Vertigo last dive trip - could it come back?

[mbs]

On a trip to LCBR this past October I had a bout with vertigo. I had a little bug before I arrived so I was stealing the wife's Alegra-d's which I continued the whole week. Anyway, dives the first day went great, no problems equalizing. I believe the 2nd day after coming up from the 3rd dive I felt dizzy on the boat and it continued throughout the evening. Was fine in the morning so I went diving. After coming up from the 2nd dive I was dizzy again and I blew off the 3rd dive and decided to take the next day off. As an aside LCBR is no place to be if you are not diving It was me and one other guy who was locked out from diving for a couple of days. Anyway I was fine all day so the next morning I went out again. I think I was fine the 1st and 2nd dives and the 3rd dive I came up and drank a glass of water and walked down and hurled in the head. Dizziness was super bad all afternoon and night and since it was still there in the am I blew off diving even though it was the last day. All this time my ears actually felt fine and I did not have any issues clearing. But I decided since I had to fly the next day I would get it looked at. So off to the clinic I went. The nurse checked my ears and said they looked perfectly fine. So she called the MD on Brac and prescribed some stuff for the nausea and dizziness and some actifed.
I returned home and in a couple of days all the symptoms were gone.
So now the question I have is does this sound like a 1-off or should I be concerned it might return the next time I dive??? I have my annual next month and will probably mention it to my Dr, but was curious what you all think?

 

[TSandM]

I don't know what the profiles were that you were diving, but I'd be a little bit worried about Type II DCS with that story.

You can certainly get alternobaric vertigo, if one ear equalizes faster than the other one, and it's apparently most common on ascent. But to have it happen when you are completely unaware of any difficulty equalizing seems odd, and having it persist long after being back on the boat seems odd as well.

You can, however, get vertigo as a result of DCS, and the fact that it was aggravated by each additional day of diving would certainly be consistent with that.

 

[mbs]

DCS did cross my mind, but I really assumed it had something to do with the bug I had earlier. The diving was VERY easy and my profiles were very conservation - 1st dives max 100ft, 45+min si, 2nd dives 60ft, 2-3hrs si for lunch and 50ft 3rd dive. My computer is not showing any fast ascents. For some reason the nurse and Dr did not think DCS although they did question me on diving and hydration. The Dr said it could possibly be something going on further down in the tubes. If was DCS would it have worsened flying? It did not.

 

[Duke Dive Medicine]

Hi mbs,
A few questions:
1. What was the "little bug" for which you were taking the Allegra, and what symptoms was it causing?
2. Can you give me an exact time line of your dives, your symptom onset, and symptom resolution? For example, you say, "I believe the 2nd day after coming up from the 3rd dive I felt dizzy on the boat and it continued throughout the evening." Please be as specific as you can as to your dives, surface intervals, and the appearance and resolution of your symptoms. For example, note whether you noticed the dizziness immediately on surfacing, while climbing the ladder, while removing your gear, etc. Also note whether the dizziness improved gradually or if it resolved all at once.
3. Can you describe the dizziness? Medically speaking, there's a difference between dizziness, which is more a "lightheaded" feeling, and vertigo, which is the feeling that everything is moving around you.
4. Was the dizziness that you describe accompanied by any other symptoms, i.e. fullness in the ear, tinnitus/ringing in the ears, or loss of hearing?
5. You said that you had no difficulty equalizing. Did you have to put ANY extra effort into clearing your ears, or did they equalize the same as they always do?

 

[mbs]

Unfortunately I didn't log the details at the time, only when I got home so I'll do my best... The immediate week before diving I felt like I had a cold or flu coming on. Chest congestion, very low fever. But it went away and I just had some minor cold symptoms - slight nasal drip. So I started on the alegra-d(24hr) Saturday morning before flying to the caymans. Sunday dive1 95' for 51min, si 47mins, dive2 58' for 59mins, si 2.5hrs, dive3 50' for 57mins - no symptoms. Monday's dives almost identical to Sunday - no symptoms. Tuesday dive1 101' for 54mins si 45mins, dive2 59' for 60mins, si 2:45mins, dive3 56' for 55mins, I didn't feel anything on the dive, but when boarding I felt dizzy. Not room spinning, more like equalibrium off. Definitely wobbly walking around the rest of the afternoon and night. Real bad when eyes closed especially showering. Sitting or lying down I was fine. Woke up Wednesday with no symptoms, but decided to take the day off assuming I had something going on in my ears. Thursday dive1 102' for 52mins, si 52mins, dive2 felt nausea when I entered the water, but it cleared and I continued the dive, 58' for 59mins. When I got up the ladder the nausea was back and the dizziness was back. I skipped the 3rd dive and the dizziness was real bad all afternoon and evening. Still not room spinning, but I really needed the handrails to keep on a straight path! In the morning it was a bit better, but definitely still there. That morning I also felt a little stuffiness in my left ear, but not that much. So dizziness and nausea impoved slowly each time, not suddenly. I really don't recall having any more trouble equalizing than usual. The nurse gave me a shot of stemetil which cleared the nausea almost immediately. The dizziness continued throughout the day although it was improving. The following morning(saturday) I still had a bit of dizziness and we flew home. Sunday I still had a little dizziness, but much less and by Monday morning it was pretty much all gone.

 

[terrylowe]

To answer your question..."can it come back"? We don't know. Assuming it was NOT a CNS hit, and just "benign positional vertigo", it can be quite unpredictable. I had a personal problem riding the same roller coaster over and over at Sea World. Felt good until the last ride and then had vertigo for a week. Think I shook a labyrinth screw loose. I have not had another attack like that in the last 10 years although I do seem to get boat sick a little easier now. Almost everything can be blamed for it, including having a cold, but we often don't know what causes it.
I am a family doctor and the ENT and Neurology docs don't really like getting a "dizzy" referral in my hometown as it can be frustrating for the patient AND the docs.

 

[mbs]

Thanks Terry... Assuming it was not DCS I guess I was fishing for is there anything an ENT could look for that might indicate further problems. I really dont want to start a roller coaster (sorry for the coaster reference ) of tests at this point. I am interested if there is anything I described that would either point to DCS or discount it... Actually when I first posted i wasn't thinking DCS, but TSandM has me wondering. I'll certainly ask my internist to prescribe something in case it should ever reoccur!

 

[Duke Dive Medicine]

Hi mbs,
DCS would not be my first thought in your case, because each time your symptoms resolved spontaneously within a day or so, even after multiple recurrences. If it was vestibular or neurological DCS, I wouldn't expect it to improve that quickly, especially without treatment. I would rule out inner ear barotrauma for the same reason. Benign positional vertigo like Terry mentioned is a possibility, but your symptoms appear to be correlated with diving. Since you had some cold symptoms before diving, your Eustachian tubes were likely irritated and even though you reported no difficulty clearing, my guess is that the air going in and out, possibly coupled with contact with salt water, inflamed them just enough to cause some alternobaric vertigo like Lynne suggested initially. My feeling is that you won't have any more problems.

That said, if you DO encounter similar symptoms the next time you dive, especially in the absence of any sinus issues, seek medical attention and do not dive again until you figure out what's going on.
Best regards,
DDM

 

[TSandM]

Thank you, DDM! When it comes to what's DCS and what's not, your opinion is FAR more valuable than mine

 

[mbs]

ALL of your opinions are valuable folks!!! I really appreciate everyone taking the time to comment! Next dives will be a tune up or 2 at Dutch Springs and then Bonaire in May with hopefully no reoccurrence Happy holidays.