SCUBA Diving and Vertigo
By Joan Whetzel
SCUBA diving, a popular pastime, takes divers to some unique and beautiful locations. However, for anyone with balance problems or allergies, or those who have had inner ear surgery, SCUBA diving is generally not suggested. While diving, the added pressure placed on the ears by all of that water, may cause vertigo and may lead to permanent balance problems and hearing loss.
Vertigo from Barotrauma
Barotrauma is defined as an injury to the middle ear, sinuses, lungs, and G.I. tract due to a pressure imbalance. Boyle's Law states that as the pressure outside the eardrum increases, the pressure inside the middle ear decreases. Unless the diver can equalize the pressure through his or her Eustachian tubes, the imbalance will damage the middle ear. This damage to the middle ear will most often lead to vertigo, followed by hearing loss and problems with balance. A rupture of the tympanic membrane as well as hemorrhaging has also been known to occur when divers descend due to the added pressure. Ruptured eardrums also cause vertigo.
Vertigo is defined as a dizzy sensation, sometimes accompanied by a confusion, disorientation, and a loss of balance. Many people also complain of nausea and vomiting. Divers who suffer vertigo while diving can become so confused that they can't tell up from down, and may have difficulty ascending from a dive. If diving in caves, they could even become lost. In either scenario, the likelihood of a diver's death increases with the onset of vertigo.
Finding the Causes of a Diver's Vertigo
The causes of vertigo are generally found through a physical evaluation of the diver's ears to look for any abnormalities, a complete nervous system exam, an evaluation of the patient's symptoms and a detailed account of what occurred during the dive. The history and physical must be followed by diagnostic testing in order to find the exact cause. Diagnostic tests include:
· a hearing test.
· a caloric stimulation test to determine if there is any vestibular damage.
· x-rays of the middle and inner ear.
· MRI of the brain and otic nerves when neurological damage is suspected.
Prevention and Treatment of Dive Induced Vertigo
To prevent vertigo during a dive, SCUBA divers should try the following measures:
· Take antihistamines before a dive. Note: Don't use antihistamines prior to diving if you are prone to sleepiness from antihistamines. Sleepiness and diving don't mix.
· Take prophylactic antibiotics, beginning a day or two before a dive, to make certain there is no inner or middle ear infection which would increase the likelihood of ear and vertigo problems.
· Perform the valsalva maneuver by closing the mouth, pinching the nose closed and forcing air into the Eustachian tubes, which increases the pressure inside the ear.
Treatment for divers who suffer vertigo during a dive is similar to the preventative measures. Treatment includes increasing the pressure in the middle ear without piercing or puncturing the eardrum and a course of antibiotics along with bed rest and observation for the diver until the vertigo clears up. If the eardrum ruptured during the dive, however, the diver's SCUBA days may be over.
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