Returning to diving after an Perilymph Fistula

[Duke Dive Medicine]

Does prompt repair of the round window after the injury alter your recommendation regard discontinuing diving? I developed brief tinnitus and hearing loss on ascent from a 70' dive 20 years ago. My ENT diagnosed PLF and repaired my round window. My hearing loss has been stable since and the vertigo only lasted seconds at the time of injury. I sat out for years, but a few years ago rolled the dice and got back in the water.

gkwalt,
How long after your injury was the round window repaired?

 

[gkwalt]

It was a while ago, but as I recall, approximately a week

 

[Duke Dive Medicine]

It was a while ago, but as I recall, approximately a week

In conjunction with our ENT folks, we typically recommend surgical repair if PLF symptoms have not resolved, or at least significantly improved, within 24 hours. A delay in repair may or may not have affected you. Also, the chance of re-injuring the ear, or injuring the opposite one, does not decrease with time. Like Mike said, each PLF case is different, and as with the OP, we can't do much more than recommend you be evaluated by an ENT physician and a board-certified diving doc. Dr. Robert Rosenthal at Shock Trauma in Baltimore is probably the closest diving physician to you. Sorry to be so non-specific, but I really can't go much beyond that in an online forum. Good luck!
Best regards,
DDM

 

[gkwalt]

Thanks for the reply!

 

[gkwalt]

As a sideline...In the picture on my posts, I am the guy in the blue shirt. Does anyone know who the other guy is?

 

[Duke Dive Medicine]

Don't know him but I'd like to have his gear collection.

 

[gkwalt]

That is Dick Rutkowski, one of the godfathers of recreational Nitrox. The picture is taken at his location in Key Largo where his teaches hyperbaric/diving medicine courses. The place is loaded with vintage diving equipment. He even has 2 functional chambers, a monoplace and a multiplace.
Regarding PLF: in a search of Pubmed, I found at least 3 articles which contradicted an absolute prohibition of resuming diving after a PLF. While the number of divers reported was small, it seems that in certain cases of PLF, as long as the diver can properly equalize, they may return to diving. Unfortunately there wasn’t any discussion of how surgery would change the recommendations.
I realized that there still may be a roll of the dice with continuing diving, but this information is encouraging.

 

[Duke Dive Medicine]

Regarding PLF: in a search of Pubmed, I found at least 3 articles which contradicted an absolute prohibition of resuming diving after a PLF. While the number of divers reported was small, it seems that in certain cases of PLF, as long as the diver can properly equalize, they may return to diving. Unfortunately there wasn’t any discussion of how surgery would change the recommendations.
I realized that there still may be a roll of the dice with continuing diving, but this information is encouraging.

Yes, we're aware of the literature. One of the limitations of online advice is that as a clinic, we pretty much have to stick with general, fairly conservative recommendations because we can't examine you or your medical records. By all means, discuss this with your ENT and a diving physician and do a risk-benefit analysis. Can you keep us posted? I'd be interested in hearing the outcome of your case.
Thanks,
DDM

 

[doctormike]

Regarding PLF: in a search of Pubmed, I found at least 3 articles which contradicted an absolute prohibition of resuming diving after a PLF. While the number of divers reported was small, it seems that in certain cases of PLF, as long as the diver can properly equalize, they may return to diving. Unfortunately there wasn’t any discussion of how surgery would change the recommendations.
I realized that there still may be a roll of the dice with continuing diving, but this information is encouraging.

One other point - and this is a point about the medical literature in general. While a published paper has a lot of weight, especially in the general media, remember not to read more into an article than is actually there.

In order to actually demonstrate that there is no increased risk in diving after PLF, you would need to do a study which would be nearly impossible to do from a practical and ethical point of view. You would need a large number of people with repaired PLFs, and then randomize them into diving and non-diving groups (by definition, not a blinded study!) and then see if there was a different rate of recurrence.

Any published article that you might find is likely a clinical guideline (expert opinion) and/or a case series (a few patients with this condition). So while it may be encouraging to read that some patients with PLF have returned to diving without further ear injury, one should not read into that that there is no risk, it simply isn't in the data.

Good luck... it sounds like you understand this point, and that you are making good use of your online and offline resources..! Feel free to keep us posted.

Best,

Mike

 

[accurist]

I did my first dive since the PLF in early March, since then I've done around thirteen dives and experienced no problems with either ear.