Question Inner ear decompression sickness

[Rai24]

Looking for some help after Inner ear decompression sickness which occurred 11/7/2024 in Belize. I still feel tired and my ear is clogged. Additionally, I had a sudden onset of similar symptoms on 11/25/24 which made me dizzy and feeling really off. How long can it take for the ear to return to normal ? I am located in Monmouth County New Jersey, does anyone have a great doctor I can see to follow up ?

Below are the details of my dives that day.
I was put into the chamber about an hour and a half after the onset of symptoms. I did 5 hours on day 1, 5 hours day 2, and 2.5 hours day 3 of the chamber.

If anyone can help I would really appreciate it. Thank you


11/7/20224

1st dive 83 ft max

• Bounce dive

• 43 min bottom time

• Water temp: 87°

• Nitrox: 32%

1 hr 15 min surface interval


2nd dive: 64 ft max

• 54 min bottom time

• Nitrox: 32%

• 87° water temp

→felt like water in ear-clogged

→Went on second dive-slight pressure in right ear - No pain

• Able to equalize

During 3 min safety stop: chest slight tightness

• complete 12-6 vertigo upon surfacing

→vomiting, disoriented, spinning

 

[tursiops]

@Duke Dive Medicine

 

[Duke Dive Medicine]

Looking for some help after Inner ear decompression sickness which occurred 11/7/2024 in Belize. I still feel tired and my ear is clogged. Additionally, I had a sudden onset of similar symptoms on 11/25/24 which made me dizzy and feeling really off. How long can it take for the ear to return to normal ? I am located in Monmouth County New Jersey, does anyone have a great doctor I can see to follow up ?

Below are the details of my dives that day.
I was put into the chamber about an hour and a half after the onset of symptoms. I did 5 hours on day 1, 5 hours day 2, and 2.5 hours day 3 of the chamber.

If anyone can help I would really appreciate it. Thank you


11/7/20224

1st dive 83 ft max

• Bounce dive

• 43 min bottom time

• Water temp: 87°

• Nitrox: 32%

1 hr 15 min surface interval


2nd dive: 64 ft max

• 54 min bottom time

• Nitrox: 32%

• 87° water temp

→felt like water in ear-clogged

→Went on second dive-slight pressure in right ear - No pain

• Able to equalize

During 3 min safety stop: chest slight tightness

• complete 12-6 vertigo upon surfacing

→vomiting, disoriented, spinning

When you say you were able to equalize on your second dive, how vigorously did you try? Can you say more about the chest tightness you experienced during the safety stop? When did that go away? Did the hyperbaric treatment make your symptoms better? If so, at what point did they resolve? What were you doing when your symptoms suddenly got worse on Monday?

Also, paging @doctormike . He is an avid tech diver and an ENT in your area. He usually sees small people but has been known to see the occasional adult diver.

If you are still having symptoms, get yourself to an emergency room at a tertiary care hospital as soon as possible and request an ENT consult. Use the words "rule out inner ear barotrauma vs. recurrence of inner ear DCS".

Best regards,
DDM

 

[Rai24]

Hi DDM,

Thank you for your response.

Here are the answers to your questions:

- I didn't feel any pain and felt at ease and equalized without pushing too hard. The sensation felt like slight pressure in the right ear throughout the dive but it was not painful or so uncomfortable that I felt the need to address it further than the way I had been equalizing on the previous dives
- the chest tightness was on the inhale and it took place during my safety stop just before surfacing. It felt like a slight constriction. I don't remember feeling that again after that moment.
- the hypobaric chamber absolutely helped tremendously. I progressively got better each day and was able to be steady on my feet by the 3rd day. The clogged ear has never gone away though.
- the reoccurrence happened while I was eating lunch. I just suddenly felt faint and really off. I did have a moment of pain that went like a line from one ear almost to the other. After that is when I felt the faint feeling and mental fog slightly confused. It wore off about 3 hours later and I was back to normal... Ear still clogged.

I saw an ENT who gave me Flonase 2 times a day and noted negative pressure in the right ear. He said it would eventually all go away. He isn't someone who dives and felt that I over did it by doing two dives in one day. I am hoping you or someone here might be able to give me a little more direction on the injury / referral to someone who is familiar with all this.

Really appreciate you reaching out to @doctormike and the information you gave about what to ask for too.

Thank you!

 

[Duke Dive Medicine]

Hi DDM,

Thank you for your response.

Here are the answers to your questions:

- I didn't feel any pain and felt at ease and equalized without pushing too hard. The sensation felt like slight pressure in the right ear throughout the dive but it was not painful or so uncomfortable that I felt the need to address it further than the way I had been equalizing on the previous dives
- the chest tightness was on the inhale and it took place during my safety stop just before surfacing. It felt like a slight constriction. I don't remember feeling that again after that moment.
- the hypobaric chamber absolutely helped tremendously. I progressively got better each day and was able to be steady on my feet by the 3rd day. The clogged ear has never gone away though.
- the reoccurrence happened while I was eating lunch. I just suddenly felt faint and really off. I did have a moment of pain that went like a line from one ear almost to the other. After that is when I felt the faint feeling and mental fog slightly confused. It wore off about 3 hours later and I was back to normal... Ear still clogged.

I saw an ENT who gave me Flonase 2 times a day and noted negative pressure in the right ear. He said it would eventually all go away. He isn't someone who dives and felt that I over did it by doing two dives in one day. I am hoping you or someone here might be able to give me a little more direction on the injury / referral to someone who is familiar with all this.

Really appreciate you reaching out to @doctormike and the information you gave about what to ask for too.

Thank you!

Wow, interesting case, and if anything it highlights the difficulty in differentiating inner ear DCS from inner ear barotrauma. The fact that the chamber rides resolved your symptoms quickly does support the diagnosis of decompression sickness, but the difficulty equalizing during the dive and recurrence of symptoms suddenly during eating and swallowing (which can affect the openings of the Eustachian tubes) 2 1/2 weeks later are more suggestive of barotrauma.

If you did have DCS, then a test for a patent foramen ovale might be a reasonable thing to speak with a provider about. Your dives were within no-stop limits but provocative enough in theory to produce venous bubbles, which normally don't cause symptoms but can move from the right side of the heart to the left through a PFO and produce certain sudden-onset DCS symptoms, among them inner ear symptoms. I'm DMing you the contact information for a couple of hyperbaric units in your area with physicians who are trained and experienced in evaluating divers and hoping @doctormike can jump in soon with some diving ENT recommendations for you. DAN might also have some recommendations.

Best regards,
DDM

 

[doctormike]

Hey, sorry you are having trouble! As is always the case with complex ear stuff and diving, the devil is in the details. Specifically, what the ear looks like and what the audiogram shows. Different things often present with the same symptoms.

I don't mind taking a look or I can set you up with an adult ENT doc, and if there were to be anything serious that required an ear procedure, I can set you up with an ear specialist.

DM me if you like.

Mike

 

[Rai24]

Hey, sorry you are having trouble! As is always the case with complex ear stuff and diving, the devil is in the details. Specifically, what the ear looks like and what the audiogram shows. Different things often present with the same symptoms.

I don't mind taking a look or I can set you up with an adult ENT doc, and if there were to be anything serious that required an ear procedure, I can set you up with an ear specialist.

DM me if you like.

Mike

Hi Dr. Mike,

Thanks for getting back to me. If possible I would like to stop in your office for an appointment. I am located in Monmouth county NJ.

The forum will not allow me to send you a DM to combat spam but if you are able to send me one I can reply. It seems that is because I am a new user.

DDM also mentioned UPENN has a great department so I plan on reaching out to them as well. The tricky part is that I started a new job today and my old insurance will cover me through the rest of the year but I will need to wait until Feb 1 if I can't get in to see anyone until after Dec. 31 of this year. If you have availability I would be able to get there as early as this Saturday.

Please let me know your thoughts and if this is possible. I really appreciate you getting back to me so quickly.

Rai

 

[doctormike]

Sure, happy to fit you in... I'm in the NJ office every Tuesday. Just call my office and say that we were in touch. Although I'm a pediatric ENT doc, my staff is well aware that a lot of dive buddies stop by for basic stuff as well!

Here's my contact info.

 

[Wallowa]

You have been directed to some top drawer docs....have you considered:

Alternobaric vertigo is a benign condition that affects individuals traveling in environments with changing ambient pressures, such as scuba diving or aviation. It is the feeling of surroundings spinning around due to a difference in pressure between the two middle ears1

I know of two divers that unequal pressure in middle/inner ear generated dizzy and spins.....you mentioned congestion.

Good luck and please post the outcome of exam.

 

[doctormike]

I made this up for a lecture and it's on my ear problems in scuba page, but here it is for reference: