Sudden and complete hearing loss from freediving. No "pop," no pain but now deaf in one ear for more than a week.

[chris_b]

Long time scuba diver, borrowed a friend's extra set of freediving fins to join him on a spearfishing session about a week ago. Those big long fins allowed me to go deeper faster, leading to me not equalizing my ears as well as I normally would on scuba.

Got out of the water after our session, seemed I couldn't hear well out of one ear--nothing that unusual, had no pain or anything. Sometimes I get muffled hearing after diving and it clears up in an hour or so. Not so in this case as I am now experiencing complete loss of hearing in one ear--like 100% no sound coming through. After a couple of days with zero improvement I became increasingly worried.

I called several ENT offices and none of them would see me without a referral. Contacted my PCP physician and was thankfully able to see her quickly. She looked in my ears and said there was no sign of infection and she would try to get me a referral, but warned that ENTs here are booked out at least a few weeks. I was prescribed 20mg prednisone once daily, which I've been taking as directed. I finally (yesterday) was able to get an appointment with an ENT, but will have to wait two more weeks to be seen.

I've been reading about different types of sudden hearing loss (often running across discussions of "Sudden Sensorineural Hearing Loss") and in some cases it sounds like I may need treatment in the first two weeks or so to avoid more serious effects like permanent hearing loss. I'm kind of at my wits' end as I live in Honolulu and can't drive to another city or state to try to get medical care more quickly but I just can't get in to see an ENT. I've been calling the office of the ENT I've been referred to every morning to check for cancellations in the hopes that I can be seen sooner.

Would love some input on whether this might be "just" middle ear barotrauma (e.g. torn/ruptured eardrum) that can heal on its own or with surgery, or if it might be something more serious. When driving up and down the valley we live in my good ear "pops" but the bad one doesn't so I'm hoping for just some eardrum damage. But the complete loss of hearing makes me think it might be something else.

Any input/ideas appreciated, I'm getting more and more worried about my condition and frustrated I can't get any help.

 

[Scubagermany]

Could be a lot of things, everything you can get here is guessing.

If you come I will examine you for free!

 

[dorsal]

Did you give the folks at DAN a call? They might have more info and link you to a local dr too

 

[Duke Dive Medicine]

Long time scuba diver, borrowed a friend's extra set of freediving fins to join him on a spearfishing session about a week ago. Those big long fins allowed me to go deeper faster, leading to me not equalizing my ears as well as I normally would on scuba.

Got out of the water after our session, seemed I couldn't hear well out of one ear--nothing that unusual, had no pain or anything. Sometimes I get muffled hearing after diving and it clears up in an hour or so. Not so in this case as I am now experiencing complete loss of hearing in one ear--like 100% no sound coming through. After a couple of days with zero improvement I became increasingly worried.

I called several ENT offices and none of them would see me without a referral. Contacted my PCP physician and was thankfully able to see her quickly. She looked in my ears and said there was no sign of infection and she would try to get me a referral, but warned that ENTs here are booked out at least a few weeks. I was prescribed 20mg prednisone once daily, which I've been taking as directed. I finally (yesterday) was able to get an appointment with an ENT, but will have to wait two more weeks to be seen.

I've been reading about different types of sudden hearing loss (often running across discussions of "Sudden Sensorineural Hearing Loss") and in some cases it sounds like I may need treatment in the first two weeks or so to avoid more serious effects like permanent hearing loss. I'm kind of at my wits' end as I live in Honolulu and can't drive to another city or state to try to get medical care more quickly but I just can't get in to see an ENT. I've been calling the office of the ENT I've been referred to every morning to check for cancellations in the hopes that I can be seen sooner.

Would love some input on whether this might be "just" middle ear barotrauma (e.g. torn/ruptured eardrum) that can heal on its own or with surgery, or if it might be something more serious. When driving up and down the valley we live in my good ear "pops" but the bad one doesn't so I'm hoping for just some eardrum damage. But the complete loss of hearing makes me think it might be something else.

Any input/ideas appreciated, I'm getting more and more worried about my condition and frustrated I can't get any help.

Sudden sensorineural hearing loss can happen outside of diving, but hearing loss that happens in close temporal proximity to known difficulty equalizing ears during a pressure change is concerning for inner ear barotrauma. That's considered a medical emergency and needs immediate treatment. I'd recommend you go to the emergency department or urgent care and see if you can get an ENT consult more quickly that way. You could also contact the University of Hawaii Hyperbaric clinic, they might be able to get you in more quickly and streamline an ENT consult. DM sent.

Best regards,
DDM

 

[TNEngineer]

My wife experienced this after a dive trip. The ENT considered it an emergency, prescribed Prednisone and 100% oxygen 90 minute hyperbaric treatments at ~35 PSI every day for a week (solo chamber, full body oxygen exposure). They too mentioned the 14 day window after which treatment becomes far less successful. Her hearing returned completely in 3-4 days and the problem has never recurred despite dozens of dives since. The docs said this unexplained hearing loss isn't necessarily related to diving and they see it across all lifestyles, though in this case it sure seems related to diving.

Get to an ENT immediately, even at your own expense.

 

[Duke Dive Medicine]

My wife experienced this after a dive trip. The ENT considered it an emergency, prescribed Prednisone and 100% oxygen 90 minute hyperbaric treatments at ~35 PSI every day for a week (solo chamber, full body oxygen exposure). They too mentioned the 14 day window after which treatment becomes far less successful. Her hearing returned completely in 3-4 days and the problem has never recurred despite dozens of dives since. The docs said this unexplained hearing loss isn't necessarily related to diving and they see it across all lifestyles, though in this case it sure seems related to diving.

Get to an ENT immediately, even at your own expense.

This is really interesting. Can you be more specific about what happened with your wife? When did she notice her ear symptoms and was there anything that led up to it?

Thanks,
DDM

 

[Pavao]

It happened to me once, about 15 years ago, I was teaching a class and tied to a wreck, went down/up the line, had no issues equalizing, had absolutely nothing out of the ordinary, it was just like any other dive.
Everything fine right up to the moment I broke the surface, I was suddenly death in one ear, no pain, no discomfort, just couldn’t hear from one side. It lasted for more than a month I think, I did not seek any treatment or see any doctors, all good now, sounds like I dodged a bullet.

 

[TNEngineer]

This is really interesting. Can you be more specific about what happened with your wife? When did she notice her ear symptoms and was there anything that led up to it?

We were on a dive cruise. She went to bed one night with everything totally normal, and woke up the next morning with utter and complete loss of hearing in one ear. It did not vary. The other ear was totally normal. She had reported no equalization issues on any previous dives, and didn't have any on later dives. In other words, there was no warning, no previous symptoms, nothing.

Since there was no feeling of pressure she continued to dive on that trip and reported no further changes other than utter lack of hearing. EQ was normal during decent and ascent, she could feel the eardrum and changes in pressure, just no acoustic response.

It happened to me once, about 15 years ago... it was just like any other dive. Everything fine right up to the moment I broke the surface, I was suddenly death in one ear, no pain, no discomfort, just couldn’t hear from one side. It lasted for more than a month I think, I did not seek any treatment or see any doctors, all good now, sounds like I dodged a bullet.

I've had that happen twice. Once was some time after a dive trip completed, the other time was after a cruise where we snorkeled instead of dived because the other members of our party were not divers and wanted to snorkel, so we opted for that to keep the group together.

Mine was transitory; it would come and go with no discernable pattern. This went on for a couple of weeks (it was before my wife's incident and us learning about the 14 day period). Usually I would just realize "hey, I can (not) hear again in that ear". But one night my wife was at a board meeting and I was sitting in the car in the parking lot, reading on my phone, when my troubled ear which had been working fine did the following over about a two-second timeframe:

zzzzzzzzZZZZZZZ-POP

...and my hearing vanished. It was so bizarre. I could literally hear something build up in my ear for about two seconds and then my hearing disappeared with a very definite pop sound. Remember, I'm sitting in a car, in a parking lot, in the dark, with no atmospheric pressure changes happening or having had happened for 30-60 minutes beforehand. It may have had the sound effects before but this was the first time where I was in a totally silent environment. As I recall my hearing returned sometime during the night because I could hear again the next morning - at least until the next cycle started!

Given this data, I went to an ENT shortly after. They ran a full hearing profile on me, and finding nothing sent me to the radiology lab for a full brain scan. Results: Nothing. It was nice to get a comprehensive report about the status of my brain, ears, eyes, etc. All normal, it said. Little do they know! {grin}

It ceased after about 5-6 weeks and my hearing was totally normal again. Then a very similar event occurred during last November's snorkeling trip. That one lasted about 5-6 weeks as well, came and went, eventually self-resolved, basically all the same symptoms. I didn't bother returning to the ENT for this second event.

Considerations for my events:

* Since it happened snorkeling, significant pressure was probably not the culprit.

* Since I had many dives between the two events with no ill effects (including 100ft+ dives), I probably don't have a chronic physiological condition such as damage to my eustachian tubes that would make this likely to recur - only possible.

* The brain scans revealed nothing, and they were taken while I was affected, so not a recognized neurological condition.

After much thought I remembered one extra detail: I had more difficulty with mask leakage on the snorkeling trip, perhaps caused by the frequent descent/ascent cycling associated with snorkeling as opposed to actual diving.

I have a habit of positioning myself in strange postures to get better photos, which includes being head-down and sometimes rolled toward my back. Combine the odd postures with mask leakage and frequent snorkeling EQ's, and I wonder if I got water up my nose which an inverted EQ could then force up my eustachian tube(s). I've read of contaminants going up the tubes, and medical reports say that can take up to six weeks to completely clear - timing which coincides with my experiences.

Summarizing, my wife's experience was radically different from mine and the doctor's reactions were also very different. If your symptoms are cycling (like mine) it's apparently far less of concern than if it's continuous (like my wife's). I'd still go to an ENT the first time regardless of symptoms, just so they can rule out anything chronic.

Hope this helps!

 

[Duke Dive Medicine]

We were on a dive cruise. She went to bed one night with everything totally normal, and woke up the next morning with utter and complete loss of hearing in one ear. It did not vary. The other ear was totally normal. She had reported no equalization issues on any previous dives, and didn't have any on later dives. In other words, there was no warning, no previous symptoms, nothing.

Since there was no feeling of pressure she continued to dive on that trip and reported no further changes other than utter lack of hearing. EQ was normal during decent and ascent, she could feel the eardrum and changes in pressure, just no acoustic response.

Whoa. Weird. How did you rule out inner ear DCS on the boat? Were her dive profiles at all provocative? Did she notice whether her hearing got better at depth?

Idiopathic sudden sensorineural hearing loss (ISSNHL) definitely happens, and it's not related to diving. It's also one of the newer indications for hyperbaric oxygen therapy. It would just be really coincidental to have it happen in close temporal proximity to diving. Differential diagnosis of inner ear problems around diving can be really challenging and misdiagnosis can happen if a provider isn't familiar with diving injuries (not that this happened in your wife's case). It sounds like whatever it was responded to HBO2 and she went back to baseline, which is the best outcome you could hope for.

Best regards,
DDM

 

[TNEngineer]

Whoa. Weird. How did you rule out inner ear DCS on the boat? Were her dive profiles at all provocative? Did she notice whether her hearing got better at depth?

Very modest dive profiles on that trip. ~60 feet max depths, mixture of Air and Nitrox dives, 60+ minute surface intervals, etc. She didn't mention anything about different hearing behavior at differing depths. Since she had absolutely no other symptoms, and no pain nor other odd side effects in her ear, we decided it did not need to preempt ongoing diving. We paid close attention in case something further occurred but nothing did.

Idiopathic sudden sensorineural hearing loss (ISSNHL) definitely happens, and it's not related to diving. It's also one of the newer indications for hyperbaric oxygen therapy.

"Newer" is right - our insurance company balked at it. To keep things moving we offered to pay personally while we argued with the insurance company. I don't remember how the financial side worked out.

There was a FAR more fascinating aspect. My wife had two schwannoma cervical tumors removed a few years ago, and that delicate(!) operation left her with some balance and muscle feedback deficits. While she was on hyperbaric 100% oxygen, those deficits disappeared completely. The improvement was so striking that people who barely knew her mentioned it. She normally has difficulty walking, but now she was literally prancing and dancing like she was 30 years younger.

When she stopped the treatments the symptoms came back. It was no worse than before, but having been reminded how much she'd lost it put her in tears and modest depression for a couple of days.

Since that time I've been trying to find a site with true 100% oxygen-at-pressure that will give her a couple of weeks of treatment to see if we can replicate the results. I've offered to pay cash out of pocket. But so far no one will do it because "it's not an approved procedure for hyperbaric". Yeah, well, this is how unexpected discoveries occur!!! There might be a medical paper in this for someone, and I'm willing to pay CASH so there's zero cost for the facility. But so far the only takers are strip mall oxygen tokers who have those inflatable ~1.4 Bar partial O2 chambers and the "wear an oxygen mask with 10-12 of your closest friends in our room-sized tent" places. That will NOT replicate the conditions. We need the single-person, no mask, high pressure 100% oxygen chambers which are typically clear prone tubes. No takers yet, but my cash offer still stands.