It appears that perilymphatic fistula responds well to surgical intervention.+

[DocVikingo]

"Diving Hyperb Med. 2016 Jun;46(2):73-5.

Perilymphatic fistula after underwater diving: a series of 11 cases.
Morvan JB1, Gempp E2, Rivière D3, Louge P2, Vallee N2, Verdalle P3.

Abstract
INTRODUCTION:
Onset of cochleovestibular symptoms (hearing loss, dizziness or instability, tinnitus) after a dive (scuba or breath-hold diving) warrants emergency transfer to an otology department. One priority is to investigate the possibility of the development of decompression sickness with a view to hyperbaric oxygen treatment of bubble-induced inner-ear damage. If this injury is ruled out, inner-ear barotrauma should be considered together with its underlying specific injury pattern, perilymphatic fistula.

METHODS:
We report on a series of 11 cases of perilymphatic fistula following ear barotrauma between 2003 and 2015, eight after scuba diving and three after free diving. All patients underwent a series of laboratory investigations and first-line medical treatment.

RESULTS:
Seven patients had a perilymphatic fistula in the left ear and four in the right. Eight cases underwent endaural surgical exploration. A fistula of the cochlear fenestra was visualised in seven cases with active perilymph leakage seen in six cases. After temporal fascia grafting, prompt resolution of dizziness occurred, with early, stable, subtotal recovery of hearing in seven. Of six patients in whom tinnitus occurred, this disappeared in two and improved in a further two. Two patients were not operated on because medical treatment had been successful, and one patient refused surgery despite the failure of medical treatment. Median follow-up time was 7.4 years (range 0.3 to 12).

CONCLUSION:
The diagnosis of perilymphatic fistula is based on clinical assessments and various laboratory findings. When there was strong evidence of this condition, surgery yielded excellent functional outcomes in all patients treated early."

Regards,

DocVikingo

 

[doctormike]

Yeah, if I had symptoms suggestive of a diving related PLF, I wouldn't wait too long. The surgery is pretty minor in good hands, with very little risk. But it seems that time is of the essence...

It's more controversial with spontaneous PLF. That's where the question "do you believe in the fistula fairy?" comes from!

 

[tndash]

Hi all, I figured I would contribute. If I am not mistaken, Dr. Mike wrote me years ago about this issue. I had a PLF after free diving and a forceful Valsava about 10 years ago. I had immediate vertigo that only lasted a minute. Lost all hearing in my left ear. Born with a small Eustachian tube on left side but don’t know if that’s a contributing factor. Gained all hearing back over a few weeks. 3 years later I tried to dive once more. My ear felt that filled up feeling again with that odd sensation of liquid moving to where it’s probably not supposed to be. Haven’t dived since. I miss it extremely. I travel regularly for business and have to deal with pressization issues constantly. That has not proven to be an issue. Over the course of the last decade I have had facial movements (such as chomping down on something hard, or singing loudly, or larger than normal yawns) that seems to trigger the “filled” ear feeling. Appears as if I re-open a tear and allow for a fluid transfer. That always reminds me that I am not healed and quite frankly, I doubt I will be after all these years. That being said, I am still very interested in getting back to the water. I have taken the conservative route for 3 reasons. 1) Being deaf in one ear scared the hell out of me. 2) Due to my business that requires frequent airline flights, I could not risk not being able to travel and 3) the potential of irreversible vertigo scared me.



I am now contemplating living on a boat and decreasing my travel and business exploits and would love to find other people who have successful returned to diving, or any new medical developments. Last I heard, diagnosing a PLF was difficult and surgery was not guaranteed to correct any issues.



Please post if you have something to contribute. Thanks.

 

[gkwalt]

I had repair of a PLF years ago. This occurred while I was a police diver. As a side bar, the departmental doctor who first examined me asked, "Why don't you guys just wear earplugs when you dive? This wouldn't happen then." Fortunately the surgeon who fixed me was a diver and knew better. On my surgeon's advice I refrained from further diving. After that I had no more vertigo and my hearing loss was stable. I truly missed diving! A number of years ago, the diving bug was still alive in me that I did a refresher and started diving again. In my opinion this was not a whimsical decision. I have now been a physician assistant for the past 30 years and researched this issue from an evidence based point of view. There is scientific literature that is both against diving after a PLF and not prohibiting further diving. I know "Dr. Mike" feels strongly that one should not dive after experiencing a PLF. Diving is so important to me that I have become an instructor so that I may teach others to experience the thrill that I do underwater. As far as I can ascertain, any prohibition placed on my future diving is based on unsubstantiated speculations of the possibility of worsening of my now minimal symptoms. It appears as there is no evidence based data to predict my risk of future diving. However, according to Mortality Risk, perhaps I should be more worried about my 1:113 chance of dying in a motor vehicle accident. Today I am more concerned about getting involved in a fatal car crash than my ear as I dive to a favorite dive site.

 

[doctormike]

Yeah, and just to clarify, it's not that I have any evidence of injury rates when diving with a history of a PLF, repaired or otherwise. It's just that it's by its very nature an unpredictable thing, and a severe vertigo attack at depth can cause more trouble than just a permanent hearing loss. Realistically, there is no way to study this, since you could never get a large group of PLF patients together (the diagnosis itself is often controversial, even after surgery), and then randomize them into diving and non-diving cohorts.

It's a lot like diving during pregnancy. We don't have much evidence of specific injuries or risks, but you are never going to find an OB/GYN to "clear" you for this.

With PLF, it's always going to come down to the diver making that hard decision on his or her own, with no real medical support. And some people may do fine in this scenario. As I always say, "there is a bell curve for everything!".

 

[Duke Dive Medicine]

If one of the vestibules is permanently injured, the brain can eventually compensate for the loss and the vertigo may improve or resolve over time. However, if the other vestibular apparatus is injured later, the brain will be unable to compensate and the diver will be at risk for permanent, possibly debilitating vertigo. That, and the fact that (as Mike said) we really don't know how well perilymph fistula repairs hold up when diving, is the reason we caution people who've suffered from PLF not to dive again. Some divers choose to do as you did and continue diving. We just do our best to make sure that that's an educated decision.

Best regards,
DDM

 

[tndash]

Hi again all. So after years of posting the same issue(PLF), I have decided to go ahead and start the process to get me back under the water. in short here are the reasons:

Will do all of the following:
1) Balloon Dilation of the Eustachian Tube.
2) buy the IST pro
3) practice new (non-valsalva) clearing methods
4) previously had deviated septum surgery
5) read uplifting news(below)

will post in a year on my progress. Good luck all. Hope this may help someone.


https://www.amazon.com/IST-ProEar-P...ocphy=9032783&hvtargid=pla-348895609094&psc=1


Prevention of Middle Ear Barotrauma



https://www.eubs.org/documents/DHM Vol44 No4.pdf#page=26

The excerpt:

Prognosis for the injured diver and returning to divingIt has been proposed that divers with IEBt are prone to further incidents that exacerbate their tinnitus and hearing loss,3 but this is not supported by others.14,24,39 One group stated; “Although the older literature clearly suggests otherwise, we believe that scuba divers who completely recover from inner (or middle) ear barotrauma may return to diving as long as they exercise caution and care”.26 However, this advice was not backed up by what these authors reported, as two of their three cases (both undergoing tympanotomy) were advised not to continue diving. Long-term follow up of IEBt cases (seven conservatively and two surgically managed) reported complete recovery of symptoms in six patients, and return to diving as early as one month post tympanotomy repair was permitted, provided that predisposing anatomical abnormalities were excluded, hearing was stable, and their balance was normal.14