title: Persistent inner ear injury after diving.
abstract: OBJECTIVE
  The purpose of this multiple case report was to discuss the occurrence and cause of sudden sensorineural hearing loss after diving.
  
  
  METHODS
  The study design was a retrospective case review.
  
  
  METHODS
  The study was conducted at an academic tertiary referral center.
  
  
  METHODS
  In this multiple case report, two teenagers with unilateral sudden sensorineural hearing loss after diving, one from a starting block and one from a 1-m board, while performing school swimsports were included.
  
  
  METHODS
  The patients underwent diagnostic tympanotomy with sealing of the round and oval window membranes and a vasoactive rheologic therapy combined with corticosteroid treatment.
  
  
  METHODS
  The average pure-tone bone-conduction thresholds were calculated. The appearance of nystagmus, vertigo, and tinnitus was analyzed.
  
  
  RESULTS
  Both patients experienced unilateral sudden deafness after performing a headfirst pike-type dive into a swimming pool. None of the patients contacted with the bottom of the pool. In one patient, a rupture of the round window was found intraoperatively. In the other patient, no rupture of the round or oval window was seen intraoperatively. In spite of sealing of the round window and application of vasoactive rheologic therapy, hearing did not improve significantly in either of the patients.
  
  
  CONCLUSIONS
  Rupture of the round window may occur after diving even if the dive is performed from a low height into the water and the bottom of the pool is not contacted. Besides direct contusion to the external ear and barotrauma, other causes such as whiplash mechanism have to be considered.
authors.affiliation: Department of Otorhinolaryngology, University Medical School, Ulm, Germany. ajnirozsasi@hotmail.com
authors.forename: Ajnacska
authors.initials: A
authors.lastname: Rozsasi
authors.forename: Otto
authors.initials: O
authors.lastname: Sigg
authors.forename: Tilman
authors.initials: T
authors.lastname: Keck
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000494:pharmacology / Q000627:therapeutic use; D001301:Audiometry, Pure-Tone / Q000379:methods; D001844:Bone Conduction / Q000502:physiology; D002648:Child; D004242:Diving / Q000009:adverse effects*; D004584:Electronystagmography; D005260:Female; D003639:Hearing Loss, Sudden / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008876:Middle Ear Ventilation / Q000379:methods; D009759:Nystagmus, Pathologic / Q000175:diagnosis; D010046:Oval Window, Ear / Q000187:drug effects; D010431:Pentoxifylline / Q000494:pharmacology / Q000627:therapeutic use; D010470:Perceptual Masking / Q000502:physiology; D011239:Prednisolone / Q000494:pharmacology / Q000627:therapeutic use; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology; D012189:Retrospective Studies; D012405:Round Window, Ear / Q000187:drug effects / Q000293:injuries*; D012720:Severity of Illness Index; D014012:Tinnitus / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D014665:Vasodilator Agents; D011239:Prednisolone; D010431:Pentoxifylline