Past ear issues - Current risk factors?

[BernieK]

Before I get going, I do realise that the best advice for anyone considering diving with any health-related concerns is to consult a doctor. However, the chances of me finding a helpful GP in the UK who's familiar with the particulars of scuba diving are fairly slim, whereas it looks like the chances of coming across a medically-qualified person here is fairly high. It's good to be informed!

Anyway, I'd like to take up scuba diving. I'm 26, male and currently fit and healthy. My concern is around issues I've had with my ears in the past:

1. BPPV: 5 or 6 years ago I experienced significant dizziness and nausea for around 3 weeks. No other symptoms. This was not debilitating (to a student at any rate), but I wasn't having much fun. The doctor at the time diagnosed it as labyrinthitis, gave me a few tablets and a few sessions of physiotherapy and it went away, though with a handful of "aftershocks" over a few months. I had one other bout of dizziness which felt similar around two years ago, but it lasted 2 or 3 hours total - may or may not have been related. Having since had a friend unfortunately suffer from full-blown labyrinthitis, I know that what I had was much less intense, and better fits the descriptions of BPPV I've read.

2. Otitis externa: From my early teen years until around the same time as the BPPV, I had suffered from regular outer ear infections, typically 2 or 3 each winter. These decreased in number from then on and, until last winter (when I had one which lasted a few days), I hadn't had an infection for 3 years.


My ears are currently healthy (you get a good feel for them after that many infections), but both these histories are noted as risk factors in scuba diving. However, the primary symptoms in both cases occurred a number of years ago.

How significant are these risk factors now? It would be great to hear from anyone with a similar history or even second hand accounts, whether good or bad.

Thanks

 

[Diver0001]

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A ScubaBoard Staff Message...

Moved to the diving medicine forum

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[DocVikingo]

Hi BernieK,

1. BPPV.

Diving with an even remotely recent history of BPPV could be considered risky business as an attack of vertigo u/w might prove fatal. One would not want to do so without the expressed consent of a physician expert in this type of disorder.

One way of evaluating for the return of symptoms is by having an ENT perform the Dix-Hallpike test for vertigo. If the test is positive, diving would be contraindicated.

A pool dive under the close supervision of a DM or instructor would provide useful information if vertigo returned, but, if it did not, uncertainty would remain. This is because if the loose crystals have moved to another location, either spontaneously or as a result of canalith repositioning procedures, it could take them a period of time before they reached an area (e.g., the posterior canal) where vertigo would ensue.

Even after treatment with protocols like the Brandt-Daroff Exercises, about 30 percent of patients will have a recurrence of BPPV within three years, and the risk of recurrence continues until at least until 5 years post onset, although at reduced frequency.

2. SCUBA-related otitis externa.

This usually is easily prevented. See --> Doc Vikingo's Preventing Swimmer's Ear

When applying for dive training, you will be asked to complete a medical questionnaire called the Self Declaration Form. If you endorse either of these conditions, even if they were in the past, you may be asked to obtain a Medical Referee's Certificate. If so, you possibly may find a Medical Referee not too far from you by using this --> UKSDMC medical referees

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[TSandM]

Diving with an even remotely recent history of BPPV could be considered risky business as an attack of vertigo u/w might prove fatal

Being the survivor of I don't know HOW many attacks of vertigo underwater, I think this is an overstatement. It really depends on your temperament. Vertigo could easily induce panic in a susceptible individual, but if you tend to be calm and you know what the problem is, it's manageable.

I really think you need an ENT evaluation, though. I suspect your original illness may well have been a mild case of labyrinthitis, unless the symptoms were intermittent and clearly positional. Labyrinthitis is not always severe, but the symptoms do not tend to be intermittent, although they may be somewhat positional.

 

[DocVikingo]

Being the survivor of I don't know HOW many attacks of vertigo underwater, I think this is an overstatement. It really depends on your temperament. Vertigo could easily induce panic in a susceptible individual, but if you tend to be calm and you know what the problem is, it's manageable.

Hi TSandM,

I would like to open by pointing out that I said, "could" be considered risky business, not "is" or "would" or similar. And do believe diving with a history of unexplained episodes of vertigo could be risky.

This is a non-diving young man who is considering getting certified. At this time how is he to gauge his susceptibility to diver panic, or his ability to manage vertigo underwater?

Perhaps administration of some sort of state-trait anxiety inventory could be used to judge his tendency "to be calm" in such a situation, but such devices really offer only modest predictive power of proness to diver panic. And he of course would have to pay out of pocket for any such evaluation, which very likely also would include a clinical interview, MSE and perhaps other testing insturments.

BTW, I agree it's possible his original illness may have been a mild case of labyrinthitis. However, this really isn't known with any certainty. We should note that the OP does indicate, "The doctor at the time diagnosed it as labyrinthitis, gave me a few tablets and a few sessions of physiotherapy and it went away, though with a handful of 'aftershocks' over a few months. I had one other bout of dizziness which felt similar around two years ago, but it lasted 2 or 3 hours total - may or may not have been related."

Although directed at Meniere's Disease specifically, the following from DAN does make a pointed comment about diving with recurring episodes of vertigo (and in Meniere's Disease these can be quite widely spaced) --> http://www.diversalertnetwork.org/medical/faq/faq.aspx?faqid=117

Regards,

DocVikingo

 

[TSandM]

Doc, we're splitting hairs here. I thought "might be fatal" was an overstatement; I may well have read a stronger warning than you intended.

I do think he ought to consult with a knowledgeable physician, and I said that.