Recurrent Ear Problems

[Dhboner]

This is like an episode of "House"....I'm LOVING this discussion.

Bob (Toronto)

 

[Duke Dive Medicine]

Well, altenobaric vertigo refers to a differential stimulation of the two labyrinths, and is classically a phenomenon associated with an acute change in ventilation. However many people have chronic underventilation of one middle ear as compared to the other. The thing is that there is usually accommodation with time, that is why kids with one ear full of fluid or negative pressure aren't usually dizzy.

Never ceases to amaze me what the brain can do. We see the same thing in divers with either PLF, or inner ear DCS and permanent damage to the vestibule - the brain compensates and the vertigo goes away after a while. I was thinking, related to the OP - usually, when we see alternobaric vertigo related to diving, it's an acute process that happens when one ear equalizes before the other one does, normally on ascent... it usually clears up pretty quickly. That's why I thought we could rule that one out.

Also, there is the possibility of a caloric response, with cold water chilling one of the semicircular canals from the outer ear to the inner ear, completely bypassing the middle ear, but let's leave that one for now…

Used to demonstrate that one with commercial diving students - I would pour cool water into the ear canal of a student volunteer, let it sit a few minutes, then have the student try to stand up. Entertaining and educational!

Since there is a SNHL, though, I have to assume some sort of inner ear process. I'm still a little surprised to hear that a hike to the mountains would result in enough of a pressure swing to cause this sort of problem...

Me too... strange.

A bit off topic, but I just saw a heartbreaking documentary about lobster divers in Central America, who have a phenomenally high rate of serious permanent DCS injuries (paralysis, etc..). These guys don't have pressure gauges, they have to go deeper and deeper to keep up with demand. Very little in the way of company support for the divers' health problems, and they only recently got a chamber. And if they refuse, there will always be someone else willing to do it for the (fairly good) money…

Unconscionable. There are a couple of very good hyperbaric docs in Mexico who are trying to work with them. From what I hear, the conditions are getting a little better but nowhere near where they need to be.

My plan of 'attack' will be to continue to avoid strenuous activities as requested by my ENT, see the results of the MRI and proceed from there to an otologist. Thanks, again!

Great, keep plugging, remember to be your own advocate! Didn't mean to go off and leave you behind with off-topic stuff but Dr. Mike is great to bounce things off of. Please keep us posted, we're interested to hear the outcome. These are great training cases for our hyperbaric fellows here.

This is like an episode of "House"....I'm LOVING this discussion.

Ah, with the neurogastrocardiothoracorthopedic pediatric adult hematologist mediconurses who can also run an MRI machine! Seriously, I love that show! Thanks Dh!

 

[doctormike]

Never ceases to amaze me what the brain can do. We see the same thing in divers with either PLF, or inner ear DCS and permanent damage to the vestibule - the brain compensates and the vertigo goes away after a while. I was thinking, related to the OP - usually, when we see alternobaric vertigo related to diving, it's an acute process that happens when one ear equalizes before the other one does, normally on ascent... it usually clears up pretty quickly. That's why I thought we could rule that one out.

Yup, exactly... if we had been able to look at her ear back at the time of the original injury, I suspect that we would have seen some sort of effusion, possibly a bloody effusion. That would be more in keeping with the duration...

Ah, with the neurogastrocardiothoracorthopedic pediatric adult hematologist mediconurses who can also run an MRI machine! Seriously, I love that show! Thanks Dh!

Yes, but not Hugh Laurie's best work, IMHO...

 

[Duke Dive Medicine]

Yes, but not Hugh Laurie's best work, IMHO...

Never made the connection... classic!


Wondering about mechanical obstruction now. Just speculating... we'll have to wait for MRI results. Great case.

 

[mauisher]

Thanks, again, for the discussion. Just a point of clarification on the hike at altitude....after hiking at altitude I drove from near the top of Haleakala volcano to sea level (approx. 10,000' in 35 miles; probably dropped 7000' in 35-45 min), so the pressure change was somewhat quick and akin to an airline descent. I'll let you know what turns up on the MRI. Aloha.

 

[doctormike]

Thanks, again, for the discussion. Just a point of clarification on the hike at altitude....after hiking at altitude I drove from near the top of Haleakala volcano to sea level (approx. 10,000' in 35 miles; probably dropped 7000' in 35-45 min), so the pressure change was somewhat quick and akin to an airline descent. I'll let you know what turns up on the MRI. Aloha.

Aha..! That makes more sense. I was wondering if you had jumped off the top or something...

 

[mauisher]

Hi,
Just a quick update. My MRI and CT scan came back normal. I wasn't able to discusse the MRI with the doctor yet regarding mechanical obstructions. I'm on a second, stronger course of prednisone with the addition of some acyclovir for good measure (shotgun approach?). I'm also taking lots of vitamins and flavinoids. Also, still no strenuous activities or heavy lifting. The ENT specialist suspects trauma/damage to the inner ear (cochlea). So far, some feeling of fullness and a bit of tinnitus has decreased. Due back to ENT in early Jan.

Haven't made an appointment for an otologist yet since I'm leery of flying to Honolulu because of the altitude changes...will give the ear a chance to heal by itself first. Hope this is smart?

My lesson, perhaps learned the hard way: Divers...be careful equalizing your ears. If it's questionable about your ability to equalize, I'd err on the conservative side and don't dive.

 

[doctormike]

Hi,
Just a quick update. My MRI and CT scan came back normal. I wasn't able to discusse the MRI with the doctor yet regarding mechanical obstructions. I'm on a second, stronger course of prednisone with the addition of some acyclovir for good measure (shotgun approach?). I'm also taking lots of vitamins and flavinoids. Also, still no strenuous activities or heavy lifting. The ENT specialist suspects trauma/damage to the inner ear (cochlea). So far, some feeling of fullness and a bit of tinnitus has decreased. Due back to ENT in early Jan.

Haven't made an appointment for an otologist yet since I'm leery of flying to Honolulu because of the altitude changes...will give the ear a chance to heal by itself first. Hope this is smart?

My lesson, perhaps learned the hard way: Divers...be careful equalizing your ears. If it's questionable about your ability to equalize, I'd err on the conservative side and don't dive.

Good advice and good news, glad that the scans were normal...! Keep us posted..

Happy Holidays!

Mike