with whether to investigate a PFO or not. My Hyperbaric doctors did not feel it was necessary as the decompression sickness was "deserved" (multiple dives on consecutive days). However, my local dive doctor has concerns, especially as I also suffer from Aura Migraines and unexplained mild Sleep Apnoea (I am very active, fit and of good weight) She feels I should be tested.

My concern with having the test for PFO is that if found, I can no longer dive. BUT... approx 30% of people have a PFO, which I guess would mean approx 30% of divers are diving with one. The rate of DCS is much much lower than that so the odds are that I could continue diving and probably not ever have an issue again. It's really hard to decide whether to take the risk or not.

Thanks so much for your advise. I am missing diving so much, but I won't be returning to it at least until my dizziness is resolved.

Cheers, Kathryn

 

[Wookie]

It has nothing to do with inexperience or not caring about your health. Inner ear DCS is extremely rare. I'll relate my story.

I was diving in Coz (Maracaibo Shallows) on a relatively benign profile, 82 feet for 78 min. Of course, I was nowhere near 82 feet for long, but if I'd been diving a square profile, that would have been it. I was using an Uwatec smart Pro dive computer set for the middle conservative level, and encountered nothing of note on the dive. One of my buddies asked me underwater if I enjoyed the dive and I flipped her off. Not normal behavior. I surfaced with the rest of my team after a long safety stop (10 minutes or so) and started cursing and spitting and generally being a butthead. I got on the boat and sat on the transom, fully kitted with my mask on my forehead (I never ever ever put my mask on my forehead) and growled at anyone who tried to help me off with my kit. No other symptoms yet. We went to the beach for an SI and I managed to calm down some. Second dive was at Santa Rosa wall (60 for 40) and back to the hotel. I chose not to make the afternoon dive, choosing to nap instead. I woke up 4 hours later with the worst vertigo, nausea, and malaise I'd ever felt. As it was late afternoon, I decided to rest for the evening. Next morning I'm worse, so I head out to the chamber. The physician is out, and the tech determines that I have an ear infection. I inform him that I get ear infections and this ain't one of them, but he insists. I am prescribed an anti-nausea and an antibiotic and sent home with instructions to return tomorrow.

Tomorrow comes and I'm worse yet. Back to the chamber and no help. Rest, he says, but don't fly back to Houston. As this is a 4 day trip, I'm headed to Houston the next day. He can't have it both ways, either treat me or let me fly. He lets me fly. Upon arrival back in Houston I can no longer function because the vertigo is so bad. I call the chamber at Hermann and tell them my story. They are not interested in seeing me, because my profiles are so benign. Finally I call DAN. At that point things start to move. I am told to go to the ER, I am examined and sent to the chamber. I am evaluated and told I have an ear infection. I get the DAN physician as well as the chamber lead physician on the phone (the lead physician is 60 miles away, but I have her cell number) and we decide to throw me in the chamber just to shut me up. I decent to 60 feet and the world is right again. I undergo a full table 6 and am 100% at the end of the treatment. I am a lucky one. 6 days following the original complaint and I am fixed with one treatment 6

I believe I was shown what a vestibular hit was because I had a crewmember take one 6 months later. I operate a liveaboard in the Florida keys, and like you, 15 minutes after surfacing he was on the deck vomiting and unable to walk. We placed him on O2 immediately and evacuated him by helo within 3 hours. He was run on 3 table 6 treatments, and numerous wound heal treatments, and he is somewhat recovered. He will never be 100%.

I wish you all the best, but you have a tough row to hoe. This is a disqualifying condition for NOAA and military divers. Not everyone recovers. If you'd like to chat, not that I have any advice, but I do know what you are going through, I can be reached at spree@spreeexpeditions.com.

I went back and reread your second post. I have a PFO, I continue to dive, in fact, I dive trimix to 300 feet. It's worth it to me.

 

[Kevrumbo]

To differentiate IEDCS [Inner Ear DCS] from barotrauma, the vertigo or deafness stabilizes or improves on surface in barotrauma, prior to treatment. This is because the barotrauma is caused by a gas pocket in the middle ear that can vent via the eustachian tube. IEDCS is caused by gas bubbles inside the cochlea and cannot be vented, it has to be removed by desaturating the cochlear fluid. Thus, over time IEDCS worsens without recompression, because the bubbles in the ear continue to grow or do not change in size. In barotrauma, even a completed blocked eustachian tube will leak a small amount of gas over time, reducing symptoms without recompression.

In tiime duration on the surface, IEDCS symptoms worsen, whereas barotrauma tends to remain unchanged or recedes. PLF [Peri Lymph Fistula] symptoms do subtely improve but not much, particularly if the ossicles are dislodged. . . Persistent dizziness after diving: a PLF can give these symptoms and if improperly healed, repeated diving may cause it to be permanently damaged. . . it's commonly caused by forceful equalization. Often, PLF are accompanied by subtle hearing loss, but not all instances. Permanent damage to a PLF at worst, causes complete deafness in the affected ear. Many supposed PLFs have spontaneous recovery --documented injury verified by audiometry & typanometry and ENG, that spontaneously improves. Surgery is not always needed in PLF.

See also:
http://www.scubaboard.com/forums/diving-medicine/81240-inner-ear-barotrauma-dci.html#post886675

http://www.scubaboard.com/forums/hawaii-ohana/204291-local-takes-hit.html

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