MEDICAL FAQs

QUESTION

ANSWER

I don't see a problem here. The only way you could worsen your hearing is by blowing your middle ear on a dive, but as you know divers do not suffer a serial decrease in hearing just because they dive.

It may be wise to get an audiogram before you do the IDC for medico-legal reasons, just in case your employers in the future send you down with a bunch of muppets who somehow cause you to blow said ear. At least you would have a baseline measurement in case of future litigation. Mind you it is part of the HSE medical you should be having to pass your IDC, but this is in the UK and not necessarily in other parts if the world.

QUESTION

ANSWER

You are right there. It very much depends on the condition that causes the lack of hearing. In a nutshell any cause that also has tinnitus and vertigo as a problem such as Menieres disease may be a problem. Likewise an auditorty nerve tumour that is untreated could also be an issue.

However if it is also a problem that has destruction of the ear drum or middle ear then there would be a situation where the inflow of water or inability to equalise would prevent diving. Some deafness, though is a simple affair present from birth and in these situations she may well be fine to dive.

There are issues of communication underwater that should be addressed. She should always stay close to her buddy and even thing of an alternative way of being attracted in case of emergencies. Also think about situations on ascent where a boat is coming in, she has to always come up under a hearing buddy so she can be protected from not hearing the props on ascent.

So don't worry about underwater hearing aids and depths, but get advice on the exact nature of her deafness, but she could well be fine to dive.

QUESTION

ANSWER

That's a long old ear question there that probably deserves a far fuller answer than I can give you right now.

But to take your points individually, the coming off the boat problem first of all. This is completely normal. In your balance part of the ears are the organs responsible for you feeling steady. They're called the "semi-circular canals" and this stuff called perilymph whooshes around inside them to tell you at which angle you are. After a boat trip the nerves that this liquid is connected to continue to think they should be getting messages of movement. You aren't of course, but the brain hasn't figured that yet so you still feel you are moving up and down. So don't let that stop you diving. As for the pea sized lump that controls your balance your friends tell you about. You are rubbing the wrong pea sized thing. The mastoid has little to do with balance and a lot to do with where a muscled attatches to your skull, so no worries there.

As for the penultimate about the ear pain, if your doc says all looks fine but you have this nagging pain around your ear it could well be a neuralgia. Get to see an ENT surgeon if your GP is offering you little help.

And finally, your dive in the pool pain was probably due to not equalising properly, and for tips of how to do this look at the archived answers I have on the e-med site as I have my pointers of how to do this properly on the "Dive Medicals" pages. All in all you will probably be fit to dive, just get seen first by your local dive doctor.

QUESTION

ANSWER

And I hope you can hear from me soon too. There are a few issues here: Firstly, there are some docs that don't let divers with deafness on one side dive, as if you were to frag your other ear, then that becomes totally deaf, a terrible situation. However it seems you have been given the OK, and are diving merrily, so it would be a cold heart that stopped you now.

So, can you dive with this little gizmo that cures nerve deafness? Well, it all depends on the manufacturer. Its rather like pacemakers, you can use them but only those that churn them out, know the mechanical limitations with depth. You have to ask your ENT surgeon to find that out for you. Once fitted, they sit in your inner ear, and interface with the middle ear. Oh, and they cost a fortune too. So you must make sure that if there were a dive problem, that you did not burst your ear drum, letting water flood in, and potentially affecting it in the inner ear, that it did not stop working. Again, this is a worst case scenario, and as you can pop your ears fine, it should not happen, but it might be an idea to wear the Pro-Ear mask, as this could build in a safety factor.

Finally, I would leave this a couple of months before diving, if all the above is OK.

QUESTION

ANSWER

That’s a long tale indeed. I assume that you have never dived before, but just being on a boat causes this intense spinning and dizziness. It sounds motion related - do you ever get the same effect in cars or on planes? You’ve been through most of the normal measures used to relieve vertigo and motion sickness without any luck. The next step would be vestibular exercises and quirky ENT manoeuvres involving twisting your head and neck into awkward positions. These can sometimes help but you would probably need to see an expert ENT doctor for these. I would say go for the pool dives on the open water course and see what effect that has on the vertigo. If you’re OK then progress to some nice calm shallow shore diving and again see what happens. You might make it to some boat diving in ultra-flat seas but if at any stage the vertigo returns you will sadly have to forget diving and choose a safer leisure pursuit that doesn’t involve big swells and brain operations.

QUESTION

ANSWER

Indeed there is. But first a little history, as some of this is great “eccentric scientist” stuff. Apparently the lengthily named Count Alessandro Giuseppe Antonio Anastasio Volta (from whom we get the well known electrical unit) was the first to discover that sound could be perceived by directly stimulating the auditory system. This he did by sticking a couple of metal rods in his own ears and connecting them to a 50 volt circuit. He experienced a “jolt” and a noise “like a thick boiling soup” (presumably his brain curdling). Nearly two centuries later some adventurous surgeons zapped an exposed acoustic nerve, whose owner heard sounds like “a roulette wheel” and “a cricket”.

These macabre experiments laid the groundwork for the cochlear implant, or “bionic ear”. Essentially it’s a surgically implanted electronic device which directly stimulates auditory nerves. External parts (including a microphone and speech processor) transmit sound signals to an internal receiver (implanted in bone behind the ear) and thence into the cochlea (the hearing bit of the inner ear) via electrodes. Not your average hearing aid, which is basically an amplifier. The results are pretty impressive, especially in those who have grown up with the implants, whose brains have presumably learned to “hear” in a different way. Older recipients are often not as enamoured with the devices; one described a human voice as sounding like “a croaking Dalek with laryngitis”.

Anyway, the deal with these and diving is that we need to be sure the various bits will not implode, explode, rust or generally become defective in water and under pressure. In this sense the situation is similar to the heart pacemaker. The implant manufacturer or surgeon who carried out the procedure should have some data on the safety of your particular device at depth, so you’d be well advised to consult them initially. If all is OK with them, and as long as your middle ears can equalize effectively, then there’ll be nothing stopping you.

QUESTION

ANSWER

Vertigo means many different things to different people. Depending on your tastes, a histrionic drone or a heartfelt chorus of Irish rock courtesy of U2; a serene cinematic exploration of obsession, courtesy of Alfred Hitchcock; or a genus of tiny land snails. Even in the medical sense the term is ripe for confusion. True “vertigo” is defined as “the sensation of spinning or rotating while the body is actually stationary with respect to the surroundings.” Not quite the same as the jelly-legged feeling as you peer over the railings of the Empire State Building; more the whirling dizziness experienced on the bathroom floor after an over-exuberant binge drinking session (so I’ve been told).

Numerous causes for vertigo exist; those specific to diving include narcosis, sea-sickness, hangovers, DCI, contaminated gas mixes, hyperventilation, and equalising problems (not necessarily in that order). I suspect in this case that the vertigo is due to the sudden exposure of the ear to cold water. This can occur in other situations such as having your ears syringed (in the medical world we call it “caloric stimulation”). If the ears are exposed unequally (for example if one ear is completely bunged up with wax), for a few seconds only, it can confuse the brain and cause vertigo and nausea. Once the water warms up the effect usually goes away. So you should get your ears checked out for any blockage such as wax, and if it persists, give your ears a good soak before you descend, to see if this will alleviate the effect.

QUESTION

ANSWER

This sounds to me like a classic case of inner ear barotrauma. The key pointers are the persistence of your symptoms, their association with positional change, and the fluctuating hearing loss. I suspect that there’s been a rupture of the cochlea, what we call a “perilymph fistula”, and each time you strain or move, there’s fluid leaking out, causing your symptoms. You should see an ENT specialist as soon as you can, to get investigated properly, but I can make a few suggestions here. What you need to do is steer clear of any situations that increase the pressure in your head. This means avoiding sneezing, coughing, lifting, sexual activity, equalising… basically anything physically strenuous. Ideally bedrest is advised, in a quiet environment, to allow the fistula to heal. This can take several months. I’m sorry to report that in many cases there is permanent loss of some hearing, although the tinnitus tends to improve as the brain gets used to it. Quite often vertigo will persist too, and it would be difficult to sanction future diving in these circumstances.

QUESTION

ANSWER

Your first name wouldn’t be Jack, would it? If so, pleased to make your acquaintance again. I think the last time we met I was victim of a quadruple shot of your good self, after losing a bet at medical school… Labyrinthitis is an inflammation of the inner ear (the labyrinths are the areas that sense changes in head position). Your typical bout comes on a few days or weeks after a trivial cold, and presents with true vertigo (spinning dizziness), vomiting and a “generalised ill feeling”. Usually a virus is the culprit, but it can be precipitated by a head injury, allergic reaction or acute stress. Recovery takes anywhere from one to six weeks, but in some unfortunates, permanent damage to the inner ear leaves them with debilitating panic and depression for years. So, Jack, whether you had labyrinthitis or not, as you are now asymptomatic I would guess that you’ll be fine to dive in 6 weeks. Just remember to drink responsibly.

QUESTION

ANSWER

Despite being the subject of one of Alfred Hitchcock’s best films, vertigo has very little to do with a fear of heights. It’s actually defined as “an illusion of movement, either of the external world revolving around the individual or of the individual revolving in space”. BPPV is a particular form that is thought to be due to things called otoliths, or “ear rocks”, collecting in the canals of the inner ear that transmit the sensation of balance. Certain postural changes cause these otoliths to shift about and the brain interprets this as movement, rendering the hapless victim dizzy, sweaty and nauseous. Attacks are often brought on by changing position, for example rolling over in bed or stretching the neck (giving rise to BPPV’s seedy alternative title, “top shelf vertigo”). Luckily episodes are normally over within thirty seconds or so.

BPPV can be treated with something called the Epley manoeuvre, a neck mangling technique which is designed to dislodge the rocks once and for all. It’s usually quite successful, but occasionally surgery is needed for those with severe or recurrent episodes. There are also some drugs which aim to suppress the inner ear impulses, but these are often sedative, don’t work well and would not be suitable for divers.

So in your wife’s case, it would be important to check whether neck movement set off any symptoms, as the neck can be extended for prolonged periods during a dive. If she hasn’t had it done already, she ought to have the Epley manoeuvre performed. If successful, I think she would then be fine to give diving a go. As with many conditions, if she’s with a trusted buddy who knows about the problem (presumably yourself), she’s in safe hands.