Hey All,
I'm hoping there might be some ENT or cardio docs on here who also specialise in (or at least know about) diving medicine too, who might be able to help me triage and differentiate between possible sinus or ear issues (barotrauma related), versus inner ear dcs i.e bubbles being shunted to the inner ear. There are no ENT docs in my country that also specialise in diving medicine (that I've been able to find). I've been fighting this issue for some time, but it's getting too frequent to ignore now, however I'm not really getting any meaningful advice from local doctors on which path to go down for further investigation for the above reasons.
The issue:
Basically, a few hours after surfacing from a single salt water (open water) dive within recreational limits, I start to get a hissing / ringing that feels like it's coming from deep within my head, not quite the same as tinnitus, for the record. Sometimes it doesn't appear until the next day, and it's usually accompanied by mild nausea. It normally takes a week or two of abstinence from diving to get better. It doesn't necessarily happen on every dive, but I'd say it happens more often than not, and is causing me to not be able to dive. If I try to continue to dive the issue progresses over a week or so to include muscle twitching around my right eye / temple, which also causes a little vision wobble on that same side. I can also sometimes get what can be described as a "wet feeling" somewhere deep inside my ear, but when my ears are examined, there's no sign of blood or fluid behind my tympanic membrane.
On the dive:
No real issues to report, occasionally some minor frontal sinus equalisation issues on the way down, which a (gentle) Valsalva maneuver resolves. There's certainly no pain and my ears feel like they are equalising properly. On the slow ascent, my nose tends to feel a little "clogged" but other than that, nothing to report. My Surface GF is normally 50% or less, even as low as 0% after hanging around in the shallows to off gas, and I'm not conducting any saw tooth silly-ness on my profile. I'm already diving Nitrox 32% on all of my dives.
My physiology / tests:
1 - I do have a PFO, diagnosed by TTE, I ordered the test as a direct result of having issues from diving (so no stroke that I am aware of, and no migraines etc.). I've never had any skin bends, or signs of embolism etc. I have had type 1 DCS on at least one occasion, which was resolved by one table 5 session in the hyperbaric chamber.
Here are the findings of the TTE
2 - I have a moderately deviated septum, with some other issues such as chronic sinusitis. I've consulted with a couple of non diving ENTs, but I'm being warned away from correcting it due to the risk of Empty Nose Syndrome. ENTs have checked my middle ear / tympanic membrane numerous times, and I'm always told it's unremarkable / in excellent condition with no signs of middle ear barotrauma. Here are the findings from my latest (recent) Paranasal CT scan (of which I also have the images I can share if needed):
My question / discussion is, how do I approach this to try and differentiate which of these are causing my issues? On one hand I'm being told that PFO closure is only really considered if there is a risk of stroke (or already had a stroke?) or, if it's been proven to be the cause of DCS, but on the sinus side, I'm being told that since my sinuses are not giving me any obvious issues outside of diving (like sleep apnea or headaches etc.) that it's not worth the risk of causing Empty nose syndrome. I've already had a type II sleep study which was looked at in detail and confirmed no apnea. I'm unsure if either of those findings (either the bubble study, or the paranasal CT scan) are anything to raise eyebrows at when it comes to diving, in particular the CT scan?
Since this issue only occurs after diving, I cannot think of anything else that might causing the ringing / hissing with nausea, besides either the PFO shunting bubbles to my arterial network which then travels to the inner ear, or, some kind of barotrauma issue which I'm not aware of due to the lack of discomfort.
More than happy to have a more detailed discussion in PM regarding cardio or ENT, the specialist in that field, if that's helpful.
Note, this is not me asking for random peoples advice on an internet forum, however I do know that some specialists frequent this forum, who might be able to give some insight or advise on a direction, though I can't find the previous topics I was reading where they contributed, hence feel free to tag.
War & Peace novel writing finished
SL
I'm hoping there might be some ENT or cardio docs on here who also specialise in (or at least know about) diving medicine too, who might be able to help me triage and differentiate between possible sinus or ear issues (barotrauma related), versus inner ear dcs i.e bubbles being shunted to the inner ear. There are no ENT docs in my country that also specialise in diving medicine (that I've been able to find). I've been fighting this issue for some time, but it's getting too frequent to ignore now, however I'm not really getting any meaningful advice from local doctors on which path to go down for further investigation for the above reasons.
The issue:
Basically, a few hours after surfacing from a single salt water (open water) dive within recreational limits, I start to get a hissing / ringing that feels like it's coming from deep within my head, not quite the same as tinnitus, for the record. Sometimes it doesn't appear until the next day, and it's usually accompanied by mild nausea. It normally takes a week or two of abstinence from diving to get better. It doesn't necessarily happen on every dive, but I'd say it happens more often than not, and is causing me to not be able to dive. If I try to continue to dive the issue progresses over a week or so to include muscle twitching around my right eye / temple, which also causes a little vision wobble on that same side. I can also sometimes get what can be described as a "wet feeling" somewhere deep inside my ear, but when my ears are examined, there's no sign of blood or fluid behind my tympanic membrane.
On the dive:
No real issues to report, occasionally some minor frontal sinus equalisation issues on the way down, which a (gentle) Valsalva maneuver resolves. There's certainly no pain and my ears feel like they are equalising properly. On the slow ascent, my nose tends to feel a little "clogged" but other than that, nothing to report. My Surface GF is normally 50% or less, even as low as 0% after hanging around in the shallows to off gas, and I'm not conducting any saw tooth silly-ness on my profile. I'm already diving Nitrox 32% on all of my dives.
My physiology / tests:
1 - I do have a PFO, diagnosed by TTE, I ordered the test as a direct result of having issues from diving (so no stroke that I am aware of, and no migraines etc.). I've never had any skin bends, or signs of embolism etc. I have had type 1 DCS on at least one occasion, which was resolved by one table 5 session in the hyperbaric chamber.
Here are the findings of the TTE
2 - I have a moderately deviated septum, with some other issues such as chronic sinusitis. I've consulted with a couple of non diving ENTs, but I'm being warned away from correcting it due to the risk of Empty Nose Syndrome. ENTs have checked my middle ear / tympanic membrane numerous times, and I'm always told it's unremarkable / in excellent condition with no signs of middle ear barotrauma. Here are the findings from my latest (recent) Paranasal CT scan (of which I also have the images I can share if needed):
My question / discussion is, how do I approach this to try and differentiate which of these are causing my issues? On one hand I'm being told that PFO closure is only really considered if there is a risk of stroke (or already had a stroke?) or, if it's been proven to be the cause of DCS, but on the sinus side, I'm being told that since my sinuses are not giving me any obvious issues outside of diving (like sleep apnea or headaches etc.) that it's not worth the risk of causing Empty nose syndrome. I've already had a type II sleep study which was looked at in detail and confirmed no apnea. I'm unsure if either of those findings (either the bubble study, or the paranasal CT scan) are anything to raise eyebrows at when it comes to diving, in particular the CT scan?
Since this issue only occurs after diving, I cannot think of anything else that might causing the ringing / hissing with nausea, besides either the PFO shunting bubbles to my arterial network which then travels to the inner ear, or, some kind of barotrauma issue which I'm not aware of due to the lack of discomfort.
More than happy to have a more detailed discussion in PM regarding cardio or ENT, the specialist in that field, if that's helpful.
Note, this is not me asking for random peoples advice on an internet forum, however I do know that some specialists frequent this forum, who might be able to give some insight or advise on a direction, though I can't find the previous topics I was reading where they contributed, hence feel free to tag.
War & Peace novel writing finished
SL
