Inner ear decompression sickness and inner ear barotrauma in recreational divers: a long-term follow-up.
OBJECTIVE
The objectives were to report the authors' experience with the long-term follow-up of patients with diving-related inner ear decompression sickness and inner ear barotrauma and to discuss residual cochlear and vestibular damage in relation to the question of fitness to dive.


METHODS
Retrospective consecutive case series.


METHODS
Eleven recreational divers with inner ear decompression sickness and nine with inner ear barotrauma (IEB) were followed. A complete otoneurological physical examination and laboratory evaluation were carried out. The latter included audiometry, electronystagmography, a rotatory chair test using the sinusoidal harmonic acceleration protocol, and computerized dynamic posturography.


RESULTS
Residual cochleovestibular deficits were found in 10 (91%) of the patients with inner ear decompression sickness and 3 (33%) of those with IEB (P <.02, Fisher's Exact test; odds ratio, 20). A significantly shorter follow-up period was required for the inner ear barotrauma group (P <.05, simple t test) because three patients (33%) recovered completely within 1 month of the diving accident. Eight patients had residual vestibular deficits on follow-up, but only one (12.5%) was symptomatic. However, five (56%) of the nine patients who had a cochlear insult, as documented by follow-up audiometry, complained of significant hearing loss and tinnitus.


CONCLUSIONS
Inner ear decompression sickness carries a high risk for residual inner ear damage despite hyperbaric oxygen recompression therapy. A favorable prognosis might be anticipated for inner ear barotrauma. The finding that most patients with residual vestibular deficits were asymptomatic at the time of follow-up emphasizes the need for a complete vestibular evaluation, including specific bedside testing and laboratory examinations, before a return to diving activity may be considered.
Shupak
Avi
A
Israel Naval Medical Institute, Israel Defense Forces Medical Corps, PO Box 8040, Haifa 31080, Israel. shupak@internet-zahav.net
Gil
Amnon
A
Nachum
Zohar
Z
Miller
Shira
S
Gordon
Carlos R
CR
Tal
Dror
D
D000328:Adult; D000368:Aged; D001299:Audiometry; D001469:Barotrauma / Q000209:etiology* / Q000503:physiopathology; D003094:Collagen; D003665:Decompression Sickness / Q000209:etiology* / Q000503:physiopathology; D004242:Diving / Q000293:injuries*; D007758:Ear, Inner / Q000293:injuries*; D004584:Electronystagmography; D016326:Extracellular Matrix Proteins; D005260:Female; D029941:Fish Proteins; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014724:Vestibular Function Tests
D016326:Extracellular Matrix Proteins; D029941:Fish Proteins; C092134:saccule-specific protein, Lepomis macrochirus; D003094:Collagen