fisherdvm:
I think you missed my point surgeon, I said viral cause is a "rule out" diagnosis, once you have not found anything else. Viral labyrinthitis can have persistant symptom for years - not months. I think viral is a catch all term for "idiopathic", which means the physician is admitting he's an idiot.
The dude need a good physician... Not necessary a physician who is a "dive" expert.
Viral labyrinthitis is an acute, debilitating illness associated with vertigo, unsteadiness and occasional hearing loss. It can last for months, even (very rarely) years, that's true, but the problem described here isn't anything like labryinthitis. In the few cases I've seen and, according to what I've read, vertigo is virtually always present and, at least initially, is incapacitating.
The only viral syndromes that might look like this, that I can think of, is chronic CMV, EBV or Hep C or B, but a) CMV is unlikely in non-immunosuppressed people; b) EBV is associated with chronic fatigue, which may or may not be what's going on here and c) chronic hepatitis is a possibility and should be looked for, as i mentioned. All of these diagnoses can be tested for easily. Distant possibilities include encephalytic pathogens like West Nile virus, which presents with acute headache and meningismus but can also produce long-term mental clouding, apparently. When people speak of a "virus" they are generally referring to crowd diseases like cold or flu bugs, not mosquito born brain viruses and it was these crowd viruses that I thought were unlikely sources here. Viral illnesses are not "waste basket" diagnoses--- they have specific geographic and seasonal demographics, specific clinical syndromes and can be diagnosed with laboratory testing in many cases.
Idiopathic means the precise etiology of a disease is not known, it doesn't mean that the physician is an idiot NOR does it mean that there is no diagnosis or treatment. Parkinson's is an idiopathic disease, as is MS, but both have effective treatments and are easily diagnosed.
You are misusing the term "rule out" --- it doesn't mean what's left after you haven't found anything, it means a diagnosis to be considered and looked for actively. When a patient presents with a list of signs and symptoms, a laundry list of potential "rule out" diagnoses are entertained and systematically eliminated, if possible. Sometimes no answer is found, but that doesn't mean the doctors are idiots. Not every problem can be solved, in medicine or any other human endeavor.
This person needs a doctor and, as I said, I agree this complaint is not likely to be dive-related.
