title: Inner ear decompression sickness in scuba divers: a review of 115 cases.
abstract: Inner ear decompression sickness (IEDCS) in scuba divers is increasingly observed, but epidemiological data are limited to small case series and the pathogenesis remains elusive. We report our experience over a 13-year period. We also thought to demonstrate that the development of this injury is mainly attributed to a mechanism of vascular origin. Diving information, clinical data, presence of circulatory right-to-left shunt (RLS), and laboratory investigations of 115 recreational divers were retrospectively analyzed. A follow-up study at 3 months was possible with the last 50 consecutive cases. IEDCS (99 males, 44 ± 11 years) represented 24 % of all the patients treated. The median delay of onset of symptoms after surfacing was 20 min. Violation of decompression procedure was recorded in 3 % while repetitive dives were observed in 33 %. The median time to hyperbaric treatment was 180 min. Pure vestibular disorders were observed in 76.5 %, cochlear deficit in 6 % and combination of symptoms in 17.5 %. Additional skin and neurological disorders were reported in 15 % of cases. In 77 %, a large RLS was detected with a preponderant right-sided lateralization of IEDCS (80 %, P < 0.001). Incomplete recovery was found in 68 % of the followed patients. Time to recompression did not seem to influence the clinical outcome. IEDCS is a common presentation of decompression sickness following an uneventful scuba dive, but the therapeutic response remains poor. The high prevalence of RLS combined with a right-sided predominance of inner ear dysfunction suggests a preferential mechanism of paradoxical arterial gas emboli through a vascular anatomical selectivity.
authors.affiliation: Diving and Hyperbaric Medicine Department, Ste Anne's Military Hospital, BP 20545, 83041 Toulon Cedex 9, France. gempp@voila.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gempp
authors.forename: Pierre
authors.initials: P
authors.lastname: Louge
mesh_terms: D000328:Adult; D001469:Barotrauma / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D003665:Decompression Sickness / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D004242:Diving / Q000009:adverse effects*; D007758:Ear, Inner / Q000293:injuries* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D012189:Retrospective Studies