Alertdiver47

DirectorDirector TToo YYouou A Year for Ears! DAN AP sees a rise in cases of severe ear problems from John Lippmann OAM ne of the first skills divers Bubbles from decompression can Case 1: This 51-year-old male is learn is how to “equalise” also form in or around the inner ear a divemaster with a history of around O their ears. Failure to and so disrupt its function - inner ear 500 dives. He conducted a single 22m adequately equalise the ears results decompression illness. In addition, a dive during which he had no in ear barotrauma (pressure injury). variety of other non-diving-related noticeable equalisation problems, This is often apparent by a feeling of conditions affecting the ear can cause although at one point he mentioned pressure, soon followed by pain, symptoms in divers during or after a pushing a finger under his hood to during descent (or sometimes ascent). dive. allow water entry. On surfacing and Signs and symptoms associated removing his hood he noticed an echo The most common and usually the with inner ear dysfunction may in one ear, muffled hearing, a buzzing most effective method of equalising include hearing loss, vertigo noise, and very slight dizziness. He involves the diver holding his/her (spinning), dizziness, ringing or other went to a general doctor several nose and blowing gently. This is ear sounds (tinnitus), nausea and hours later and was given known as the “Valsalva Manouvre”. vomiting. decongestants. Still rightly concerned, Although this method is very he consulted a specialist two days Any diver with these signs or effective, damage can occur if it is later and various tests were symptoms after diving should done too vigorously. Overly-forceful conducted. However, by the time the promptly call a DAN-supported diving equalisation should be avoided. diagnosis of inner ear barotrauma emergency hotline for advice. The Other methods include swallowing (IEBT) was made, he sustained doctor or medic will take a thorough (with or without the nose blocked), permanent severe hearing loss and history including the dive profile, the wriggling the jaw, squeezing the tinnitus in the affected ear. mode of equalisation and any tongue against the soft palate, or a equalisation issues, and the time of Case 2: A 34-year-old technical combination of these. Divers need onset and progression of symptoms. diver had completed two deco dives to ensure that whatever technique A suitable course of action will then and surfaced with “a feeling of they use is effective in preventing be determined. fullness in his ears and sinuses”. pressure build-up. Back on the boat when later he An inner ear barotrauma or If the pressure is not equalised, forcefully equalised his ears decompression illness needs to be swelling and bleeding of the lining (valsalva), he heard a loud popping managed swiftly and appropriately to withing the ear will occur, which and felt sudden dizziness and minimise the potential for permanent helps to equalise the pressures and complete hearing loss in one ear. injury. relieve the pain, although this can Believing this not to be serious, he often lead to infection. In some cases Although ear injuries very did not call DAN and remained on the the eardrum can rupture and, in very commonly result from diving, boat for the next 3 days, not diving severe cases, delicate membranes especially with novices, historically, but with persistent hearing loss and within the inner ear can tear, enabling DAN AP has had relatively few dizziness. On returning to Singapore, fluid to leak from the inner ear and Members who sustained severe ear he contacted DAN and was directed creating the potential to damage this injuries. However, this appears to be to a nearby hospital with an Ear Nose delicate organ, possibly affecting changing and over recent years, we and Throat Specialist. A diagnosis of hearing and balance. are receiving an increasing number of IEBT was made and he remained in reports of divers with serious ear hospital for week. However, the injuries. Following are examples of damage was irreversible and he was some very recent cases: left with permanent hearing loss and ringing (tinnitus) in one ear. Alert Diver Asia Pacific 2 Case 3: While on a diving problems. However, about 1.5 hours and certain other disorders, a vacation in the Solomons, this 51- after surfacing, and while having a specialist can make a provisional year-old diver with a history of more hot shower, he suddenly suffered diagnosis and advise the best course than 3000 dives noticed a full feeling severe vertigo (spinning), of action based on the likely problems in one ear, dizziness and hearing loss accompanied by nausea and and the severity of the symptoms. while boarding the boat after the vomiting. He was taken to the local Sometimes permanent injury may be second of two 50-60m navy chamber and he was already unavoidable but on other occasions, decompression stop dives. He inside and receiving treatment by the quick action can minimise the reported that he had no equalisation time DAN was called. The chamber likelihood of permanent hearing or difficulties. Believing that he had an was small and it was very hot inside balance problems. ear infection, he self-medicated with and he continued to vomit continuously. He became very antibiotics and did another three Well, here we are again at the end distressed and later said that he dives. After flying home, he of another very busy but successful thought he was going to die in there. contacted DAN some 5 days after the year for DAN AP. Despite tough DAN arranged to evacuate him to injury and was referred to an ENT enconomic times, we have seen some Singapore where he was diagnosed specialist after discussion with a good membershio growth, we have with inner ear decompression illness hyperbaric doctor. He was diagnosed helped an increasing number of DAN and received several more with IEBT. By this time, irreversible Members and other divers at their time recompression treatments. Fortun- damage was done and he is left with of need, trained more divers in accident ately, his symptoms improved profound hearing loss and tinnitus in prevention and management and greatly. one ear. completed several important research Case 4: This diver had done 30 The above cases highlight the projects and commenced others. importance of seeking specialist dives over two weeks in Indonesia to The management and staff at DAN diving medical advice as soon as a maximum depth of 23m. Despite AP wish you a happy and safe festive symptoms develop. Although it can suffering severe diarrhoea, he season and look forward to serving sometimes be very difficult to decided to continue diving, although you in 2012. likely to still be dehydrated. On the differentiate between inner ear final day he did 3 dives with no barotrauma, decompression illness, reported equalisation or other 3.

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