ISSN 0813 - 1988 Volume 34 No. 1 ABN 29 299 823 713 March 2004 Quarterly Journal of the South Pacific Underwater Medicine Society (Incorporated in Victoria) A0020660B The ear and diving Inner ear barotrauma Inner ear decompression sickness Carbon monoxide poisoning Flying after diving Diving accidents Workshop Diving medicine in Vanuatu Print Post Approved PP 331758/0015 South Pacific Underwater Medicine Society (SPUMS) Journal Volume 34 No. 1 March 2004 OBJECTS OF THE SOCIETY To promote and facilitate the study of all aspects of underwater and hyperbaric medicine To provide information on underwater and hyperbaric medicine To publish a journal To convene members of the Society annually at a scientific conference OFFICE HOLDERS President Dr Robyn Walker RAN, Headquarters Australian Theatre, 14-18 Wylde St E-mail <[email protected]> Potts Point, New South Wales 2011 Past President Dr Guy Williams P.O.Box 190, Red Hill South E-mail <[email protected]> Victoria 3937 Secretary Dr Cathy Meehan McLeod Street Medical Clinic, 67 McLeod Street E-mail <[email protected]> Cairns, Queensland 4870 Treasurer (Acting) Dr Andrew Patterson 28A Roland Avenue E-mail <[email protected]> Wahroonga, NSW 2076 Editor Dr Mike Davis SPUMS Journal, C/o Office 137, 2nd Floor, E-mail <[email protected]> Christchurch Hospital, Private Bag 4710, Christchurch, NZ Education Officer - All enquiries to Dr Mike Davis SPUMS Journal, C/o Office 137, 2nd Floor, E-mail <[email protected]> Christchurch Hospital, Private Bag 4710, Christchurch, NZ Public Officer Dr Guy Williams P.O.Box 190, Red Hill South E-mail <[email protected]> Victoria 3937 Chairman ANZHMG Dr David Smart Department of Diving and Hyperbaric Medicine E-mail <[email protected]> Royal Hobart Hospital, Hobart, Tasmania 7000 Committee Members Dr Mike Bennett Department of Diving and Hyperbaric Medicine E-mail <[email protected]> Prince of Wales Hospital, Randwick, New South Wales 2031 Dr Simon Mitchell Department of Anaesthesia E-mail <[email protected]> Auckland Hospital, Auckland, New Zealand Dr Douglas Walker P.O.Box 120, Narrabeen, New South Wales 2101 E-mail <[email protected]> ADMINISTRATION Membership Steve Goble C/o ANZ College of Anaesthetists E-mail <[email protected]> 630 St Kilda Rd, Melbourne, Victoria 3004 Journal Sarah Webb C/o Office 137, 2nd Floor, E-mail <[email protected]> Christchurch Hospital, Private Bag 4710, Christchurch, NZ Phone: +64-3-364-1277, Fax: +64-3-364-1683 North American Representative Jeffrey Bertsch E-mail <[email protected]> European Representative Henrik Staunstrup E-mail <[email protected]> MEMBERSHIP Membership is open to all medical practitioners. Associate membership is open to all those who are not medical practitioners but are interested in the aims of the Society, and/or those engaged in research in underwater medicine and related subjects. Membership application forms can be downloaded from the Society’s web site at <http://www.SPUMS.org.au> Further information on the Society may be obtained by writing to: SPUMS Membership, C/o Australian and New Zealand College of Anaesthetists, 630 St Kilda Road, Melbourne, Victoria 3004, Australia or e-mail <[email protected]> The Society’s financial year is January to December, the same as the Journal year. The 2004 subscription will be Full Members A$132.00 and Associate Members A$66.00, including GST in Australia. All those outside Australia will be charged the same amounts as the GST component to partly cover the cost of having the Journal delivered to them by Air Mail. These fees must be paid in full. South Pacific Underwater Medicine Society (SPUMS) Journal Volume 34 No. 1 March 2004 1 This brings me to the UHMS and SPUMS Annual Scientific The Editor’s offering Meetings in Sydney and, immediately following, in Noumea. Both meetings are under-subscribed. Such a The major focus of this issue is inner ear injury from diving. double opportunity to enhance knowledge and meet with Whilst middle ear barotrauma is the commonest diving international colleagues is rare. Please do give serious medical problem presenting to health workers, few see more consideration to coming to one or both meetings. There is than a handful of inner ear problems in a career. This makes still time to register for what will be an exciting two weeks. Edmonds’ large series of inner ear barotrauma all the more If these meetings are not what you as a member want then remarkable. Enthusiasm for early surgical intervention in take the time to write the Committee and tell them what round-window rupture has given way to a more conservative activities SPUMS should be providing for its members. approach. Vestibular decompression sickness (DCS) is clearly not limited to deep heliox or mixed gas diving, Sadly, David Doolette has resigned as Education Officer. though with the upsurge in ‘tech’ diving its frequency will David has done an outstanding job maintaining the standard increase. Wong and Walker make the point that many cases of theses for the SPUMS Diploma and helping applicants present out of hours when sophisticated otological to see their research projects through to fruition. The high investigations are unavailable, and this lends credence to standards he has set have resulted in disappointment for the view of Klingmann et al that where there is diagnostic some, but have also ensured that the Diploma has grown in doubt one should do bilateral myringotomies and administer stature. This has been clearly recognised by the Australian hyperbaric oxygen therapy. Doolette and Mitchell, in a paper and New Zealand College of Anaesthetists in endorsing the reprinted from the Journal of Applied Physiology, SPUMS Diploma as the stepping stone for the College’s hypothesise that in the inner ear a transient supersaturation Certificate in Diving and Hyperbaric Medicine. for helium resulting in a counter-diffusion mechanism may explain the onset of DCS with breathing gas switches, and If any academic member of SPUMS wishes to be considered that these should be carefully scheduled on the ascent. It is for this extremely important role within the Society then evident from the papers presented here that a variety of please contact the President. We need to find a replacement mechanisms may lead to permanent inner ear damage from urgently. In the interim, all enquiries regarding the Diploma diving. A very recent paper suggests the likelihood of should be addressed to the Editor, who is a current member residual damage is greater with inner ear DCS than of the Academic Board, at the journal address. following barotrauma.1 Recently, a working group reviewed the Society’s rules, Professor Gorman based a talk at the 2003 ASM on the which had not been revised since 1999. Several proposed, paper reprinted here from Toxicology. The toxicity of carbon mainly minor, changes for consideration at the AGM in monoxide (CO), which is known to be a neurotransmitter, June 2004 are posted in this issue. Most importantly, it was is a complex issue. He concludes “while the incidence and felt that the international standing of this journal would be often poor outcome of CO poisoning is well recognised, enhanced by the adoption of a less parochial name. SPUMS and although the biology of CO is increasingly understood, is now an international society with nearly 20% of its the toxicology of the gas is mysterious and no data exist to membership outside of the South-East Asia Pacific region. establish best practice for managing poisoned patients.” Choosing a journal title is not easy, though many entertaining acronyms were put forward! There is increasing unease regarding the escalating financial and human costs of long air evacuations for Reference hyperbaric treatment of tourists developing DCS in remote areas. One response has been the establishment, for instance 1 Shupak A, Gil A, Nachum Z, Miller S, Gordon CR, by DAN and Subaquatic Safety Services, of recompression Tal D. Inner ear decompression sickness and inner ear chambers in various countries around the world where barotrauma in recreational divers: a long-term follow- diving activities are high but the local health infrastructure up. Laryngoscope. 2003; 113: 2141-7. is minimal. As Grace points out this has its own disadvantages in that the local community then has to fund Mike Davis out of meagre health resources the maintenance of this facility - not cheap - and the hyperbaric care of uninsured Front cover photos depict the ear of a surfer showing tourists - the majority, I suspect. Combine this with real exostoses in the external canal and a traumatic doubts about the cost-benefit of air evacuation in mild cases perforation of the tympanic membrane courtesy of - also the majority - compared with conservative local Murray Grieg, an otolaryngologist in Christchurch, and medical care, and clearly we have a problem in the SEAP ‘The Lady’ from the wreck of the President Coolidge region that requires attention. The Phuket Workshop, in courtesy of Robert Grace. part, and that on remote management of DCS in Sydney in May are intended to address this issue. SPUMS members We are still hoping the many SPUMS photographers will should always act responsibly when diving abroad and send us photos for the journal front page – hope lives eternal! ensure they have adequate diving travel insurance. 2 South Pacific Underwater Medicine Society (SPUMS) Journal Volume 34 No. 1 March 2004 conversion into haemorrhages and exudates in the inner Invited editorial ear.6 Bubble enucleation in the osteoplastic cell cavities around the inner ear increases local pressure and may Diving and inner ear damage disrupt into the perilymph spaces. This pathology is converted, after a month or so, into fibrosis and new bone Carl Edmonds formation around the permanently damaged inner ear.