title: Inner ear decompression sickness and inner ear barotrauma in recreational divers: a long-term follow-up.
abstract: 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.
authors.affiliation: Israel Naval Medical Institute, Israel Defense Forces Medical Corps, PO Box 8040, Haifa 31080, Israel. shupak@internet-zahav.net
authors.forename: Avi
authors.initials: A
authors.lastname: Shupak
authors.forename: Amnon
authors.initials: A
authors.lastname: Gil
authors.forename: Zohar
authors.initials: Z
authors.lastname: Nachum
authors.forename: Shira
authors.initials: S
authors.lastname: Miller
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Gordon
authors.forename: Dror
authors.initials: D
authors.lastname: Tal
mesh_terms: 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
chemical_list: D016326:Extracellular Matrix Proteins; D029941:Fish Proteins; C092134:saccule-specific protein, Lepomis macrochirus; D003094:Collagen