Second opinion and dive doctors - Confirmed Perilymphatic Fistula

[TangQiuYue]

Hello!

So I've searched and found a handful of questions surrounding possible perilymphatic fistulas, but haven't found a recent thread about someone who was operated on.

I was diagnosed a couple of years ago with a right ear perilymphatic fistula, it was successfully operated on in March 2019. Left ear fistula was confirmed a few months later, symptoms being milder the doctor wanted to fix the first before diagnosing the second. I went through a left ear surgery in November 2019.

I have since had no symptoms (minus surgery related symptoms).

My doctor, who is by far the best in terms of fistulas here, has informed me that I could return to normal life. When I mentioned diving, he kind of shrugged and said he didn't see a problem, but indicated it being a risk factor.

Since we're not sure diving caused them in the first place, as me being hit by a car was the most likely culprit, we do know diving made them worse... so I want to know, can I dive again? I haven't dived since a pool dive in January 2018... and I'm really itching to go back, but obviously, I don't want to go through another surgery like this.

Has anyone gone through a bilateral perilymphatic fistula and returned to diving? Is there any chance a diving doctor might clear me?

Thoughts, experiences and pointing me in the right direction would be awesome

Thanks!

 

[Duke Dive Medicine]

Hello!

So I've searched and found a handful of questions surrounding possible perilymphatic fistulas, but haven't found a recent thread about someone who was operated on.

I was diagnosed a couple of years ago with a right ear perilymphatic fistula, it was successfully operated on in March 2019. Left ear fistula was confirmed a few months later, symptoms being milder the doctor wanted to fix the first before diagnosing the second. I went through a left ear surgery in November 2019.

I have since had no symptoms (minus surgery related symptoms).

My doctor, who is by far the best in terms of fistulas here, has informed me that I could return to normal life. When I mentioned diving, he kind of shrugged and said he didn't see a problem, but indicated it being a risk factor.

Since we're not sure diving caused them in the first place, as me being hit by a car was the most likely culprit, we do know diving made them worse... so I want to know, can I dive again? I haven't dived since a pool dive in January 2018... and I'm really itching to go back, but obviously, I don't want to go through another surgery like this.

Has anyone gone through a bilateral perilymphatic fistula and returned to diving? Is there any chance a diving doctor might clear me?

Thoughts, experiences and pointing me in the right direction would be awesome

Thanks!

Hello @TangQiuYue ,

You mentioned a car accident being the likely cause of your perilymph fistulas. How bad was the car accident? Were you injured in any other way? How did your physician explain both of them being caused by the car accident when they happened so far apart?

Best regards,
DDM

 

[TangQiuYue]

Hello @TangQiuYue ,

You mentioned a car accident being the likely cause of your perilymph fistulas. How bad was the car accident? Were you injured in any other way? How did your physician explain both of them being caused by the car accident when they happened so far apart?

Best regards,
DDM

Hello! It was a car vs cyclist. Me being the cyclist. Bruises, scrapes and a good concussion.

I have had symptoms of PLF since. It was aggravated by scuba diving and taking up running years later.

Since PLF is a hard call, the doctor suspected that my hearing loss and other symptoms in my left ear were unrelated to the worse symptoms caused in my right ear. After the initial surgery of my right ear, we reassessed and found that symptoms were less but still present. Tell tale signs like taking the metro and having my ear go insane at small pressure changes, and on cue dizziness when bad weather hit. This made him believe I might have the left ear plf too. I think he was being cautious as to not operate for nothing.

 

[Duke Dive Medicine]

Hello! It was a car vs cyclist. Me being the cyclist. Bruises, scrapes and a good concussion.

I have had symptoms of PLF since. It was aggravated by scuba diving and taking up running years later.

Since PLF is a hard call, the doctor suspected that my hearing loss and other symptoms in my left ear were unrelated to the worse symptoms caused in my right ear. After the initial surgery of my right ear, we reassessed and found that symptoms were less but still present. Tell tale signs like taking the metro and having my ear go insane at small pressure changes, and on cue dizziness when bad weather hit. This made him believe I might have the left ear plf too. I think he was being cautious as to not operate for nothing.

I would think that your ENT surgeon would be able to determine whether the repairs would stand up to diving, especially a Valsalva maneuver performed under less-than-optimal conditions. PLF can happen with diving alone, so if your otic capsule has any sort of congenital weakness, you may be at increased risk. Have you reached out to the hyperbaric medicine folks at Sacre Coeur Hospital? They treat divers with decompression illness so they may have a diving medical examiner there. You should really be seen in person for this. Also tagging @doctormike for any other advice he may have.

Best regards,
DDM

 

[doctormike]

Thanks for the writeup! I don't do this surgery myself, but it's pretty hard to give a scientific answer to that question about returning to diving. Even diagnosing a PLF at surgery is controversial unless it's a really big leak with a congenital or traumatic defect, which isn't always the case. Also, it's very hard to do science about the risk of returning to diving, since the combination of the two things is so small that it's always going to be anecdotal.

Bottom line is that I would think that there might be some unquantifiable risk, just because diving involves pressure differentials between the middle and inner ear, especially if equalization is slow or incomplete. So that could lead to a recurrence. I would go with what your PLF surgeon says, thought, since he probably is going to know better than any diving doc, it's such a specialized area. It sounds like he is telling you something similar.

However, if it's any help, it seems that diving is OK after stapedectomy, which can result in a PLF. It's not an exact analogy, but it's something!

 

[TangQiuYue]

Thanks both of you!

I'll definitely try to get a referral to sacré cœur to have a consult, I guess I was hoping for an anecdotal Story of someone going back to diving and not having any issues, but that's the day dreamer inside of me.

My first surgery, the PLF and leak were confirmed. Second surgery, they did a blind patch as they couldn't detect the hole. Either way, my balance came back, nausea went away and thats all that matters at this point. Hitting inanimate objects was not pleasant ‍

I know I never want to have another PLF surgery. I went into shock both times. (Local anesthesia only) but the pull to diving is a magical one. I guess I'll probably never have a 100% answer no matter what I do.