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 @Duke Dive Medicine, I really appreciate you and others providing info. It was your information and previous threads here on SB (I believe some also involving @doctormike) that helped me figure out what was likely going on, giving me the incentive to self-advocate more strongly and with confidence that I was close to the right track.

In the slim literature I could find on barotrauma-related PLF I got the general impression that fistulae are found/confirmed visually in more than half of the cases. I'm incredibly thankful to my surgeon, who was straightforward and treated me like an educated/informed patient. Once I was able to get to him (no thanks to the medical system here) he recognized the urgency of the situation and got me scheduled for surgery incredibly quickly.

My wife has been very supportive but also upset about access to medical care here. When we first moved to the US in the 1990s she had a number of situations where lack of direct access to specialists led to unnecessary delays in treatment. Before moving back to the US again a year or so back, we lived in Japan for about 10 years. If this had happened there, I would have walked right into an ENT clinic the first day I noticed something wrong, would have been seen within an hour, then referred directly to the closest prefectural or university hospital, probably being seen by an otologist or neurotologist within a day and likely surgery within a few days after that. It would have cost less than what my copay was here, as there's a low cap on out of pocket medical costs under the national health insurance system. The total cost for my surgery here was about $20,000 and I had a ~$2,700 copay--a small price for a shot at getting my left ear back. I will say that once I finally got to my neurotologist the care was exemplary.

I won't know much about my recovery progress until I get the plug protecting my incision taken out next week, but I can already "hear" myself chewing food in my left ear, something that I didn't have before. Tinnitus has calmed down compared to last night, though it's still pretty intense. My brain is probably re-habituating to yet another physical ear configuration, so I'm hopeful it will ebb as the days/weeks go by. I think the worst thing right now is a terrible sore throat from being intubated for ~3 hours!

I'll try to give an update after my 1-week post op next week. Fingers crossed that things improve!

 

[2TH DIVR]

DAN should cover any expenses not covered by your insurance.
I lost complete hearing in my right ear due to a ruptured cochlear window.
The only advise was to stop diving.
I still dive.

 

[doctormike]

Thanks @Duke Dive Medicine, I really appreciate you and others providing info. It was your information and previous threads here on SB (I believe some also involving @doctormike) that helped me figure out what was likely going on, giving me the incentive to self-advocate more strongly and with confidence that I was close to the right track.

In the slim literature I could find on barotrauma-related PLF I got the general impression that fistulae are found/confirmed visually in more than half of the cases. I'm incredibly thankful to my surgeon, who was straightforward and treated me like an educated/informed patient. Once I was able to get to him (no thanks to the medical system here) he recognized the urgency of the situation and got me scheduled for surgery incredibly quickly.

My wife has been very supportive but also upset about access to medical care here. When we first moved to the US in the 1990s she had a number of situations where lack of direct access to specialists led to unnecessary delays in treatment. Before moving back to the US again a year or so back, we lived in Japan for about 10 years. If this had happened there, I would have walked right into an ENT clinic the first day I noticed something wrong, would have been seen within an hour, then referred directly to the closest prefectural or university hospital, probably being seen by an otologist or neurotologist within a day and likely surgery within a few days after that. It would have cost less than what my copay was here, as there's a low cap on out of pocket medical costs under the national health insurance system. The total cost for my surgery here was about $20,000 and I had a ~$2,700 copay--a small price for a shot at getting my left ear back. I will say that once I finally got to my neurotologist the care was exemplary.

I won't know much about my recovery progress until I get the plug protecting my incision taken out next week, but I can already "hear" myself chewing food in my left ear, something that I didn't have before. Tinnitus has calmed down compared to last night, though it's still pretty intense. My brain is probably re-habituating to yet another physical ear configuration, so I'm hopeful it will ebb as the days/weeks go by. I think the worst thing right now is a terrible sore throat from being intubated for ~3 hours!

I'll try to give an update after my 1-week post op next week. Fingers crossed that things improve!

Great to hear that you found someone to take care of you, and thanks for the update! Fingers crossed.

There are some conditions where the time window is very important, and I think that it's up to a doc to let their staff know about that. One procedure like that for me is nasal fractures. If you are going to do a closed reduction, you need to do that between day 3 and 12 or so. One frustrating thing that can happen is that a kid breaks their nose playing basketball, the parents call for an appointment and are given a spot a month out. Then they come in and you have to tell them that it's too late to just reduce it, and they are NOT happy. So my staff all knows that nasal fractures get fit in that day.

With dive stuff, there is a similar problem, since even very experienced neurootologists don't see a lot of that, especially if they aren't near a dive location.

The take home is that if you think you have a PLF or you are bent, etc.. .you need to push for early care. I know that there are major barriers to that in the US healthcare system, but you would be surprised what can happen if someone in a position of power understands the urgency of the situation.

 

[crofrog]

Great to hear that you found someone to take care of you, and thanks for the update! Fingers crossed.

There are some conditions where the time window is very important, and I think that it's up to a doc to let their staff know about that. One procedure like that for me is nasal fractures. If you are going to do a closed reduction, you need to do that between day 3 and 12 or so. One frustrating thing that can happen is that a kid breaks their nose playing basketball, the parents call for an appointment and are given a spot a month out. Then they come in and you have to tell them that it's too late to just reduce it, and they are NOT happy. So my staff all knows that nasal fractures get fit in that day.

With dive stuff, there is a similar problem, since even very experienced neurootologists don't see a lot of that, especially if they aren't near a dive location.

The take home is that if you think you have a PLF or you are bent, etc.. .you need to push for early care. I know that there are major barriers to that in the US healthcare system, but you would be surprised what can happen if someone in a position of power understands the urgency of the situation.

I’d be curious how he presented it to the clinic. Sudden hearing loss is a medical emergency and it should be treated as such sometimes the best thing to do is to go a hospital emergency department even though that’s painful experience.

That being said I’m lucky to have 2 of the best university medical systems around with in a 20 minute drive. So my experience might be biased by that fact.

 

[doctormike]

I’d be curious how he presented it to the clinic. Sudden hearing loss is a medical emergency and it should be treated as such sometimes the best thing to do is to go a hospital emergency department even though that’s painful experience.

That being said I’m lucky to have 2 of the best university medical systems around with in a 20 minute drive. So my experience might be biased by that fact.

Right, but the treatment for SSNHL is just steroids and any doc can start that. It's true that there is some evidence that intratympanic steroids (injected into the ear by an ENT doc) may have some advantages, but there is certainly no problem starting with high dose oral steroids while setting up that consult. And there is other evidence that hyperbaric O2 (chamber ride) can help as well!

But of course, the devil is in the details. You wouldn't want to recompress someoene with a PLF. So if you just wake up with a SNHL, yeah, steroids. If you have a sudden hearing loss during a dive, that's probably not the typical auto-immune related SNHL, and you need to see an ENT doc ASAP to make sure it's not barotrauma that needs surgery...

 

[chris_b]

I’d be curious how he presented it to the clinic. Sudden hearing loss is a medical emergency and it should be treated as such

I definitely was very up front that this was a direct result of dive activity. My PCP did give me oral prednisone right away but sort of threw up her hands with the ENT situation as no one her office called would see me right away. The ENT I finally saw clearly had never seen anything like this before and was inclined to just treat it like idiopathic SNHL. When I pushed for moving quickly to surgery he pooh-poohed the idea, saying something like "even if it is PLF I don't think anyone has actually seen one of these fistula in real life." Once I finally got my case in front of the neurotologist it was almost an instant "get him in to see me right now" and once I saw him it was "schedule him for surgery immediately." Probably similar to @doctormike's nasal fracture staff instructions.

In retrospect yes it might have been better to go directly to an ER, but given experiences in the past we expected I'd be triaged into "not openly bleeding or on death's doorstep" and at best sent home with the same corticosteroids my PCP gave me and an ENT referral. Maybe there'd have been a competent ENT on call? Given the lack of specialists here I'm not so sure...the guy who did my surgery is literally the only person in the state qualified to do it (other than potentially military docs).

 

[doctormike]

Maybe there'd have been a competent ENT on call?

I think that the thing is that "ENT" really is a collection of subspecialties. Yes, there are general ENT docs, but for a lot of stuff, we really don't know much about what our colleagues do. There are a lot of things that are definitely done by ENT docs, but not EVERY ENT doc.

I think that I would have about as much success doing a cochlear implant or removing a tongue base cancer as you might. And I doubt that there are many neurootologists who have a lot of practice getting earwax out of a screaming, struggling two year old!

So yes, an acute PLF from barotrauma deserves an exploration, and it's possible that you saw an ENT doc who didn't know that. Hard to say much more than that...

 

[crofrog]

I definitely was very up front that this was a direct result of dive activity. My PCP did give me oral prednisone right away but sort of threw up her hands with the ENT situation as no one her office called would see me right away. The ENT I finally saw clearly had never seen anything like this before and was inclined to just treat it like idiopathic SNHL. When I pushed for moving quickly to surgery he pooh-poohed the idea, saying something like "even if it is PLF I don't think anyone has actually seen one of these fistula in real life." Once I finally got my case in front of the neurotologist it was almost an instant "get him in to see me right now" and once I saw him it was "schedule him for surgery immediately." Probably similar to @doctormike's nasal fracture staff instructions.

In retrospect yes it might have been better to go directly to an ER, but given experiences in the past we expected I'd be triaged into "not openly bleeding or on death's doorstep" and at best sent home with the same corticosteroids my PCP gave me and an ENT referral. Maybe there'd have been a competent ENT on call? Given the lack of specialists here I'm not so sure...the guy who did my surgery is literally the only person in the state qualified to do it (other than potentially military docs).

It’s a sad state of affairs for most patients. One thing to keep in mind is having the physician put in the order with a stat priority for seeing the specialist tend to help move things a long and get you into reserved slots.

 

[duke dive medicine]

It’s a sad state of affairs for most patients. One thing to keep in mind is having the physician put in the order with a stat priority for seeing the specialist tend to help move things a long and get you into reserved slots.

This is a good point and could speed up treatment for divers like the OP who are strong advocates for themselves. It also requires that the provider recognize the urgency of the situation, which doesn't always happen. Connecting providers with experts can be helpful - DAN has physicians on call who can sometimes provide direct consultation with providers who are not trained in diving medicine.

Best regards,
DDM

 

[chris_b]

Giving a bit of a belated update. Coming up on nearly three weeks post surgery now.

The surgery itself went fine. I was asked to show up at 8am with surgery scheduled for 10am. Fasted (not even any water) from 8pm the night before. Unfortunately the surgeon's first case of the day took a lot longer than planned so we got to know one of the nurses very well--he kind of kept us company while waiting. Surgery finally started around 1pm. Had 8mg dexamethasone given via IV a bit before the surgery. I wasn't sure if it was to reduce potential post-operative inflammation or as an anti-emetic. Maybe both? Surgery took just about 2 hours total.

I had originally assumed that the surgeon would be cutting my eardrum to access the inner ear, but it turns out that he cuts into the skin around the eardrum and then sort of lifts the eardrum out of the way. He did find a fistula and leakage from the oval window. Just in case, he grafted patches over both the oval and round windows, taking a couple of patches of skin from inside my outer ear to use for the grafts. Most of this was relayed to me by my wife later as I was pretty out of it after the anesthesia.

The first week after the surgery I had to keep a bunch of what my surgeon referred to as "packing material" in my outer ear to help the incision heal. Put antibiotic drops on it twice a day. Pretty much like having an extremely effective ear plug in my bad ear. Due to no sound coming through, tinnitus was pretty bad, but I was hopeful as I could now hear the movement of my jaw when chewing--that hadn't been something I could hear at all before.

After a week I had a follow-up to take out the packing material. When it all came out it almost felt like I could hear again like before the incident, but it was just perceptual--taking the "plug" out of my ear was such a relief I temporarily felt like I could hear again. Driving home from the clinic I realized the radio in the car sounded about as bad as it did before. However, I do seem to have regained some of the high frequencies. Sounds seem to have a sort of metaIlic ring to them now. Human voices and quite a bit of music is still muffled, but my left ear does seem to be working a bit better.

My surgeon said that it's likely to take several months for improvement to show. I haven't been scheduled for an actual audiogram until late December, but I've been using the Mimi app and my AirPods Pro to do self-administered audiogram testing--I have a bunch of previous testing from before the surgery, so even if the tests may not mean much as an absolute measure, I can at least look at them relative to previous results. From what I can tell, I've regained a bit in the midrange (at the 1Khz band) but still exhibit severe loss at 500Hz. The tinnitus really interferes with my ability to hear the tones for the audiogram measurements.

I do feel like I'm having bits and pieces of improvement here and there, kind of two steps forward one step back. I applied my audiogram to my phone's audio settings and used that to set up my left AirPod in transparency mode. Crank up the gain and it's sort of like a hearing aid. Used it to watch a movie with family a few nights back, and I realized when I went to bed that the tinnitus was greatly reduced. That sort of carried over into the next day but I eventually reverted back to the incessant whine. Gives me hope that things can change, though.