Perilymphatic Fistula

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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 appreciate any thoughts anyone may have on this.

Thanks,

Dolores
 
Dear Dolores,

I can't really speak to the other medical aspects of your injury or the surgery that followed.

However, if your numbness immediately followed a lower jaw dental procedure, the most likely culprit is the anesthetic injection itself.

During a typical month of giving anesthetic injections, I may get one person who reports a sudden "electric" sensation during the Mandibular Block Injection Technique.
During the injection we "aim" for a point about half way back on the vertical part of the mandible (lower jaw). This puts the needle tip in close proximity to the mandibular nerve before it enters the jaw bone. Unfortunately, not everyone is built exactly the same so, in some cases, the injection can brush up against the nerve, put pressure on the nerve or even penetrate the nerve. In addition, the nerve to the tongue is also potentially on the same trajectory as the needle and it too can be traumatized as well. Finally, to make matters worse another nerve branch (the long buccal nerve) may also be in the way. So...it is possible to get a triple header :) !

The good news is that paresthesia is rare and permanent paresthesia is even more rare. My partner of 25 years had one case of permanent paresthesia and to date I have had none after 32 years of practice...tomorrow, however is another day. As we all know spit happens!

Other causes of tongue or lip paresthesia is wisdom tooth surgery...especially empactions...ESPECIALLY on adults who didn't listen (or parents didn't listen) to their dentists and get those teeth out as a teenager.

Rarely, the anesthetic itself may be the cause of the paresthesia...a toxicity reaction.

Since you needed a root canal on a lower tooth and anesthesia is more difficult to achieve on lower teeth under the best circumstances AND some teeth needing root canals may be difficult to numb...I wouldn't be surprised if your dentist had to give you multiple injections...increasing (only slightly) a paresthesia incident.

On your snorkeling question: If you stay at the surface and "just look" you most likely won't have a problem. ON THE OTHER HAND...THE BIGGEST PERCENT PRESSURE CHANGE IS FROM THE SURFACE TO 33 FEET. If you begin to free dive, you will be at some risk for a ruptured ear drum, oval or round window. If you dive, it will be at your own risk. No doctor can ethically tell you that it is OK to continue diving...not even myself. I don't know anyone who snorkels and just floats on the surface and just looks.

Regards,

Laurence Stein, DDS
 

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