Question Vertigo on Ascent - Stumped

[TMurrr]

Posting for a friend / dive buddy. Yes, we have called DAN. Yes, we have gone through a few months of tests / appointments with a DAN recommended Dr. No, my buddy is not currently diving... The Dr is stumped so we're turning to Scubaboard for help and brainstorming what we can do next. We're also looking into 2nd opinions, obviously.

Also we understand that none of any of the comments or posts are to be considered 'medical advice' and we will of course consult with a medical professional specializing in the area of need blah blah blah. Throw your ideas out there, share your own personal experiences please and hopefully we can become a little more educated and solve this with our medical team.

In summary, my dive buddy has always had the vertigo problem to a minor degree. But on ascent, they get varying severities of vertigo. It doesn't happen every dive and the severity differs every dive. My buddy has ~50-60 dives over 3ish years of diving. The last major incident before the fins were 'hung up' was a highly stressful incident for the diver in ~15 feet of water. Stress was introduced unnecessarily out of my buddies control. Details are unnecessary and will not be provided, but the result left my buddy spinning in a state of the worst vertigo experienced to date and in need of a shallow water rescue. Thankfully, there was another (competent) instructor in the water immediately on hand who thankfully took over and handled the situation.

We've since contacted DAN and gone to a well known ENT in the area at a prestigious medical institution. Scans have been done and that particular ENT did not see anything wrong with the inner ear. Inner ears are usual contributing cause for vertigo. Hearing was checked, my buddy is in the top 99% of ability to hear, so we were able to rule out hearing loss definitely. Vertigo only appears during diving and is isolated to ascents, not descents.

One particular detail that stuck out to me is my buddy is unable to equalize both ears at the same time, so while descending they equalize one ear at a time. As a non-medical professional myself, I suspect the uneven equalizing on descents may contribute somehow to the vertigo on ascent? Not sure how/why, but just my suspicion.

Our questions:

What do we do next?

What questions do we ask the next Dr we see?

What questions do we ask our current specialist?

Anyone ever hear of similar symptoms and how was it resolved/not resolved?

Really stumped and at a loss, so anything helps at this point. We just want to solve the underlying root cause and safely get back in the water.

 

[MAKO Spearguns]

The vertigo is caused by one ear venting on ascent. For some reason, unequal pressure on descent does not cause vertigo (or only mild) while it can be much more intense on ascent and especially in shallow water. Freedivers have little choice to ascend, but scuba divers can monitor the feeling of pressure in the ears and at the first sign of problem, they can stop and redescend a few feet until the feeling subsides.

Then a super gentle attempt to equalize and open the tubes and then try to very slowly ascend.

When one ear is really slow on descent then that is a good reason to suspect that it may be a problem on ascent.

One important thing to realize is that if the descent is so rapid that one side is slow, then this failure to equalize “early and often” may result in stress on the tube and middle ear, which when underpressurized will result in swelling and even if equalization is eventually attained, the diver has compromised that side due to the swelling.

Those are my personal observations and may not be applicable to anyone else. In short, the best prevention is to avoid disequilibrium on descent, don’t get behind, go as slow as you need and be very gentle with your ears, because pushing it makes it worse not better, and have enough gas to allow yourself to do a very slow ascent. One technique if the diver can not seem to get up, is to remove the mask and blow their nose. Sometimes this helps me when on scuba.

 

[Duke Dive Medicine]

Posting for a friend / dive buddy. Yes, we have called DAN. Yes, we have gone through a few months of tests / appointments with a DAN recommended Dr. No, my buddy is not currently diving... The Dr is stumped so we're turning to Scubaboard for help and brainstorming what we can do next. We're also looking into 2nd opinions, obviously.

Also we understand that none of any of the comments or posts are to be considered 'medical advice' and we will of course consult with a medical professional specializing in the area of need blah blah blah. Throw your ideas out there, share your own personal experiences please and hopefully we can become a little more educated and solve this with our medical team.

In summary, my dive buddy has always had the vertigo problem to a minor degree. But on ascent, they get varying severities of vertigo. It doesn't happen every dive and the severity differs every dive. My buddy has ~50-60 dives over 3ish years of diving. The last major incident before the fins were 'hung up' was a highly stressful incident for the diver in ~15 feet of water. Stress was introduced unnecessarily out of my buddies control. Details are unnecessary and will not be provided, but the result left my buddy spinning in a state of the worst vertigo experienced to date and in need of a shallow water rescue. Thankfully, there was another (competent) instructor in the water immediately on hand who thankfully took over and handled the situation.

We've since contacted DAN and gone to a well known ENT in the area at a prestigious medical institution. Scans have been done and that particular ENT did not see anything wrong with the inner ear. Inner ears are usual contributing cause for vertigo. Hearing was checked, my buddy is in the top 99% of ability to hear, so we were able to rule out hearing loss definitely. Vertigo only appears during diving and is isolated to ascents, not descents.

One particular detail that stuck out to me is my buddy is unable to equalize both ears at the same time, so while descending they equalize one ear at a time. As a non-medical professional myself, I suspect the uneven equalizing on descents may contribute somehow to the vertigo on ascent? Not sure how/why, but just my suspicion.

Our questions:

What do we do next?

What questions do we ask the next Dr we see?

What questions do we ask our current specialist?

Anyone ever hear of similar symptoms and how was it resolved/not resolved?

Really stumped and at a loss, so anything helps at this point. We just want to solve the underlying root cause and safely get back in the water.

@MAKO Spearguns is referring to alternobaric vertigo; given your description it seems like this would be high on the differential. How quickly does the vertigo resolve, and does your buddy do anything to help get rid of it?

Best regards,
DDM

 

[tursiops]

Posting for a friend / dive buddy. Yes, we have called DAN. Yes, we have gone through a few months of tests / appointments with a DAN recommended Dr. No, my buddy is not currently diving... The Dr is stumped so we're turning to Scubaboard for help and brainstorming what we can do next. We're also looking into 2nd opinions, obviously.

Also we understand that none of any of the comments or posts are to be considered 'medical advice' and we will of course consult with a medical professional specializing in the area of need blah blah blah. Throw your ideas out there, share your own personal experiences please and hopefully we can become a little more educated and solve this with our medical team.

In summary, my dive buddy has always had the vertigo problem to a minor degree. But on ascent, they get varying severities of vertigo. It doesn't happen every dive and the severity differs every dive. My buddy has ~50-60 dives over 3ish years of diving. The last major incident before the fins were 'hung up' was a highly stressful incident for the diver in ~15 feet of water. Stress was introduced unnecessarily out of my buddies control. Details are unnecessary and will not be provided, but the result left my buddy spinning in a state of the worst vertigo experienced to date and in need of a shallow water rescue. Thankfully, there was another (competent) instructor in the water immediately on hand who thankfully took over and handled the situation.

We've since contacted DAN and gone to a well known ENT in the area at a prestigious medical institution. Scans have been done and that particular ENT did not see anything wrong with the inner ear. Inner ears are usual contributing cause for vertigo. Hearing was checked, my buddy is in the top 99% of ability to hear, so we were able to rule out hearing loss definitely. Vertigo only appears during diving and is isolated to ascents, not descents.

One particular detail that stuck out to me is my buddy is unable to equalize both ears at the same time, so while descending they equalize one ear at a time. As a non-medical professional myself, I suspect the uneven equalizing on descents may contribute somehow to the vertigo on ascent? Not sure how/why, but just my suspicion.

Our questions:

What do we do next?

What questions do we ask the next Dr we see?

What questions do we ask our current specialist?

Anyone ever hear of similar symptoms and how was it resolved/not resolved?

Really stumped and at a loss, so anything helps at this point. We just want to solve the underlying root cause and safely get back in the water.

Seek out an ENT who is a scuba diver.

 

[TMurrr]

@MAKO Spearguns is referring to alternobaric vertigo; given your description it seems like this would be high on the differential. How quickly does the vertigo resolve, and does your buddy do anything to help get rid of it?

Best regards,
DDM

Great questions, passing along and will report back.

Seek out an ENT who is a scuba diver.

We did. DAN provided us a list of medical doctors in the area, and somehow we got one of their partners who is not a scuba diver. The medical office isn't allowing us to change specialists... its frustrating. I used Scubaboard as a tool, searching the Dr's names to investigate previous divers experiences with them.

 

[tursiops]

Great questions, passing along and will report back.


We did. DAN provided us a list of medical doctors in the area, and somehow we got one of their partners who is not a scuba diver. The medical office isn't allowing us to change specialists... its frustrating. I used Scubaboard as a tool, searching the Dr's names to investigate previous divers experiences with them.

Start over if necessary. You NEED a diver.

 

[jmark18]

You don't need a diver just someone with common sense. I had the same problem when I started diving. It was totally caused by unequal pressure in the middle ears on ascent. Resolution was by a slow ascent so that both sides could equalize the pressure.

 

[JMBL]

My experience : vertigo on ascent is rather not uncommon to me, while diving in cold water (meaning 16 to 12°C).

Probable cause : Eustachian tube constricting because of the cold, sinuses as well. So, my ear (the right one) doesn't clear properly.If I keep ascending it becomes painful and vertigo begins.

Solution : gently ascending (10m / min,), stopping if the problem happens, waiting a bit, then ascending again. If no improvement, stopping again, gently blowing my nose. It does the trick.

Prevention : rinsing my nose with saline before the dive. It helps a lot.

Had the problem for more or less 35 years, never prevented me from diving. Puzzling and worrying the first time, but manageable even on trimix dives or cave diving reverse profile.

 

[TMurrr]

Finally got a response:

@MAKO Spearguns is referring to alternobaric vertigo; given your description it seems like this would be high on the differential. How quickly does the vertigo resolve, and

"Between 3s-60s, its gotten longer and more aggressive as I've gotten older"

does your buddy do anything to help get rid of it?

"I stare at the ground, I find a piece of coral and stare at it as well as monitor my depth because sometimes I start to breathe faster"

Best regards,
DDM

Bear in mind I did not share the description of alternobaric vertigo with my buddy before asking her your questions.

My experience : vertigo on ascent is rather not uncommon to me, while diving in cold water (meaning 16 to 12°C).

Probable cause : Eustachian tube constricting because of the cold, sinuses as well. So, my ear (the right one) doesn't clear properly.If I keep ascending it becomes painful and vertigo begins.

Solution : gently ascending (10m / min,), stopping if the problem happens, waiting a bit, then ascending again. If no improvement, stopping again, gently blowing my nose. It does the trick.

Prevention : rinsing my nose with saline before the dive. It helps a lot.

Had the problem for more or less 35 years, never prevented me from diving. Puzzling and worrying the first time, but manageable even on trimix dives or cave diving reverse profile.

All of our diving is here in sunny South Florida, or closer to the equator. But noted on gentle ascending and rinsing and blowing the nose! I'm sensing a theme that my buddy needs to pay more attention to equalizing and slow ascents.

 

[tursiops]

I'm sensing a theme that my buddy needs to pay more attention to equalizing and slow ascents.