Perilymph Fistula

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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 :wink:'. 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
Dolores, I am happy that your hearing returned 85%. But, how long did it take?
I went for my first scuba dive in St Lucia in mid-december and suffered what they think is PLF. I am three weeks post-surgery, and no relief from the tinnitus or high-frequency hearing loss. My surgeon says it is still early and improvement is possible. I am curious: how long did your recovery take? my surgeon said the inner ear takes a long time to heal.

David L, NYC
 
Hello David,

I am sorry to learn you are going through similar incidence as I did. The return to 85% was not a quick process. I would say that around 40% occured in 6-8weeks post op and the rest within 6 months. My doctor said my testing results pre and post op then months later were astounding. She also added that she has seen this before in people that seek treatment quickly after a scuba injury.
I hope this a help for you. Best wishes in your recovery.
Dolores
 
There was a paper on Medline search that suggests a diver can continue to dive after rupture of the round window....

I think the current recommendation of the diving folks is that you should not dive.
 
My ENT doc had no issues with my return to diving.

In fact from day one he was quite certain I would be able to dive again as had many of his previous patients.
My PLF( round window ) occured Aug 05 and I was cleared to dive again Feb 06.
I've logged close to 100 dives since then with no issue, including deep dives and deco.

The ringging and hearing loss has never improved, just got used to living with it, although the first couple of months I thought I would go crazy.

Happy diving
 
I had written my original post before I went to the Galapagos. I was wondering about snorkeling. I wore ear saftey guards that they sell in snorkeling shops and I was just fine, even with a few plunges down under to play with sea lions.

I do not, however, think I dare return to scuba diving b/c I fear the 'what if' I lose that hearing to the point it was before. I was mopderate to severely deaf in the right ear. If there were a guarenteed way I could be assured my inner window would not break exposing and damaging the delicate nerves I would go book a dive trip now. I know that guarentee is not an option. I toy with the idea though, maybe if I wear a rubber head hood etc.

I guess the dizziness, WHAT IF IT HAPPENED TO THE OTHER EAR, and the fright I got, for longer than I liked, of staying deaf and fear of it happening again have kept out of a wonderful sport I adore.

Someone wrote once that they thought my injury was just an outer ear drum break...NOT...I was fully tested and documented at mass eye and ear along with all the correct symptoms. I so wish that person was right and I was wrong. :)

Carpe Diem to whatever choice you make that is best for you!
D
 
Here's an article that suggests a clear CT scan is required before returning to diving:

1: Otol Neurotol. 2006 Dec;27(8):1193-6. Links
Recurrent diving-related inner ear barotrauma.Shupak A.
The Otoneurology Unit, Lin and Carmel Medical Centers, Haifa, Israel. shupak@internet-zahav.net

OBJECTIVE: To present two cases of recurrent diving-related inner ear barotrauma (IEB) and to discuss the possible cause and pathogenesis of the increased inner ear vulnerability. STUDY DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: Two scuba divers suffering from repeated cochleovestibular barotrauma. INTERVENTIONS: Neurotological evaluation, perilymphatic fistulae repair, and conservative treatment. MAIN OUTCOME MEASURE: The increasing popularity of scuba diving expose the individuals involved in this sport to unique pathologies that are not common under terrestrial conditions. The otolaryngologist who is involved in the care of these patients is required to diagnose and treat diving-related ear injuries and to consider the risk for recurrent inner ear injury when diving is resumed. CONCLUSION: IEB carries a risk for permanent hearing loss and chronic vestibulopathy. We recommend complete neurotological evaluation including high-resolution CT of the temporal bones as a routine workup for IEB. The presence of a significant residual sensorineural hearing loss, evidence for noncompensated vestibular damage, and CT findings of possible enhanced cerebrospinal fluid-perilymph connection should be considered when a return to diving activity is considered.

PMID: 16983314 [PubMed - in process]
 
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