Slight vertigo & headache for days after diving

[jdiv]

Like it says in the title...

I'm a beginning diver, currently on my PADI OWD course. I've completed all my pool dives and I'm ready to hit the open water. However I have a nagging problem that has kept me from going underwater again (at least mentally).
Two weeks back I had a pool dive. Everything went well and my ears equalized just fine. Then there was the free dive part where I'd make a few dives to the bottom of the pool without scuba gear. At one dive I didn't quite equalize well and had some pain in my left ear and turned back to the surface. The ear felt a bit weird but nothing else happened. I went home and slept, the next day I had a headache, aching left ear and a slight feeling of vertigo. Painkillers helped but the slight vertigo didn't go away. Two days later the feeling was slowly fading away but I decided to go see a doctor to make sure all was ok with my ears. The doctor (a generalist) didn't see anything wrong and suggested that the feeling should go away on its own like it was already going. Two days later after that the feeling was gone and I went in for another pool dive. This time I had no problems equalizing and everything felt good. However the next day, the same thing happened. Slight headache accompanied with a slight, but noticeable feeling of vertigo with the left ear not feeling completely right. Once again I did the same thing, waited for a while and as the feeling was going away slowly, I went to see an ENT (specialized in military aviation). He inspected my ears and all airways quite thoroughly and said that everything looked fine, however he could of course not see into the inner ear. He prescribed me some anti-histamines to ensure my airways stayed clear and said he did not see any reason to stop diving. Now 3 days later the feeling of vertigo is still present, although it's quite slight but it's still there. Then there's a little feeling of drowsiness which may or may not be related.

So the question is, what's going on in my ears/head?
Reading similar cases the symptoms would point to inner ear infection. I'm just not sure. I'm also a bit conflicted with whether I should dive or not. Physical activities aren't an issue I've noticed, in fact exercising makes me feel better. Any suggestions, experiences, wisdom on the issue?

 

[doctormike]

Hi, Jdiv...thanks for writing! I really can't diagnose anything over the Internet, but these sorts of questions come up frequently. Here is some background information that might be helpful. Also, did the ENT doctor do a hearing test? Did you have a hearing loss? Was it a "conductive" hearing loss or a "nerve" hearing loss?

There are a lot of misconceptions about ear problems with diving, and it's important to keep things straight. The problem is that people tend to view any pain, dizziness or hearing loss as being the same thing, which is not always true. Also, the term "ear infection" has three very different possible meanings, and many non-specialists may not be very specific when giving a patient the diagnosis.

To summarize- there are three places where you can have ear trouble during diving, and they all have different clinical courses, prognosis and treatment. Here is a diagram to help you follow along:



1) Outer ear problems: Water from the ocean can get stuck in the external ear canal, especially if there is a good plug of wax. Rarely, a tight wax plug can cause a squeeze in the outer ear, but this isn't very common. Also, you can get an irritation of the skin of the ear canal (swimmer's ear). People who spend a lot of time in cold water can get bony growths in their ear canals ("surfer's ear"), these can also trap wax and water if they get big enough.

Treatment (if it doesn't get better by itself) is careful office cleaning by an ENT doc with a microscope, possibly followed by medicated ear drops. If there is swimmer's ear, it is good to keep the ear dry. This is not always possible with multiple days of diving, but using an Ear Dryer or a mix of rubbing alcohol with a little white vinegar may help prevent recurrence. The bony growths occasionally require surgery if they get too big. Q-tips can cause injury or further impaction of earwax against the drum- not a great idea.

2) Middle ear problems: The middle ear is the space behind the eardrum. Barotrauma (pressure injury) can be caused, as you all probably know, by not allowing for the Eustachian tube (the natural drainage pathway of the ear) to do it's thing and equalize the pressure from the airtight middle ear with ambient pressure. This usually happens when you descend too fast without equalizing (remember, equalize early and often), or when you dive with a cold (causing swelling of the Eustachian tube). Generally, this results in a clear fluid with or without blood in the space behind the eardrum. This does NOT lead to middle ear infections (pus behind the eardrum, as commonly seen in young children).

You can see middle ear problems by looking in the ear.

Treatment- Unblock the Eustachian tube by valsalva maneuvers (pinching the nose and blowing) or Toynbee maneuvers (pinching the nose and swallowing, or other maneuvers with the jaw to ventilate the ear (see this site for more information). Medical therapy (decongestants, anti-inflammmatory agents like motrin, or steroids) can help to some degree. Very rarely, it will be necessary to make a hole in the eardrum. This usually is necessary when a "vapor lock" sets in and the fluid lasts more than a few weeks.

Middle ear problems cause a specific type of hearing loss - a "conductive" hearing loss which is usually temporary. Middle ear problems can also cause balance problems like vertigo, dizziness or nausea.

3) Inner ear problems: The inner ear is the space deep in the ear bone where the cochlea sits. The cochlea is the organ of hearing (like the retina in the eye) that converts sound waves into nerve signals. You can't see inner ear problems by looking in the ear.

Diving related inner ear problems are very rare, but have the potential to cause permanent hearing loss. There are two types- inner ear decompression illness (a type of DCI in which the bubbles form in the inner ear), and inner ear barotrauma (leakage of inner ear fluids through a fistula). These require immediate attention, and in the case of a leaking fistula, may require emergency surgery.

Inner ear problems may cause a "nerve" or "sensorineural" hearing loss, which can be permanent. A formal hearing test can determine which type of hearing problem if any is present. Inner ear problems are also often associated with dizziness or balance issues.

 

[TSandM]

Great post, doctormike! I have an essay I wrote a while back on the subject, but it doesn't have the lovely diagram you used.

 

[doctormike]

Great post, doctormike! I have an essay I wrote a while back on the subject, but it doesn't have the lovely diagram you used.

Thanks...! I really HAVE to make a sticky at some point. Right now I just search for my old posts and re-assemble them into something relevant....

 

[Duke Dive Medicine]

Nice one, Mike. If you do make a sticky this post should be part of it!

 

[doctormike]

Nice one, Mike. If you do make a sticky this post should be part of it!

OK, now that BOTH of you have mentioned it, I guess I should do it! Maybe I'll make it a web page with images, etc...

I do explain a lot of stuff like that here: Ear Infections, fluid and hearing loss

Will work on it...

M

 

[jdiv]

Well it's been a while now and I thought I'd bring closure to this. There are probably some people interested in how things went.

I ended up being out of the water for 2 weeks after the last dive. The symptoms disappeared during the first week but to be on the safe side I decided to wait another week and not dive immediately like I did last time. I'm happy to say that now after my last dive I'm feeling perfectly fine again :biggrin:. I suspect I had some sort of middle ear barotrauma from the first dive which I hadn't completely recovered from before I went back underwater, which then reversed the recovery - not really sure what kind of barotrauma since the doctors didn't see anything wrong, I guess we'll never know. I'm just happy that I can dive without problems again.

I guess this just goes to show how important it is to make sure you equalize often and stop right away if you have equalization problems.

Also thanks DoctorMike, that was a great post. It's a great starting point for that little bit of self-diagnosis we all want to do... but as you say, in the end it's always best to go see a doctor and get yourself checked out. With the ears affecting so much, especially balance, it's serious business.

 

[doctormike]

Well it's been a while now and I thought I'd bring closure to this. There are probably some people interested in how things went.

I ended up being out of the water for 2 weeks after the last dive. The symptoms disappeared during the first week but to be on the safe side I decided to wait another week and not dive immediately like I did last time. I'm happy to say that now after my last dive I'm feeling perfectly fine again :biggrin:. I suspect I had some sort of middle ear barotrauma from the first dive which I hadn't completely recovered from before I went back underwater, which then reversed the recovery - not really sure what kind of barotrauma since the doctors didn't see anything wrong, I guess we'll never know. I'm just happy that I can dive without problems again.

I guess this just goes to show how important it is to make sure you equalize often and stop right away if you have equalization problems.

Also thanks DoctorMike, that was a great post. It's a great starting point for that little bit of self-diagnosis we all want to do... but as you say, in the end it's always best to go see a doctor and get yourself checked out. With the ears affecting so much, especially balance, it's serious business.

So glad to hear that, and I'm always happy to help as best as I can!

Thanks for giving us the update...

Mike