Struck with terrible vertigo while on vacation

[Donnah]

Had this happen to a friend on a dive trip. It was her first dive trip, and her first dive. We were at Lighthouse Reef in Belize. She spent the rest of the week in bed. Whenever she moved, vertigo and nausea. Called an ENT on the radiophone. He said not to take her anyplace by boat or plane for a week because of possible pressure problems that would make the barotrauma worse. Doc said no diving for 6 months -- I don't think she ever dove again. It was a horrible experience, made much worse by the fact that we were isolated from any medical help.

 

[Duke Dive Medicine]

Duke Dive Medicine, What about the possibility of Ciguartera ?

Good suggestion... if the vertigo is accompanied by nausea and vomiting, are the n/v secondary to the vertigo or are they separate GI symptoms possibly caused by food-borne illness? It's impossible to make a definitive diagnosis over the internet, which is why the medical people here are careful about not doing so and instead recommend that individuals with acute medical problems be evaluated in person.

My thinking was that the OP had already spoken with a DAN medic who most likley asked her a number of questions and concluded that this was likely to be barotrauma. The symptoms as described are suggestive of inner ear barotrauma rather than middle ear, but it's possible that there was a misinterpretation of the DAN medic's statement since the two are often confused (see my last post - no offense intended Don!).

Best regards,
DDM

 

[underH2Oman]

Hope all is well Divergirl, Trust you made it home nd have a chance to seek medical attention. Did you get a definitive cause?

 

[DiverGirl1972]

Thanks for asking, underH20man!

By the time we left Dumaguete to head to Manila on Friday, the vertigo had pretty much resolved. What I was left with was a feeling of dizziness, equilibrium issues, nausea, and a feeling of "sensory overload" as it pertained to my vision. We took the given advice of arranging wheelchair assistance the whole way, which also had the benefit of being expedited through security, customs, etc... during our connections, so we all enjoyed that aspect We got back into PA late Saturday night and we were simply too exhausted to pursue any type of treatment that night.

I called the "on call" doctor on Sunday at my PCP (family doctor) office and he basically told me there was nothing much they would be able to do and to just relax on Sunday. I was a little dismayed at that response, but being very jet-lagged and exhausted, I didn't have much fight in me to push the issue. He told me to make an appt for the following day, which I did.

On Monday, I went to my appt and the doctor thoroughly checked out my ears (she said they were fine after a visual exam) and diagnosed my vertigo as BPPV - benign paroxysml positional vertigo. She gave me some meds for the nausea and told me to continue to take Meclizine. She also referred me to a vestibular clinic at a local hospital, so I immediately proceeded there after my appt. He performed the Epley Maneuver a few times, to see if it would help and also so that I would know how it should be done properly should this ever happen again (which I seriously hope not!). He noticed that I was still having some irregular eye movement (nystagmus) when going through the procedure. Maybe the medical mods could chime in, but I think that this can be an after-effect of the BPPV.

He went on to perform vestibulo-ocular reflex testing. Apparently, my left eye is hyporeactive (?) or was delayed while performing a head/eye movement test. He says this is causing the the equilibrium issues and the feeling of wooziness. He also said that it explained my feeling of sensory overload in busy environments, such as airports, etc... He gave me some homework to do (visuo-vestibular and gaze stabilization exercises) and he asked me to go back this morning so that he could re-evaluate before I take my next dose of Meclizine.

Yesterday, I went back to the therapist and was put through the testing again. He didn't see any change, for the better or worse. During my visit yesterday, he said that I am going to have to continue these exercises indefinitely so that I can re-train my eyes. I asked him what caused this, but he couldn't really tell me. To be clear, he is not a medical doctor, he is a physical therapist.

So, that's all I know for now. It's somewhat disconcerting to know that another episode of BPPV could and will likely happen again at some point. I'm still not really sure how the two issues are linked (the BPPV and the VOR issues) or whether or not this is cause for me to be concerned about diving moving forward. I plan on making a consultation appointment with an ENT at UPenn within the next week or two. Hopefully they can give me more information about future diving. At this point, it is unlikely it was related to any ear barotrauma as there was a 36-hour delay between our last dive and the onset of the vertigo. In addition, other than the minor ear soreness on my last dive day, I've had no other ear pain or discomfort, feelings of fullness in my ears, hearing loss, etc...

Hopefully this was just "one of those things" and eventually, all of the symptoms will resolve completely. I feel as though there has been improvement, but I'll see how I am feeling next week and go from there.