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Chapter 9 — 13
One or more of these must be present to make the diagnosis. Fluid may be noted in the middle
ear.
Tinnitus
is a ringing, buzzing or musical sound in the ear, usually high pitched, due to damage
or irritation of the nerve cells of the cochlea.
Hearing loss
is due to damage of the cochlea. It may improve, stay the same or deteriorate.
Audiograms may differentiate this type of hearing loss (sensori-neural) from that due to middle
ear barotrauma (conductive). See Chapter 30.
Vertigo
is the spinning or pulling sensation due to balance organ damage (see Chapter 31).
Treatment
A diver presenting with any of these symptoms needs
immediate assessment
by a diving
physician. In the interim, he should avoid any exertion, middle ear equalisation, altitude or
diving exposure, sneezing or nose blowing.
The physician will examine the ear and perform
serial audiograms
to detect any hearing loss,
which may not be obvious to the diver.
Tests
of
balance organ function (ENGs)
may be
necessary.
Aspirin, nicotinic acid (vitamins), other vasodilators or anti-coagulants should not be taken.
An expert diving medical opinion concerning
future diving
should be sought if the diver has
sustained permanent hearing loss, tinnitus or balance disturbance, as it is probable that further
episodes of inner ear barotrauma will cause additional and possibly permanent disastrous
effects. Training in correct middle ear equalisation techniques is essential if a return to diving is
contemplated.
•
Round window fistula.
This condition can usually be managed conservatively with
absolute bed rest in the sitting
position.
Straining, sneezing, nose blowing, sexual activity, loud noise and middle ear
equalising should be avoided, to prevent pressure waves in the inner ear.
The round window fistula often heals spontaneously within a week or two with this regimen but
if hearing loss progresses or the other features persist, it may be necessary to resort to
surgery
to
patch the round window leak.
Once an oval or round window fistula or cochlea injury has healed, the diver's future in this
sport is bleak. Flying should be completely avoided for some months to allow complete healing
of the injury or the surgical repair.
•
Cochlea damage.
In the absence of a round window fistula, no specific treatment is available
for this type of injury. Rest in a head elevated position, repeated pure tone
audiograms, and avoidance of exertion, equalisation attempts and further
exposures to barotrauma (flying or diving), is necessary until the condition
has stabilised.