Hi!
I am writing for a friend of mine who does not have internet access, and she
asked me to post this question:
My friend, is an animal trainer at (we worked there together for 3 1/2 years, I left but she is still there). The trainers are required to take a physical fitness test every six months. One of the tests is a free dive (with just a mask) down to 24 feet to pick up a weight. The water is about 63 to 65 degrees, so it's pretty chilly. She took the test on a day that she was feeling kind of congested. At about 20 feet down she could feel that she was getting a "squeeze" because she couldn't clear her ears to equalize pressure. She kept going because she didn't want to fail the test. During the next several days she began to experience severe headaches and dizziness. When I talked to her she said it was kind of like vertigo, in that it was almost like being drunk. (At this point she was keeping up with the story about the Olympic diver with vertigo who was able to overcome it and dive.) She told me that no one could help her with the dizziness, but it was continuing to impare her work ability, and would occaisionally be incapacitating enough so that she couldn't sleep at night.
After 2 months, she was sent to a doctor who prescribed a drug generally used for high blood pressure, called Calan. At first she thought the doctor was some kind of miracle worker because her symptoms completely cleared up. After a month though, they started getting worse again, and the doctor decided to up the dosage. Symptoms cleared up again, then began to steadily worsen. Finally she began to experience severe side affects from the drug (she had 9 of the 10 symtoms listed on the warning label) including swelling of the hands and feet, tiredness, headaches and nausea. She stopped taking the Calan. The same doctor ordered an MRI but found nothing. Finally she called DAN-divers alert network, to get a referral for an MD specializing in diving medecine. After talking to her, he diagnosed her with a "round window fistula" or tear in her round window. He told her there wasn't anything he could do for her surgically, and she is now stuck with this condition, but no one seems to be able to offer her any relief. Do you have any alternative suggestions for what her condition might be, or any suggestions for possible treatment if it is actually a round window fistula?
Thanks for your help,
Sorry, I wanted to add some additional information to the stuff below. I submitted the question without reading thru some of the related articles
1. Alana is not suffering from any discharge from her ear.
Reply: --------------------
The description of the problem suggests an inner ear problem related to
barotrauma from diving. Barotrauma denotes pressure-related injury from
exposure to sudden pressure change such as that which might occur during
rapid descent in an airplane with a poorly pressurized cabin, or diving.
Individuals who are exposed to such physical conditions during a time
when an upper respiratory condition such as a cold, sinusitis, or ear
infection is present are particularly susceptible to developing
barotrauma. Barotrauma can affect the middle ear, the inner ear, or the
sinuses.
Inner ear barotrauma can be associated with whirling vertigo, alteration
in hearing acuity, and tinnitus. This type of problem can be associated
with a rupture of the round window membrane as you indicated, or it may
be associated with a rupture of an internal membrane inside the inner
ear. Frequently such ruptures can heal on their own spontaneously
provided they be given an opportunity to do so. This means that one
needs to avoid similar pressure changing environments, strenuous
activities, bending, straining, nose-blowing etc. for a minimum of
several days to a couple of weeks. The best advice is bedrest for a
week. Urgent medical evaluation by an otolaryngologist is strongly
advised if such symptoms have occurred in this type of situation
(diving) so that an examination of the ear as well as a neuro-otologic
assessment can be performed including audiometric studies. Suspected
round window fistulas that continue to cause symptoms despite a week or
more of conservative medical management including bedrest, and
particularly when supported by objective findings from audiometric
tests, warrant consideration of surgical exploration of the ear to
evaluate the round window and patch it if fluid leakage is seen
microscopically.
--
Steve Dankle, MD
NOTICE: OFCN is not engaged in the rendering of professional medical
services. The information contained on this system or any other OFCN system
should not supplant individual professional consultation. It is offered
exclusively as a community education service. Advice on individual
problems must be obtained directly from a professional.
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