Returning to diving after an Perilymph Fistula

[accurist]

I recently suffered from a Perilymph Fistula in my left ear after diving. This has resulted in the loss of my hearing in my left ear, the last audiogram showed around -80db across all frequencies.

I'm looking for advice on returning to diving after suffering such an injury.

 

[Duke Dive Medicine]

Hello Accurist,
A few questions for you:
1. What brought about the fistula, and how was it diagnosed?
2. What symptoms did you have initially, and how was the fistula treated?
3. Do you have any other residual symptoms besides hearing loss? Do you have vertigo or tinnitus (ringing in the ears)?
Best regards,
DDM

 

[accurist]

Basically, I was doing a lot of tech diving in the weeks leading up to the accident on the 5th of November 2010, and had developed an outer ear infection, which had spread to a full blown left sinus infection. Which I only found out about from the MRI scans in hospital afterwards.

During the first dive, as I ascended to my first deco stop my mask filled up with what I can only describe as 'snot' bubbles from my left nostril. Second dive, no problems, got back on the boat, had lunch, after lunch my left ear felt blocked. Tried to clear it, nothing, then performed a gentle valsalva manoeuvre, right ear popped, then I heard a high squeak in my left ear and the whole world started spinning...

Got back to Singapore, went straight to an ENT specialist, who told me I had probably permanently lost my hearing and admitted me straight into hospital. Where I was treated with IV steroids, and IV antibiotics. After discharged from the hospital I was given a weeks course of oral steroids and antibiotics. Now I'm just on Vitamin B tablets.

My balance while initially effected seems to have fully recovered and no signs of vertigo. I still have the tinnitus in my left ear.

 

[Duke Dive Medicine]

Hi Accurist,
Thanks for the info. It sounds like you received appropriate treatment.

In a perilymph fistula, the inner ear can be permanently damaged. From your description, it sounds like that's what has happened to you. The inner ear consists of two parts: the cochlea, which is responsible for hearing, and the semicircular canals, which regulate balance. Your initial symptoms indicate that both parts were injured. The brain will eventually compensate for damage to one set of semicircular canals, which you experienced in your gradual recovery from the vertigo.

The problem arises if the other set of semicircular canals is injured, either through decompression sickness or another perilymph fistula. While this is unlikely, if it does happen, your brain will not be able to compensate and you will likely suffer from permanent vertigo - think of the "whole world spinning" feeling you experienced when you first had the injury.

The conservative approach, and the advice we give divers in your situation, is to stop diving and eliminate that risk altogether. The less conservative approach is to dive VERY carefully and always be mindful of your ability to clear and your dive profile/risk for inner ear DCS. The bottom line is that you do not want to risk injuring the other ear, since doing so would likely result in a profound disability and alteration in your lifestyle.

I'm sorry the news isn't better. I hope this information helps. Please feel free to PM me or post here if you have any other questions. I'm going to PM Dr. Mike, who's an ENT physician, and ask him to weigh in as well.
Best regards,
DDM

 

[accurist]

DDM, thank you for the information, it is greatly appreciated.

I understand I will always be at high risk now; being deaf in one ear is one thing, deaf in both is another.

I'm very interested in your comment about the brain compensating for balance, is there a chance that the balance did recover, or is it always a case of the brain compensating?

The vertigo recovered quite quickly, it was only the first day I had symptoms which I would describe as vertigo, followed by a few days of 'bad' balance i.e. not walking in a very straight line.

 

[Duke Dive Medicine]

I'm very interested in your comment about the brain compensating for balance, is there a chance that the balance did recover, or is it always a case of the brain compensating?

The vertigo recovered quite quickly, it was only the first day I had symptoms which I would describe as vertigo, followed by a few days of 'bad' balance i.e. not walking in a very straight line.

Great question. Yes, there is a chance that your semicircular canals recovered. From your other post, it wasn't clear how long it took for you to get your balance back. If it was only a few days, it's possible that they have healed - typically brain compensation takes several weeks. There are tests that can be done to determine the level of injury to your semicircular canals. I'd recommend seeing an otologist (an ENT physician who specializes in ears).

 

[accurist]

I have my next appointment with an Otologist on the 1st of February, I will put the question to him.

If I was to consider diving again, how long should I wait to before attempting to dive again? How long does a Perilymph Fistula take to heal?

 

[doctormike]

Hi, Accurist...

So sorry to hear about your accident. I hope that I don't seem insensitive here, but I really can't give you any sort of timetable or advice about returning to diving over the Internet.

Perilymph fistula, especially a traumatic one (such as the one that you seem to have suffered) is not a very well understood condition, and there are no standard schedules for recovery or predictors of further injury. In addition to the excellent points that DDM has made above, there is the possibility of losing any residual hearing in your injured ear even if the other ear is OK, and you may want to try amplification someday depending on your final hearing levels.

This is a complicated subject, and if you make a decision to return to diving after this injury following consultation with an otologist (who has had the opportunity to examine you thoroughly in person), that would be your decision.

I can tell you personally that I would likely not do it in such circumstances, but that is just me.

If you read this board, you will see that I am always willing to help as best as I can, discussing the anatomic and physiological details of ear injuries in diving, etc.. And I am more than happy to try to help explain anything that seems unclear. But I just can't tell you that it is OK to dive after PLF.

I hope that you understand, I wish you a speedy and full recovery!

Best,

Mike

 

[Duke Dive Medicine]

Thanks Mike.

For Accurist: I can't add anything to what Dr. Mike said. Again, we tend to be fairly conserviative with PLF and advise divers in your situation not to dive again. Any decision to get back in the water is going to have to be made in very close consultation with your otologist, who has the advantage of seeing you face-to-face and having access to your medical records. If you do get back in, please be extremely careful with your remaining good ear.
Best regards,
DDM

 

[accurist]

Fully understood, I realise this is an internet forum and as such I'm not expecting specific advice. I'm also aware that all the medical advice will ultimately be not too, as I'm running on redundancy now, and a further injury could leave me with a life altering disability. But the danger of that isn't probably enough to stop me, so I'm trying to collect as much information as possible to make a sensible decision.

Dr. Mike and DDM, your information has been very helpful to me and is greatly appreciated. I'll let you know how I get on. Thank you for your time.

Regards,

Dan