Is the inner ear barotrauma DCI?

[Laurence Stein DDS]

Dear Larry,
Thanx for good points you made but i am afraid you misunderstood some little parts and that is most likely due to the fact that i learned my English watching Tarzan movies. I would try to put it other way for all to easier follow the logic that was used in this case and add some more little thoughts. I am even going to put numbers to make it more obvious for all:

1) patient (not me) had inner ear injury from diving
2)single dive, 26m, 5 minutes in total
3)onset of symptoms at bottom (26m) after forceful Valsalva manuever
4)sensorineural hearing loss, tinnitus, vertigo...got significantly worse during ascent
5)DCI excluded as there was no upward motion before symptom onset and keeping the history of forcefull equalizing followed by the sudden pop, hearing loss, tinnitus and vertigo in mind inner ear barotrauma (PLF) diagnosis was made.
6)despite that patient was recompressed with special precautions to 60ft (whatever the justifications) and USNTT6 followed
7)marked improvement after first O2 period (almost total resolution of severe hearing loss and significant decrease of tinnitus and vertigo)
8)question about possible special form of DCI from air penetration through fistula arised as so far nothing else could explain this rather controversial case
9)revision of some border line (inner ear barotrauma was not excluded) cases of "inner ear DCI" successfully treated in chamber further rises the question
10)standardizing and reevaluation of precaution measures is needed if any general recomendations to treat inner ear barotraumas in chamber ever arise
11) I believe that what we need to catch is a clear audiogram after chamber treatment of a 'pure' PLF case like i believe this was...unfortunately due to remote area location i am not in possession of such follow up possibilities. I am trying to convince the patient via mail to do audiometry at home but i am "afraid" the answer is going to be "Why?"


As for those German HBO treatments i mentioned them ( i regret because it just confused everything and as you pointed it is not relevant to this case) as an answer to your claim that cilial damage is definite.

Hi Luba,

You have raised some interesting points with this case. HBOT under certain circumstances may be appropriate for this type of DCI injury but the treatment parameters must be well documented and developed into a protocol.

I don't know why your diver's treatment was successful nor do I know why there was no other damage secondary to additional movement of perilymph during recompression and final decompression.

This certainly raises the possibility that this treatment might minimize or prevent damage to the inner ear. Further monitoring of similar treatments would be appropriate.

This thread and your obsevations remind me of another observation in the same part of the world...stomach ulcers.

Was it not an Australian medical student that noticed the presence of bacteria in bipopsy samples that led him to conclude that ulcers were primarily caused by these bugs? His supervising physicians thought it was perposterous. Now, however, we know the truth. Perhaps you're on to something...just document it for the rest of us (doubters).

Good things in the future.

Larry Stein