Inner Ear Problems

Inner Ear Barotrauma

Straining or a forceful Valsalva can cause rupture of the round or oval window , as first described by Fred Pullen in 1971. This results in a fistula with drainage of fluid into the middle ear, sensineural hearing loss, vertigo, or tinnitus and should be operated upon immediately to correct the fistula. They should not be recompressed if the above symptoms occur during a dive that has not required decompression.

References

Dr. Murray Grossan feels that the best way to diagnose perilymph fistula is as follows:
“I notice that one of the reasons perilymph fistula is missed so often is that the “textbooks” state to use the otoscope and rubber bulb to increase pressure on the middle ear to elicit dizziness. This doesn’t work.

It is actually necessary to use a tympanometer and an experienced audiologist who has done many of these tests. In tympanometry, the ear is sealed and an exact pressure is placed against the ear drum, both positive and negative. By putting excessive pressure – measured by the machine – you
can then determine if dizziness occurs and if you can see nystagmus. I routinely see cases missed because they relied on the otoscope and rubber bulb for the test.”

Inner Ear Decompression Sickness

Here are two references to this entity:
Inner Ear Decompression Sickness (IEDCS)–manifested by tinnitus, vertigo, nausea, vomiting, and hearing loss–is usually associated with deep air or mixed gas dives, and accompanied by other CNS symptoms of decompression sickness (DCS). Early recompression treatment is required in order to avoid permanent inner ear damage. They present an unusual case of a scuba diver suffering from IEDCS as the only manifestation of DCS following a short shallow scuba dive, successfully treated by U.S. Navy treatment table 6 and tranquilizers. This case suggests that diving medical personnel should be more aware of the possible occurrence of IEDCS among the wide population of sport scuba divers. Aviat Space Environ Med 61 (6): 563-566 (Jun 1990)

Inner ear decompression sickness (IEDCS) is one form of Type II decompression sickness. Most cases of IEDCS have been associated with saturation dives, so there are very few reports of occurrence following shallow scuba dives. They present a case of a diver who suffered from IEDCS following a shallow scuba dive (30m), and was successfully treated by the protocol outlined in U.S. Navy treatment table 6. This case suggests that there is the possibility of occurrence of IEDCS, even following a shallow scuba dive, if proper decompression procedures are not adhered to. In addition, detailed analysis of diving profiles should be used to distinguish the inner ear dysfunction seen in some divers from inner ear barotrauma which may be attributable to IEDCS. Nippon Jibiinkoka Gakkai Kaiho 95 (4): 499-504 (Apr 1992).

References for Barotrauma and Sudden Hearing Loss in Divers

Sudden hearing loss in divers and fliers.
Laryngoscope. 1979 Sep; 89(9 Pt 1): 1373-1377.
In our experience immediate surgical exploration and correction of sudden severe or profound sensorineural deafness in the diver or flier is absolutely essential and the excellent results of hearing improvement in this select group certainly corroborates this theory.

Report of an isolated mid-frequency hearing loss following inner ear barotrauma.
Undersea Biomed Res. 1983 Jun; 10(2): 131-134.
A case describing an isolated mid-frequency hearing loss as a result of inner ear barotrauma is presented. The onset of symptoms was insidious but progressed to a profound total-range hearing loss in the right ear. This loss resolved rapidly with cessation of diving activity, bed rest, and head elevation, leaving only an isolated 20-dB hearing decrement at 1000 Hz. Since the diver was participating in evaluation of experimental decompression tables, differentiation had to be made between barotrauma and inner ear decompression sickness.

Sudden sensorineural hearing loss.
Otolaryngol Clin North Am. 1983 Feb; 16(1): 189-195.
Therapy includes efforts to treat known causes either medically or surgically, to keep the patient at reduced physical activity, and depending upon the treating physician’s own preference, attempts to favorably alter the ultimate prognosis through medical manipulation.

[Acute low tone sensorineural hearing loss caused by inner ear barotrauma].
Nippon Jibiinkoka Gakkai Kaiho. 1989 Sep; 92(9): 1381-1388. Japanese.
Inner ear barotrauma and so called labyrinthine window rupture were considered to be one of the diseases needed to differentiate from low tone sudden deafness without reference to mono-attack type or recurrent type.

Sudden sensorineural hearing loss.
Am Fam Physician. 1988 Mar; 37(3): 207-210.
Most patients are ultimately found to have idiopathic sensorineural hearing loss, and the spontaneous recovery rate is high. If no improvement occurs within one month, evaluation to rule out tumor is recommended.

Barotrauma-induced hearing loss.
Scand Audiol. 1991; 20(1): 1-9. Review.
MEBT should be treated by prevention and symptomatically when occurring. A labyrinthine window fistula necessitating surgical repair may be caused by IEBT.

Perilymphatic fistula induced by barotrauma.
Am J Otol. 1992 May; 13(3): 270-272.
Any patient with a history of diving and subsequent sensorineural hearing loss within 72 hours should be suspected of having a round or oval window perilymphatic fistula and surgical exploration and closure of the fistula should be undertaken. Patients who have a loss of hearing, vertigo, nausea, or vomiting followi a decompression dive should be re-compressed and if symptoms do not clear, exploration should be performed. Surgical treatment should be executed as soon as possible after the diagnosis is suspected for the best possible results.

Surgical treatment of long-term sensorineural hearing loss due to labyrinthine fistula.
J Am Aud Soc. 1979 Jul; 5(1): 1-5.
This paper presents the case of a patient whose fistula and resulting hearing loss had persisted ten years before surgical repair. Restoration of normal hearing and discrimination of speech occurred in the ear which had previously presented a severe sensorineural hearing loss with no useful discrimination for speech.

Barotraumatic fracture of the stapes footplate.
Am J Otol. 1996 Sep; 17(5): 697-699.
We believe that early exploration and repair of suspected perilymph fistulae optimises hearing recovery.

Idiopathic sudden sensorineural hearing loss. University hospital experience.
Med J Malaysia. 1993 Dec; 48(4): 407-409.
.The combined regime of bed rest, intravenous dextran 40, vasodilator and steroid therapy produced good improvement in 63.4% of patients. Unfavourable prognostic factors were found to be, hearing loss of more than two weeks duration, vertigo and bilateral hearing loss.

Hearing loss in Australian divers.
Med J Aust. 1985 Nov 11; 143(10): 446-448.
The results of this survey revealed that, even allowing for the very liberal requirements of the Australian Standard for divers, over 60% had unacceptable sensorineural, high frequency deafness.

Sudden hearing loss. Determining the specific cause and the most appropriate treatment.
Postgrad Med. 1989 Aug; 86(2): 125-128. Review. No abstract available.

AUTHOR

Ernest S. Campbell, M.D., FACS

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