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Not all EADs function In the last few years the occurrence of isolated inner ear well in a hyperbaric environment and Acott provides decompression illness (IEDCI) in recreational divers considered advice on which gear to carry and a protocol for breathing air has been clearly established as nothing like management. May it never happen! as rare as previously thought. Several articles and reprints on this subject have appeared in past issues of this journal, The new in vitro models for studying skin growth and its including modelling of the pathophysiological processes components, reviewed by Malda and his colleagues, have that may be involved and the possible link with patent great potential for enhancing our understanding of the role foramen ovale. All these pertinent references are listed in of hyperbaric oxygen in wound healing. Submission of this Richard Smerz’s article and are not reproduced here. The review article arose from a chance discussion following Hawaiian series of 28 presentations of isolated IEDCI is a presentation given by Malda at the 2006 meeting of well documented and provides only the second series of the Hyperbaric Technicians and Nurses Association; an any size in the literature.1 example of the importance of interaction between the various professional groups involved in hyperbaric medicine. Smerz has gone to considerable lengths to develop a database incorporating one of the largest reported series (1,422 patient Those of us who treat divers with the ‘bends’ are very records) of decompression illness in recreational divers. The aware of the potential for post-injury stress reactions in total series is summarised in a recent paper, in which he these patients. Unfortunately most go their own way after argues for the effectiveness, compared with other reports, discharge and are lost to follow up; a few go on to have of the ‘deep spike’ Hawaiian treatment tables.2 However, long-term problems. This was highlighted many years ago all case series differ and similar results have been achieved in a paper from the Auckland chamber.3 The impact of a by some other centres with shallow oxygen tables, though diving accident on those involved, other than the victim, many hyperbaric units using tables such as the US Navy has been given little consideration in the diving medical Table 6 alone have reported substantially poorer outcomes literature. The case report by Ladd is thus important in than those of the Hawaiian unit. Many chambers treating highlighting this issue and describing how one such incident divers do not have the pressure capability to emulate these was successfully treated. deep tables, which include pulls to as deep as nearly 70 metres at the start of treatment. This journal issue should reach readers about a week before the Annual Scientifi c Meeting in Tutukaka, New Zealand; It will remain diffi cult to show that such treatments, heavy just enough time to down tools at short notice and head on manpower and potentially carrying additional long-term across the Tasman or into the Southern Ocean from the occupational risk for attendants, are indeed more effi cacious North and participate in what will be an excellent week in than shallow oxygen tables, unless units with similar depth all respects. An exciting conference programme has been put capabilities combine their resources to conduct a prospective together and the surroundings and diving are outstanding. randomised study. Since chambers with such capabilities See you there! If not, then plan now to attend the 2008 tend to opt for going deeper, e.g., Comex 30 treatment table, ASM in Papua New Guinea, for which Chris Acott is the in severe cases anyway, the ethics of such a randomised trial Convenor. of deep mixed-gas versus shallow oxygen treatment tables would be problematic. Michael Davis Intuitively it may come as little surprise that navy divers References tend to have personality traits indicative of more thrill and adventure seeking than other groups as reported by van Wijk. 1 Nachum Z, Shupak A, Spitzer O, Sharoni Z, Doweck Does this have potential to help in the selection process for I, Gordon CR. Inner ear decompression sickness in military diving training or in predicting those candidates sport compressed-air diving. Laryngoscope. 2001; who are likely to successfully complete such training? 111: 851-6. This would then be a potentially useful tool. One wonders 2 Smerz RW, Overlock RK, Nakayama H. Hawaiian what this might have to do with completing the ‘mud run’ deep treatments: effi cacy and outcomes, 1983-2003. in Auckland Harbour as an RNZN diver, but one could Undersea Hyperb Med. 2005; 32: 363-73. certainly put this down to ‘experience’, though not one to 3 Sutherland A. Diving accident cases treated at HMNZS be actively sought after. Philomel in 1988. SPUMS J. 1990; 20: 4-5. Chris Acott completes his review of extraglottic airway devices (EADs) in the acute resuscitation of swimmers and Up close and personal. Front cover photo taken by Dr divers with a look at one of the most challenging, if not Martin Sayer in Benga Lagoon at the Fiji ASM 2006. 2 Diving and Hyperbaric Medicine Volume 37 No. 1 March 2007 Original articles A descriptive epidemiological analysis of isolated inner ear decompression illness in recreational divers in Hawaii Richard W Smerz Key words Decompression illness,decompression sickness. inner ear decompression illness, inner ear decompression sickness, treatment, epidemiology Abstract (Smerz RW. A descriptive epidemiological analysis of isolated inner ear decompression illness in recreational divers in Hawaii. Diving and Hyperbaric Medicine. 2007; 37: 29.) Inner ear decompression illness (IEDCI) was once thought to be relatively rare and seen predominantly in deep, mixedgas divers. The incidence of this type of injury is unknown, but IEDCI may be more common than previously thought and can be seen in recreational scuba divers using compressed air as their breathing medium. This study was conducted at the Hyperbaric Treatment Center (HTC) in Honolulu, Hawaii, to determine the frequency of occurrence of IEDCI and to evaluate some of the epidemiological parameters associated with these cases. Between 1983 and 2006, 28 presentations (2.8% of all cases of decompression illness treated) with a diagnosis of isolated IEDCI were identifi ed in 26 divers. Presenting symptoms and physical fi ndings included vertigo, nausea, postural imbalance, vomiting, nystagmus, hearing loss, and tinnitus. Most cases developed after multiple deep dives or after dives in which adequate decompression did not occur. All but two divers were breathing air. Symptoms developed on average 70 minutes after diving. The average delay to treatment was nine hours post injury. All but three cases were treated using the HTC deep treatment tables. Nineteen cases made a full recovery, with all cases achieving substantial improvement. Most cases required four to fi ve treatments to obtain that level of recovery.