title: Initial Severity Scoring and Residual Deficit in Scuba Divers with Inner Ear Decompression Sickness.
abstract: BACKGROUND
  Inner ear decompression sickness (IEDCS) in scuba diving results in residual vestibulocochlear deficits with a potential impact on health-related quality of life. The aim of this study was to determine the predictive factors for poor clinical recovery and to try to establish a prognostic score on initial physical examination.
  
  
  METHODS
  The medical records of injured divers with IEDCS treated in our facility between 2009 and 2014 were retrospectively analyzed. The clinical severity of the deficit was evaluated on admission using a numerical scoring system taking into account the intensity of vestibular symptoms and the presence of cochlear signs. The clinical outcome was assessed at 3 mo by telephone interview. After multivariate analysis of potential risk factors for sequelae, the discriminating value of the score and these prognostic reliability indices were calculated.
  
  
  RESULTS
  Among the 99 patients included in the study, 24% still had residual symptoms. Statistical analysis revealed that only a high clinical score [OR = 1.39 (95% CI 1.13-1.71)] and a delay in hyperbaric recompression >6 h [OR = 1.001 (95% CI 1-1.003)] were independently associated with incomplete recovery. The advantage of the score lay in its highly specific nature (92%) rather than its sensitivity (48%) for a threshold of 10.
  
  
  CONCLUSIONS
  Results suggest that the severity of IEDCS can be easily determined by a clinical score during the acute phase. Recompression treatment should not be delayed. Gempp E, Louge P, de Maistre S, Morvan J-B, Vallée N, Blatteau J-E. Initial severity scoring and residual deficit in scuba divers with inner ear decompression sickness. Aerosp Med Hum Perform. 2016; 87(8):735-739.
authors.affiliation: Department of Diving and Hyperbaric Medicine and the Department of Otorhinolaryngology, Head and Neck Surgery, Sainte Anne's Military Hospital, Toulon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gempp
authors.forename: Pierre
authors.initials: P
authors.lastname: Louge
authors.forename: Sébastien
authors.initials: S
authors.lastname: de Maistre
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Morvan
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vallée
authors.forename: Jean-Eric
authors.initials: JE
authors.lastname: Blatteau
mesh_terms: D000328:Adult; D003665:Decompression Sickness / Q000175:diagnosis* / Q000628:therapy; D004242:Diving / Q000009:adverse effects*; D007758:Ear, Inner / Q000293:injuries*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index