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

[chris_b]

Thanks for the reply and support @TNEngineer. I don't have a lot of physiological discomfort other than a sort of "full ear" feeling but the psychological impact of the hearing loss and 24/7 tinnitus is pretty rough. I really appreciate the thoughts and feedback of others.

I was able to push to see the ENT again this past Friday as I was really unhappy with my first appointment. He wasn't particularly pleased to see me again and continued to be pretty dismissive of my concerns, but at least we had a discussion this time (instead of him pretty much shooing me out of the exam room once he'd given me his diagnosis and treatment plan). He explained that (a) surgery isn't the go-to option in his opinion because there's no way to know for sure it's PLF and (b) he wasn't someone who would be able to do the surgery. He also mentioned something along the lines of "I don't think anyone's ever even seen an actual fistula" which seems at odds with the case reports referenced in this thread. Makes me concerned that this situation might be too far outside this ENT's experience for him to treat me properly.

I did get the audiogram results back and I have severe hearing loss in my left ear and mild hearing loss in my right. The loss in the right was somewhat of a surprise to me but after thinking about it that might be why it's so hard to function--the right ear can't even fully pick up the slack from the left. Subjectively I think the left ear has started to improve a little bit (can hear a few low frequency sounds) but not a lot.

I pushed for more info on surgery and was told that there are only two otologists on Oahu who could do it; the ENT warned me that both were booked out for 4-6 months. He gave me an urgent referral to both but I was told I'd probably have to wait a week or two to even hear back from their offices about getting an appointment (so much for "urgent!"). They should have received the referrals by tomorrow morning so I plan instead to call directly tomorrow, and call back regularly to see if there are cancellations so I can at least see an otologist and figure out what my options are at this point.

Worst case scenario I've also considered flying to LA to see an otologist but flying at altitude seems like way too much risk.

 

[Richard Dayan]

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.

Yeah, don't wait those doctors only care about money not your health. Better go to the emergency room and tell them to treat it and not wait.

 

[TNEngineer]

FWIW, my wife and I both flew with our ear conditions and had no ill effects. I agree you may be making a trip to the mainland... your hearing is worth it.

The ER idea is a good one, too. Maybe an ER once you land at LAX.

 

[duke dive medicine]

FWIW, my wife and I both flew with our ear conditions and had no ill effects. I agree you may be making a trip to the mainland... your hearing is worth it.

The ER idea is a good one, too. Maybe an ER once you land at LAX.

Your and your wife's conditions are/were different than the OP's. Perilymph fistula carries the risk of fluid leaking out of the vestibular apparatus into the middle ear with pressure changes or straining, which can lead to worsening symptoms. If that's indeed what the OP has, then flying would be more risky.

Best regards,
DDM

 

[chris_b]

Another update, I've completed my week+ on 60mg prednisone then 20mg/day taper. My left ear has definitely improved in terms of feeling and hearing but is still operating at maybe 40-50% and the tinnitus is insane. I've been using the "Mimi" hearing test app daily and continue to have a huge audiogram drop off at 500Hz and 1KHz. Right ear actually seems like it might be getting slightly worse as well.

Scheduled to see my Mediocre ENT this afternoon to discuss next steps. I've pretty much lost confidence in the guy especially after reading horror stories about him on Yelp and Google that echo my experiences--seriously, I've never seen an MD with such abysmal reviews. It sounds like the main reason I was able to get in to see him is because nobody wants to go to him--he's the only ENT not fully booked up for weeks/months for a reason. As I mentioned before, I think he might just not be competent enough in this area to treat me--I wish he'd referred me immediately rather than just proceeding as if it's a "standard" case of idiopathic SSHL.

Thanks to my own persistence and legwork I've finally secured an appointment with the only non-military surgical otologist on the island on Monday. He only takes referrals from ENTs so I had to go through the Mediocre ENT, whose staff lied to me about sending my urgent referral, then after me pushing for a couple of days finally agreed to "re-send." Within a couple of hours of me finally ensuring they got the referral, the otologist saw my case info and scheduled the consult, which makes me hopeful they recognize the urgency.

So now I'm up in the air about what to do with Mediocre ENT in the interim. He previously suggested going for corticosteroid injections into the inner ear if I wasn't better, but now that I'm just a few days out from the otologist I'm leery of doing that--seems like penetrating the eardrum for the injection might set things up poorly for surgery? Also slightly scared by reading more about cases where even short-but-intense prednisone regimes like I've been on lead to osteonecrosis (particularly hip joints) months or years later. Hoping my total oral prednisone load to date of 620mg is low enough to not trigger something like this, but worried that intratympanic steroid injections might be just the thing to push me over.

Psychologically the tinnitus is really starting to wear me down. I'm sleeping okay but if I wake up in the middle of the night it's hard to get back to sleep because the tinnitus seems to really get screaming around 4-5am. During the day I often get busy enough that it fades into the background.

 

[duke dive medicine]

Another update, I've completed my week+ on 60mg prednisone then 20mg/day taper. My left ear has definitely improved in terms of feeling and hearing but is still operating at maybe 40-50% and the tinnitus is insane. I've been using the "Mimi" hearing test app daily and continue to have a huge audiogram drop off at 500Hz and 1KHz. Right ear actually seems like it might be getting slightly worse as well.

Scheduled to see my Mediocre ENT this afternoon to discuss next steps. I've pretty much lost confidence in the guy especially after reading horror stories about him on Yelp and Google that echo my experiences--seriously, I've never seen an MD with such abysmal reviews. It sounds like the main reason I was able to get in to see him is because nobody wants to go to him--he's the only ENT not fully booked up for weeks/months for a reason. As I mentioned before, I think he might just not be competent enough in this area to treat me--I wish he'd referred me immediately rather than just proceeding as if it's a "standard" case of idiopathic SSHL.

Thanks to my own persistence and legwork I've finally secured an appointment with the only non-military surgical otologist on the island on Monday. He only takes referrals from ENTs so I had to go through the Mediocre ENT, whose staff lied to me about sending my urgent referral, then after me pushing for a couple of days finally agreed to "re-send." Within a couple of hours of me finally ensuring they got the referral, the otologist saw my case info and scheduled the consult, which makes me hopeful they recognize the urgency.

So now I'm up in the air about what to do with Mediocre ENT in the interim. He previously suggested going for corticosteroid injections into the inner ear if I wasn't better, but now that I'm just a few days out from the otologist I'm leery of doing that--seems like penetrating the eardrum for the injection might set things up poorly for surgery? Also slightly scared by reading more about cases where even short-but-intense prednisone regimes like I've been on lead to osteonecrosis (particularly hip joints) months or years later. Hoping my total oral prednisone load to date of 620mg is low enough to not trigger something like this, but worried that intratympanic steroid injections might be just the thing to push me over.

Psychologically the tinnitus is really starting to wear me down. I'm sleeping okay but if I wake up in the middle of the night it's hard to get back to sleep because the tinnitus seems to really get screaming around 4-5am. During the day I often get busy enough that it fades into the background.

Thank goodness you're a strong advocate for yourself.

Re the intratympanic steroid injections, do you have a way of contacting the otologist you've been referred to? He/she would be in the best position to comment on whether that would affect any of his/her interventions.

Tinnitus can be maddening. It is treatable in some cases. If your hearing is improving then the tinnitus may improve alongside it. Again that's something your new otologist would be in a good position to speak to.

Best regards,
DDM

 

[chris_b]

Thanks for the feedback @Duke Dive Medicine

I did ask the otologist's office for advice on the injections and was told that they couldn't advise me as I hadn't even yet been seen by them--fair enough.

I'm leaning towards not going with the injections but will just have to discuss that with Mediocre ENT at my appointment. So far he seems to feel that only the most conservative solutions are worth exploring, so I'm guessing he won't push for the injections. Plus he seems to want me in his exam room no longer than about 5-10 minutes, so not having to do injections lets him move his assembly line process along faster.

 

[chris_b]

Another update in my ongoing saga--I met with the neuro-otologist today for a good 30-40 minutes and had a discussion about my situation. Even though I haven't received any treatment yet, just being able to talk about my symptoms/condition with a knowledgeable professional and ask questions (instead of having my concerns minimized and being rushed out the door) was a huge relief.

He agreed that the chances that this was unrelated to dive activity are extremely small and that surgery would therefore be a good option. He also mentioned that in his experience those with no dizziness or other evidence of vestibular issues tend to be more successful in regaining some of their hearing. It's not a sure thing, of course, but it at least gives me some hope. Taking the corticosteroids not too long after the injury probably helped me avoid even worse outcomes as well.

We went through the surgery in broad strokes--general anesthesia, cut and lift the eardrum, two slightly different types of graft for the round and oval windows; about a 1.5 hour outpatient procedure. If he goes in and isn't able to clearly visualize fistula(e) he will still do the grafts just to be safe. Follow up at one week post op to remove some material related to the graft, follow up at one month for general assessment, then another follow up at three months for a hearing evaluation.

I'm scheduled for surgery exactly one week from today. Doc says that's within a reasonable window of time since the injury in terms of hopes for recovery. He's had patients go significantly longer before surgery and still achieved improvement, though he suggested that the longer the delay the longer the road back.

I didn't have the heart to ask at this point, but I'm kind of assuming my diving days are done. A good chunk of my adult life I've chosen to live near the ocean because I love being in the water. I'm sure I can still do surface snorkeling, sea kayaking, and surfing, but I sure will miss diving if I have to give it up. I think I'd miss being able to hear conversations, music, movies, etc. a hell of a lot more, though.

 

[chris_b]

Update: had my PLF surgery today. Entered the hospital at 8am and left at 4pm. Surgery itself took a bit over 3 hours, the surgery before me went way longer than planned but that gave me lots of time to talk to the nurses and the anesthesiologist. First time in my 53 years on the planet going under general anesthetic which had me a little freaked out. They gave me 8mg dexamethasone intravenously about an hour before the procedure--I wasn't clear if that was to reduce any inflammation during/after surgery or if it was intended to be an antiemetic; maybe both?

I was too out of it immediately after the surgery to discuss so the surgeon gave my wife a rundown. He did find a fistula + leak in one location; she couldn't remember whether it was the round or oval window but as we discussed before he patched both to be safe. At/near the end of the procedure they administered a local anesthetic--it's now (~8 hours post op) completely worn off and inside my ear was more painful than I expected. One thing I didn't realize is that the surgeon doesn't cut through the eardrum at all--he cuts into the flesh slightly below the eardrum, lifts it up, and then works through the space created.

Have a spongy plug over the incision inside my ear that we need to drip a liquid antibiotic into 2x daily for a week plus oral antibiotics. My tinnitus has ramped up considerably but there could be a multitude of reasons for that. Couldn't eat for 12 hours before the scheduled surgery time so I ate pretty well after coming home, then just pretty much slept straight through until about 3am where I now find myself wide awake and in mild pain. Probably will take another hydrocodone+acetaminophen soon and see if I can get back to sleep for a bit.

 

[duke dive medicine]

Update: had my PLF surgery today. Entered the hospital at 8am and left at 4pm. Surgery itself took a bit over 3 hours, the surgery before me went way longer than planned but that gave me lots of time to talk to the nurses and the anesthesiologist. First time in my 53 years on the planet going under general anesthetic which had me a little freaked out. They gave me 8mg dexamethasone intravenously about an hour before the procedure--I wasn't clear if that was to reduce any inflammation during/after surgery or if it was intended to be an antiemetic; maybe both?

I was too out of it immediately after the surgery to discuss so the surgeon gave my wife a rundown. He did find a fistula + leak in one location; she couldn't remember whether it was the round or oval window but as we discussed before he patched both to be safe. At/near the end of the procedure they administered a local anesthetic--it's now (~8 hours post op) completely worn off and inside my ear was more painful than I expected. One thing I didn't realize is that the surgeon doesn't cut through the eardrum at all--he cuts into the flesh slightly below the eardrum, lifts it up, and then works through the space created.

Have a spongy plug over the incision inside my ear that we need to drip a liquid antibiotic into 2x daily for a week plus oral antibiotics. My tinnitus has ramped up considerably but there could be a multitude of reasons for that. Couldn't eat for 12 hours before the scheduled surgery time so I ate pretty well after coming home, then just pretty much slept straight through until about 3am where I now find myself wide awake and in mild pain. Probably will take another hydrocodone+acetaminophen soon and see if I can get back to sleep for a bit.

Wow. Thanks for this update. The fact that the surgeon found a fistula really drives home the importance of advocating for yourself the way you did. I hope you get some rest and that your recovery goes smoothly.

Best regards,
DDM