Perilymph Fistula

[Dbillings]

Hello all I am new to this forum as of today, but I have been diving for over 20 years.

I was diving approximately 30 days ago at Doctors Cove (Emerald Bay Boy Scout Camp) on Catalina [fyi visibilty 10-15, water temp 71]. I was diving to ~ 40' and after my 3rd dive and last dive over 2 days I could not get my right ear to clear, left ear is/was fine. No pain or dizzyness, it just felt as if there was water or wax clogging in the ear. Nothing really unusual as I have had same symptoms with swimmers ear in the past and they usually cleared up in a week or so.

Symptoms were and are some feeling of pressure in the ear, ringing, mild irratation, and impaired hearing (in right ear only), no pain.

I went to an Urgent Care Doctor (of course my regular Doctor was on vacation) about 7 days after my normal home remedies for wax/water/outer ear irratation did not clear the symptoms (alcohol, acetic acid, OTC wax remover) as I was flying out of town on business. We went over symptoms including my diving, I specifically noted that the symptoms occurred after SCUBA diving. They advised that I had a clog in my estachion tube, and perscribed over the counter anti-hystamines and Aleave. They advised that it would take some time to clear.

During the time since my first Doctors visit I have done several "pressure causing" activities (flying, mountains, snorkeling) and had no trouble equalizing and no pain, only the persistant "clog", annoying but not painful.

After 3 weeks of the OTC treatment recommended and no change I went to an Ear/Nose/Throat Doctor today. The Doctor advised that I probably have a PERILYMPH FISTULA. Symptoms are consistant and hearing is ~ 30% in my right ear compared to my left ear. A real bummer! I am now on a Prednisone 40mg treatment for 7 days and then reducing after down after that. He indicated that hearing return was 50/50. I follow up with him in 14 days.

Questions:
1) Is this consistent with anyone else symptoms and/or experiences?
2) Is anyone aware of other treatments or suggestions to explore?
3) Any experience direct, anectodatal or other about future diving experience?
4) Anyone have any suggestions about questions I should ask or points to consider?
5) Sources of information on this subject would be much appreciated

Any help information is much appreciated. I went from mildly annoyed to very concerned today.


Thanks


Darrell

 

[Windwalker]

I am sure that you have done some online research. Did you manage to run upon this site?
http://www.dizziness-and-balance.com/disorders/unilat/fistula.html

 

[ouachita]

I had the same symptoms and it was a middle ear infection. I thought it would go away as many of mine have done in the past( bad history of ear infections) . The pressure built up so much it ruptured my eardrum (no pain, just fluid). It took eight weeks to get over that.

I now put drops in my ear both before and after I dive. I have been twice with no problems. My mixture(as recommended by my ENT) is 50% water, 50% white vinegar, then a just splash of alcohol. She said too much alcohol will dry the ear and get rid of needed wax which will cause more infections. It has worked really well so far.

She did imply however that since my eardrum was intact when I got the infection that it could have come in from my sinuses. Therefore I don't know if the eardrops would help in that case. We did not get into an elaborate discussion on it. Should it happen again I will go to her immediately rather than waiting it out like an idiot. That move cost me the first two months of spearfishing season.

I had to go through 2 ENT's to find a good one. They are all not created equally.

Good luck

 

[Saturation]

Dbillings once bubbled...
...I probably have a PERILYMPH FISTULA. Symptoms are consistant and hearing is ~ 30% in my right ear compared to my left ear. A real bummer! I am now on a Prednisone 40mg treatment for 7 days and then reducing after down after that. He indicated that hearing return was 50/50. I follow up with him in 14 days.

Questions:
1) Is this consistent with anyone else symptoms and/or experiences?
2) Is anyone aware of other treatments or suggestions to explore?
3) Any experience direct, anectodatal or other about future diving experience?
4) Anyone have any suggestions about questions I should ask or points to consider?
5) Sources of information on this subject would be much appreciated

Any help information is much appreciated. I went from mildly annoyed to very concerned today.
Thanks
Darrell

The fistula is commonly caused by a rupture of the round window, usually from forceful equalization. It may not be due to force itself, but from a propensity of the window to rupture.

The URL included here is a wonderful link, thank you, and should detail the issue.

Clinicians make the diagnosis on exclusion, meaning they ruled out more common causes for your complaints because as the URL details, the diagnosis of PLF is not easy. Generally, a doc examines you ears, finds nothing, yet you have complaints, then PLF is suspected.

Because the ears can be visualized by an otoscope up to the ear drum, and any change in color BEHIND the drum suggests problems in the middle ear, its easy to rule out diseases from the external ear to roughly the middle ear.

For the inner ear, added testing is needed, but having hearing loss is a crucial sign. The treatment is controversial, but in many cases the disease heals itself after 3-6 months, no diving during this time unfortunately. One sign of improvement is improvement in hearing, so tracking your hearing acuity tracks improvement.

There are more severe manifestations of PFL, and the most dangerous is a persistent dizziness [vertigo] which can begin in the dive and not abate.

The controversy lies in whether you can dive again, if it ruptured once, it will rupture again. The repaired window may be scarified, in which case it could be stronger than the original, but cause a residual hearing loss or no problems at all.

In general, the only way to find out is to dive again, learn less forceful ways to equalize, and be very aware of the symptoms of PFL, including the chance of in-depth vertigo.

I have one instructor who was diagnosed with PLF 30 years ago, she not only dives but instructs.

Surprisingly, the injuries I have heard mostly occur in shallow water, as the crucial changes in pressure occur in the first 30'.

 

[atrossen]

Hello all I am new to this forum as of today, but I have been diving for over 20 years.

I was diving approximately 30 days ago at Doctors Cove (Emerald Bay Boy Scout Camp) on Catalina [fyi visibilty 10-15, water temp 71]. I was diving to ~ 40' and after my 3rd dive and last dive over 2 days I could not get my right ear to clear, left ear is/was fine. No pain or dizzyness, it just felt as if there was water or wax clogging in the ear. Nothing really unusual as I have had same symptoms with swimmers ear in the past and they usually cleared up in a week or so.

Symptoms were and are some feeling of pressure in the ear, ringing, mild irratation, and impaired hearing (in right ear only), no pain.

I went to an Urgent Care Doctor (of course my regular Doctor was on vacation) about 7 days after my normal home remedies for wax/water/outer ear irratation did not clear the symptoms (alcohol, acetic acid, OTC wax remover) as I was flying out of town on business. We went over symptoms including my diving, I specifically noted that the symptoms occurred after SCUBA diving. They advised that I had a clog in my estachion tube, and perscribed over the counter anti-hystamines and Aleave. They advised that it would take some time to clear.

During the time since my first Doctors visit I have done several "pressure causing" activities (flying, mountains, snorkeling) and had no trouble equalizing and no pain, only the persistant "clog", annoying but not painful.

After 3 weeks of the OTC treatment recommended and no change I went to an Ear/Nose/Throat Doctor today. The Doctor advised that I probably have a PERILYMPH FISTULA. Symptoms are consistant and hearing is ~ 30% in my right ear compared to my left ear. A real bummer! I am now on a Prednisone 40mg treatment for 7 days and then reducing after down after that. He indicated that hearing return was 50/50. I follow up with him in 14 days.

Questions:
1) Is this consistent with anyone else symptoms and/or experiences?
2) Is anyone aware of other treatments or suggestions to explore?
3) Any experience direct, anectodatal or other about future diving experience?
4) Anyone have any suggestions about questions I should ask or points to consider?
5) Sources of information on this subject would be much appreciated

Any help information is much appreciated. I went from mildly annoyed to very concerned today.


Thanks


Darrell

Hi Darrell,

What is your current status as of today, February 20, 2005?

I recently had a similar situation over New Year's Holiday in Cozumel. It's now been a month and 1/2 and I am on my third round of antibotics (Z-PAK) and had done prednazone once at initial dr visit. Have had two visits to the ENT, which confirmed some hearing loss in my left ear, which is odd as it seems I do not hear correctly out of my right ear. They put a tube in my right ear so I can fly (need to for work). Still have a slight ringing in my right ear hearing loss that is not improving... I know I am told to be patient!

Please advise how you have improved (hopefully) since your initial thread.

Am also very happy to see I.G. Saturation, MD give info that there is hope the hearing loss will improve (3-6 months) and I may be able to dive again. Not sure if the tube in my right ear will siginificantly delay this though! Any advise greatly appreciated.

Thanks,
Atrossen

 

[Dbillings]

Hi Atrossen,

My status is the same. I have lost about 70% of the hearing in my right ear and still have tinnitus, though I've learned to jsut tune out the ringing and do not really notice it much any more. My biggest frustration is directional related, for example if a phone is ringing I can not tell where it is and in my household the cordless phones are never back where they should be.

The good news is that I am back diving, even to depth, 105'. I also fly a lot and have not had any problems with flying either commercial or private.

I was told that after 3-6 months, it was most likely as good as it gets. You are still in the recovery window which is good. I believe my biggest problem was that I did not get treatment from an ENT soon enough, my "Doc in the Box" kept treating me for an ear infection.

Hope you get better!

Darrell

Hi Darrell,

What is your current status as of today, February 20, 2005?

I recently had a similar situation over New Year's Holiday in Cozumel. It's now been a month and 1/2 and I am on my third round of antibotics (Z-PAK) and had done prednazone once at initial dr visit. Have had two visits to the ENT, which confirmed some hearing loss in my left ear, which is odd as it seems I do not hear correctly out of my right ear. They put a tube in my right ear so I can fly (need to for work). Still have a slight ringing in my right ear hearing loss that is not improving... I know I am told to be patient!

Please advise how you have improved (hopefully) since your initial thread.

Am also very happy to see I.G. Saturation, MD give info that there is hope the hearing loss will improve (3-6 months) and I may be able to dive again. Not sure if the tube in my right ear will siginificantly delay this though! Any advise greatly appreciated.

Thanks,
Atrossen

 

[Doloressann]

Hello, I know the posts on this PLF string have dated back awhile, and I am new to this forum. I am hoping that the experience I had with PLF/diving/treatment/results get emailed to the other folks who posted on this string.

That all said, 3 years ago I was diving 80 feet down viewing an awesome shipwreck, all was going fine "EXCEPT" that I was unable to make the morning dive hours earlier bcause I could no get my right ear to clear. I tried to equalize for about 15 minutes but it was not meant to be (thinking I blew to hard and damaged/weakened outer eardrum then).

I was ascending and when I neared 33 feet I felt pressure so I slowed but by 30 feet water gushed in. I was diving in Grand Cayman so at least the water flooding into my ear was relatively warm. I immedietly felt dizzy and bit down hard on my regulator. I had thoughts like 'wouldn't it suck to pass out under water' pardon my language..Boston girl here '. I thankfully did not pass out. Other than the dizzy feeling I mainly felt a tickle in my right ear. I seemed fine, did not notice hearing loss right away but after I dive my ears always feel 'swollen' and there is less hearing than usual for a day for me. The loss is not out of the ordinary.

Within 24 hours though, I was in agony, my ear ached and I could not sleep or lie down. We were on a cruise and I finally gave in and went to see the ships doc. Long story short, he put me on Cipro and antibiotic eardrops. My ear drum burst at night and you do not want a description of what oozed out. I was told go ahead and take the flight home as your ear drum has already ruptured, so I did.

Once home I went immedietly to an ENT. She did emergency tubal surgery in her office that day after performing hearing tests on me. She also continued the Cipro and added prednisone. I had moderate to severe hearing loss in my right ear. I was starting to panic as the whole incident did not 'seem' to be that big of a deal but had snowballed. I kept telling myself that once the infection was under control I would hopefully gain some hearing back. The ENT as not as hopeful.

I went for rechecks and two months later, after not being able to sleep with my 'deaf ear' up because I could not hear if the children were safe. The eerie silence creeped me out. I had not realized that I 'scanned' the house each night with my hearing befoe fallin asleep. Also my voice sounded drastically different to myself. I found myself saying 'what what what' to people all the time, avoiding places with loud background noises, like restaurants, theater, museums. I would turn my 'good' ear towards people when they spoke. I am a proud person who likes to handle stuff myself so to have to be percieved as weak...was NOT something I wanted to admit. Silly I know.

I did regain about 85% of my hearing in my right ear. The ENT was dumbfounded. She works in a suburben office but is a physician of Mass Eye and Ear. She told me I would be nuts to ever dive again, that PLF is serious and I am a miracle to have regained as much hearing as I had. I wanted a second opinion. I went directly to Mass Eye and Ear and saw a 2cnd specialist, he sadly confirmed her directions to never dive again.

Oddly, one of you mentioned nerve damage and tongue numbness from surgery. I had not put 2+2 together on myself until I read your post, but 6 months after my surgery, I had to get a crown and root canal on the lower right side of my mouth. I was numbed up and the numbness not only did no go away, it stayed and stayed and stayed for another 6 + months, even now well over a year+ later, my tongue is not 100% in the feeling department. I am grateful it is not feeling swollen and numb and that I can taste on it again. Also oddly, when I would eat ice cream or cold stuff, it felt like burning whilst it was numb. Go figure, who knows if the two are related or not.


Ok long schpeel here, thank you if anyone actually read this. I do have a question. I want to a least snorkel. I am wondering if there is anything I can do to prevent water from gushing into my ear, like maybe wear a rubber hood? I am going to the Galapagos in June and can not imagine not snorkeling. I do not have to dive down for pebbles etc but I have noticed that when I am in a pool, that I sometimes have the outer eardrum burst still just from swimmin laps.

One last thing, I litterally apear to have thin skin, I had PRK (think thoseare the right letters) lasik surgery 2 years ago and they could not do the usual both eyes at once, lasik flap surgery because the skin on my cornea is too thin. I have often wondered if that may be the case with my eardrum also.

Hoping to snorkel and I apreciate any thoughts anyone may have on this.

Thanks,

Dolores

 

[Saturation]

....

Ok long schpeel here, thank you if anyone actually read this. I do have a question. I want to a least snorkel. I am wondering if there is anything I can do to prevent water from gushing into my ear, like maybe wear a rubber hood? I am going to the Galapagos in June and can not imagine not snorkeling. I do not have to dive down for pebbles etc but I have noticed that when I am in a pool, that I sometimes have the outer eardrum burst still just from swimmin laps.

One last thing, I litterally apear to have thin skin, I had PRK (think thoseare the right letters) lasik surgery 2 years ago and they could not do the usual both eyes at once, lasik flap surgery because the skin on my cornea is too thin. I have often wondered if that may be the case with my eardrum also.

Hoping to snorkel and I apreciate any thoughts anyone may have on this.

Thanks,

Dolores

What was described sounded more like a ruptured ED with or without a PFL.

A patient with PFL can snorkel or even dive, but the patients need to address this question to a dive physician near you for the recommendation is personal, not generic.

A diver with a PFL can dive again if they understand the worse case scenario is complete deafness in that ear. The dive physician should determine how well they can truly equalize and if forceful equalization caused the injury.

To protect against ED rupture there are 2 common options, ProPlugs and ProEar.

 

[atrossen]

Hello, I know the posts on this PLF string have dated back awhile, and I am new to this forum. I am hoping that the experience I had with PLF/diving/treatment/results get emailed to the other folks who posted on this string.

That all said, 3 years ago I was diving 80 feet down viewing an awesome shipwreck, all was going fine "EXCEPT" that I was unable to make the morning dive hours earlier bcause I could no get my right ear to clear. I tried to equalize for about 15 minutes but it was not meant to be (thinking I blew to hard and damaged/weakened outer eardrum then).

I was ascending and when I neared 33 feet I felt pressure so I slowed but by 30 feet water gushed in. I was diving in Grand Cayman so at least the water flooding into my ear was relatively warm. I immedietly felt dizzy and bit down hard on my regulator. I had thoughts like 'wouldn't it suck to pass out under water' pardon my language..Boston girl here '. I thankfully did not pass out. Other than the dizzy feeling I mainly felt a tickle in my right ear. I seemed fine, did not notice hearing loss right away but after I dive my ears always feel 'swollen' and there is less hearing than usual for a day for me. The loss is not out of the ordinary.

Within 24 hours though, I was in agony, my ear ached and I could not sleep or lie down. We were on a cruise and I finally gave in and went to see the ships doc. Long story short, he put me on Cipro and antibiotic eardrops. My ear drum burst at night and you do not want a description of what oozed out. I was told go ahead and take the flight home as your ear drum has already ruptured, so I did.

Once home I went immedietly to an ENT. She did emergency tubal surgery in her office that day after performing hearing tests on me. She also continued the Cipro and added prednisone. I had moderate to severe hearing loss in my right ear. I was starting to panic as the whole incident did not 'seem' to be that big of a deal but had snowballed. I kept telling myself that once the infection was under control I would hopefully gain some hearing back. The ENT as not as hopeful.

I went for rechecks and two months later, after not being able to sleep with my 'deaf ear' up because I could not hear if the children were safe. The eerie silence creeped me out. I had not realized that I 'scanned' the house each night with my hearing befoe fallin asleep. Also my voice sounded drastically different to myself. I found myself saying 'what what what' to people all the time, avoiding places with loud background noises, like restaurants, theater, museums. I would turn my 'good' ear towards people when they spoke. I am a proud person who likes to handle stuff myself so to have to be percieved as weak...was NOT something I wanted to admit. Silly I know.

I did regain about 85% of my hearing in my right ear. The ENT was dumbfounded. She works in a suburben office but is a physician of Mass Eye and Ear. She told me I would be nuts to ever dive again, that PLF is serious and I am a miracle to have regained as much hearing as I had. I wanted a second opinion. I went directly to Mass Eye and Ear and saw a 2cnd specialist, he sadly confirmed her directions to never dive again.

Oddly, one of you mentioned nerve damage and tongue numbness from surgery. I had not put 2+2 together on myself until I read your post, but 6 months after my surgery, I had to get a crown and root canal on the lower right side of my mouth. I was numbed up and the numbness not only did no go away, it stayed and stayed and stayed for another 6 + months, even now well over a year+ later, my tongue is not 100% in the feeling department. I am grateful it is not feeling swollen and numb and that I can taste on it again. Also oddly, when I would eat ice cream or cold stuff, it felt like burning whilst it was numb. Go figure, who knows if the two are related or not.


Ok long schpeel here, thank you if anyone actually read this. I do have a question. I want to a least snorkel. I am wondering if there is anything I can do to prevent water from gushing into my ear, like maybe wear a rubber hood? I am going to the Galapagos in June and can not imagine not snorkeling. I do not have to dive down for pebbles etc but I have noticed that when I am in a pool, that I sometimes have the outer eardrum burst still just from swimmin laps.

One last thing, I litterally apear to have thin skin, I had PRK (think thoseare the right letters) lasik surgery 2 years ago and they could not do the usual both eyes at once, lasik flap surgery because the skin on my cornea is too thin. I have often wondered if that may be the case with my eardrum also.

Hoping to snorkel and I apreciate any thoughts anyone may have on this.

Thanks,

Dolores

Just a quick update on my status since 2/20/2005 now that it is over a year later. After a CT, meds and many visits to the ENT the months following my issue I'm happy to report I'm a diver again!

My ENT removed the tube in my ear last summer, my hearing is back to about 98% and I dove Grand Cayman over the holidays Dec/Jan 2006 up to 110' North Wall dive. To be honest, I was a little hesitant at first, so we did a number of shore dives before the deep wall. No issues with my ears and/or hearing.

I too had lasik done, but over 4 years ago and have had two root canals and crowns put on, so not sure if any of that is truly related. All I can say, is one needs to understand the significance of all the lessons learned in scuba diving and be cautious. When in doubt, do not dive, lay on the beach, read a book... I should not have dove with the bad cold/congestion I was experiencing last year. Seems I am very blessed to be able to enjoy this wonderful sport again.

Just purchased a new dive computer (yesterday) and am looking forward to celebrating my 48th Birthday in Grand Cayman down under in April!

Good Luck and for snorkeling, pick up some good earplugs and stay on the surface!

 

[FTTRM]

Here is my experience.

Last August I sustained a right ear PLF ( confirmed by scuba ENT)
Defining symptoms were the intense vertigo following the dive, hearing loss and very loud tinnitus.

I am left with permanent hearing loss and tinnitus but the rupture did heal itself.
I have also returned to diving after being cleared by my doc, 20 dives as deep as 150ft back on the ear now and no problems.

Mike