Trouble focusing vision after some dives

[SomeGuy509]

Hi all,


This is long so tlr at the end

I'm totally in love with the sport but I have been having some problems.

On one of my open water checkout dives I had issues equalizing. After some trying I thought I had equalized but turns out I didn't and instead ended up with classic barotrauma.

I had fluid in the ears but it eventually cleared up after a week. However I had an ongoing combination of dizziness and difficulty focusing my vision for the next 1-2 months.

Fast forward and I went on another trip, and another barotrauma. Obviously I'm doing something wrong here. Not as bad as the first, fluid cleared up after a day but had issues with difficulty focusing vision. Doctor puts me on antibiotics saying I may have a bit of bppv. Also recommended I take Flonase, claritin for two days before diving and take Sudafed 12h the day of.

Next trip no issues.

Another trip, little tricky to equalize again but I was certain I was ok. On the ascent however I went a bit quick than normal during the last 5-10ft. I got very dizzy on the ascent but was fine afterwards. Been having trouble focusing my vision for about two weeks now.

Tl:dr
Been having issues with clearing ears and and dizziness on ascent. Have trouble focusing vision after some dive trips and it seems to be related to the last 5-10ft of ascent. ENT didn't have a clue and general practitioner said maybe bppv.

Question: What's the mechanism causing the difficult to focus vision and what can I do aside from being even more careful to prevent this?

 

[Duke Dive Medicine]

Hi all,


This is long so tlr at the end

I'm totally in love with the sport but I have been having some problems.

On one of my open water checkout dives I had issues equalizing. After some trying I thought I had equalized but turns out I didn't and instead ended up with classic barotrauma.

I had fluid in the ears but it eventually cleared up after a week. However I had an ongoing combination of dizziness and difficulty focusing my vision for the next 1-2 months.

Fast forward and I went on another trip, and another barotrauma. Obviously I'm doing something wrong here. Not as bad as the first, fluid cleared up after a day but had issues with difficulty focusing vision. Doctor puts me on antibiotics saying I may have a bit of bppv. Also recommended I take Flonase, claritin for two days before diving and take Sudafed 12h the day of.

Next trip no issues.

Another trip, little tricky to equalize again but I was certain I was ok. On the ascent however I went a bit quick than normal during the last 5-10ft. I got very dizzy on the ascent but was fine afterwards. Been having trouble focusing my vision for about two weeks now.

Tl:dr
Been having issues with clearing ears and and dizziness on ascent. Have trouble focusing vision after some dive trips and it seems to be related to the last 5-10ft of ascent. ENT didn't have a clue and general practitioner said maybe bppv.

Question: What's the mechanism causing the difficult to focus vision and what can I do aside from being even more careful to prevent this?

Hi @SomeGuy509 ,

Middle ear barotrauma is the most common injury in diving. Your persistent symptoms afterward are a bit worrisome though. Can you describe what you mean by dizziness? Are you experiencing vertigo, i.e. the feeling of movement even when you're not moving? Also, can you describe the difficulty focusing your vision? Is your vision cloudy,
or are you having double vision? Please provide details.

Best regards,
DDM

 

[SomeGuy509]

Certainly,

The dizziness feels a little bit like when you stand up after a long time and you feel a bit light headed. Sometimes you just need to reach your hand out a grab something for bit of extra stability.

The vision is more reminiscent of if you were staring off into space or something like that. For example I was trying to solder some small wires last night on a project I was working on and it felt like I had less than normal depth perception. I had a lot of trouble lining the wire up with the solder terminal. Maybe a little bit of double vision then in?

The issues seem to be bit more prevalent when I'm up and walking around. If I'm sitting it gets a bit better and if I lie down on my back the symptoms pretty much disappear.

 

[Duke Dive Medicine]

Thanks for the details. From your description it sounds like you may have injured your inner ear but other pathologies can't be ruled out. You've already seen an ENT but I'd recommend you see one who specializes in diving injuries. What part of Connecticut are you in?

 

[SomeGuy509]

I'm in the Hartford area.

I actually contacted DAN regarding this a when it occurred a few months back and they suggested I get in touch with the Hyperbaric unit at Hartford hospital and ask for a referral. They also suggested the Norman Knight Hyperbaric unit at Mass Eye and Ear.

I've been reluctant to do anything because:
A:it cleared up by mostly by itself ultimately
B:My prior experience with the ENT was a total waste of time and money.
C:I've had successful dives where the symptoms did not appear afterwards (slow decent and really, really dragging out the last 5ft of ascent. That last 5ft I can really hear the air escaping the middle ear)
D: My insurance is awful so I'm paying every penny (see above about wasting time and money).

That said if I can be convinced that the person/or I am seeing is knowledgeable and will actually take the time to figure this out I'll make the commitment on my end to go. Inner ear issues are no joke and I certainly don't want to deal with anything long term.

I really appreciate you taking the time to reply back. This community is great.

 

[SomeGuy509]

I did some googling to see if the symptoms I think I have might relate to anything.

This page caught my attention:

Symptoms

If it helps narrow things down I've had most of the symptoms under vision, and several of the ones under hearing or cognitive over the time I've been dealing with these episodes

I guess the real thing I need to figure out is who to go see to get an in person diagnosis.

 

[Duke Dive Medicine]

That's what I was going to recommend - contact a local hyperbaric unit and see if they have an ENT they refer to regularly. Jacobi in NYC still does 24/7 emergencies and divers so they might be an option if you can't find somebody closer.

If your symptoms resolved quickly, i.e. within a few minutes of surfacing, maybe after drinking liquid, I would say that you were probably experiencing alternobaric vertigo. It happens when one middle ear equalizes but the other doesn't - this produces unequal pressures in the middle ears and can result in vertigo. ABV is usually transient, though. The visual symptoms are interesting - there are a couple of case reports of visual disturbances (up to and including temporary blindness) in divers, and several in mountaineers and aviators, related to a bony dehiscence in the sphenoid sinus which exposes the optic nerves to pressure changes in the sinuses.

Just from what you've described, I don't think that inner ear barotrauma can be ruled out. The fact that the symptoms have resolved each time is reassuring, but if this is inner ear barotrauma that you're experiencing over and over, you could be risking permanent damage. I also wonder if you may have some anatomic anomalies that make it difficult for you to equalize - Eustachian tube stenosis is a possibility. I'll tag @doctormike here, he is an ENT and also an avid technical diver. I saw he was on when I signed in, maybe he has some ideas as well.

Best regards,
DDM

 

[doctormike]

Basically, I agree (as I almost always do!) with DDM. It's worth getting checked out, and for inner ear issues I would do a regular ENT exam and an audiogram. If those are normal, it's less likely that there is any sort of inner ear pathology causing recurrent labrynthine injury. Antibiotics aren't used to treat BPPV, and nasal steroids don't really affect ET function.

The focusing thing is less likely to be related to a labyrinthine pressure injury. Altenobaric vertigo is a reasonable possiblity, and any sort of dizziness can give the impression of transient visual changes, although usually it's subjective environmental motion rather than a true focus issue. Are you taking any sort of medication? Some things taken for seasickness can cause focusing issues. Don't focus (hah!) just on the visual issues, remember that a good medical evaluation is important too. There is a long list of things that can cause the sort of symptoms that you describe, and they are not all related to the eyes or ears.

How was the barotrauma diagnosed? By exam? Audiogram? Tympanogram?

It might be worth calling that hyperbaric unit to see if they think it would be worth the time and expense to arrange for a consultation...

 

[SomeGuy509]

Thanks for all the replies. Work got super busy so I haven't had time to reply.

Vision is still a bit weird. It's frustrating for sure. It is significantly worse walking through a store or somewhere indoors. Outside it's not much of an issue. Sometimes I feel my balance is a little weird as well, especially in the dark.

The very first barotrauma was diagnosed when the doctor saw fluid behind the ear drum. Since it was withing 1-2 days of the dive it was probably a walks like a duck quacks like a duck sort of thing.

The first time I went to go and see an ENT (zero knowledge of dive medicine) was back in early June 3-4 weeks after the second injury. They did an audiogram and a pressure test. The audiogram showed a slight reduction in the left ear but nothing outrageous. I'm struggling to remember right now if the first and second injury were on the same ear. The right is definitely more troublesome to equalize, but the left had the hearing reduction... Pressure test showed the typatic membrane had plenty of mobility.

I've managed to schedule an exam with a local ENT who has some knowledge of dive medicine (he is listed with DAN). Unfortunately I can't get in for another 3 weeks. My general practitioner also wants a CAT Scan as he thinks there could be a benign tumor causing some sort of issue.

I've never had any trouble with seasickness and don't take medication for it. In fact I love being out on the boat. I'm pretty sure I've felt alternobaric vertigo before. Have had it happen within a few feet of surface where everything just starts spinning. It clears up quickly though.

I am currently on 12h sudafed (2x daily), 24h Claritin (1x daily), Nasal Spray (1x Daily), Amoxicillin (875mg, 2x daily). On my 7th of 10 days per my doctors orders. This is pretty much exactly how he treated it after the second injury.

 

[SomeGuy509]

Update

Met with a DAN recommended ent today.

Went through another audiogram, no delta between this and the previous one so no hearing issues.

They put me through a series of balance test such as tracking moving objects on a screen, tilting my head to the side and also applying hot air to each ear to induce dizziness. That all came back as normal as well.

Expecting a call from the doctor tomorrow to go over all this. He was thinking fistula so curious what these results will indicate.