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  #1  
Old 23 February 2018, 14:31
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Icon5 Barotrauma Injury (Ear)

I may have permanently damaged my left ear due to barotrauma. My ENT conducted an audiology test today and concluded that the damage is in the inner ear where the Cochlea, Cochlear nerve and Ossicle bones merge. He believes I may have fractured or dislocated the "little bones" and I'm headed to a specialist at the U of Miami on Monday.

I'm looking for any studies from the Navy since they probably have amassed a great deal of data regarding this injury and may have had some success in treating their divers who come up with this injury. I've used my Google-fu and no joy.

Sadly, this may end diving for me and puts flying at risk.
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  #2  
Old 23 February 2018, 16:44
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Also consider contacting Diver's Alert Network (DAN).

They have staff physicians and a referral network.

This is from an article they put out as sort of an FAQ. The bold is mine, but may mean good news for you.

Barotitis Media (middle ear barotrauma): This is by far the most frequently reported injury among divers. People with barotitis media generally develop symptoms immediately following the dive, but delays of up to one day or longer have been reported. When the diver descends, the pressure can cause injury to the middle ear. This overpressure of the middle ear can cause serious fluid and blood to leak into the middle ear, partially or completely filling it.

Signs & Symptoms: A feeling of fullness in the ear may develop, like the feeling of fluid inside the ear. Muffled hearing or hearing loss are other indications of middle ear barotrauma. On examination with an otoscope (a special device medical personnel use when examining the ear) fluid may appear behind the tympanic membrane, causing it to bulge and appear red. In other cases, the eardrum may be retracted or sunk in. Either condition warrants immediate medical attention.

Treatment: First, diving must stop. Also, changes in altitude—as with flying—must be considered a concern as well. See a medical practitioner. The combination of drugs and time will usually allow this injury to heal in a few days, but cases have lasted up to several months. If you have been on decongestant therapy for seven days and have experienced little or no relief, it’s time to see your otolaryngologist, an ear, nose and throat (ENT) specialist."
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Old 23 February 2018, 17:25
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JAC, send me the specifics of your injury via PM.

A close friend of mine is a hyperbaric physician who specializes in barotrauma and I'm having dinner with him next week.

I'll see what he has to say.

Cheers.
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  #4  
Old 23 February 2018, 18:08
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Found an abstract from NIH. Does not look good.

https://www.ncbi.nlm.nih.gov/m/pubmed/25596834/

Ronix, I’ll PM after I put my thoughts together. Thanks for the outreach.
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Old 24 February 2018, 13:32
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Originally Posted by diverescue View Post
Also consider contacting Diver's Alert Network (DAN).

They have staff physicians and a referral network.

This is from an article they put out as sort of an FAQ. The bold is mine, but may mean good news for you.

Barotitis Media (middle ear barotrauma): This is by far the most frequently reported injury among divers. People with barotitis media generally develop symptoms immediately following the dive, but delays of up to one day or longer have been reported. When the diver descends, the pressure can cause injury to the middle ear. This overpressure of the middle ear can cause serious fluid and blood to leak into the middle ear, partially or completely filling it.

Signs & Symptoms: A feeling of fullness in the ear may develop, like the feeling of fluid inside the ear. Muffled hearing or hearing loss are other indications of middle ear barotrauma. On examination with an otoscope (a special device medical personnel use when examining the ear) fluid may appear behind the tympanic membrane, causing it to bulge and appear red. In other cases, the eardrum may be retracted or sunk in. Either condition warrants immediate medical attention.

Treatment: First, diving must stop. Also, changes in altitude—as with flying—must be considered a concern as well. See a medical practitioner. The combination of drugs and time will usually allow this injury to heal in a few days, but cases have lasted up to several months. If you have been on decongestant therapy for seven days and have experienced little or no relief, it’s time to see your otolaryngologist, an ear, nose and throat (ENT) specialist."
I believe he's saying his issue is in the inner ear, past the oval and round windows, into where the nerves innervate the cochlea, as well as the middle ear where the "little bones" reside.

Justaclerk- how did the initial trauma occur? Problem on ascent, something else funky or just bad juju? Really sorry to hear this-that's gotta be frustrating. Best of luck to you!
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Old 24 February 2018, 17:41
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Apparently, some things have gone right.

I’m seeing Dr. Fred Telischi on Monday. When I mentioned his name in a conversation with DAN - thanks diverescue - the rep’s immediate reaction was, “you have the best otolaryngologist in the country seeing you and the one we recommend first. How you got an appointment that fast is stunning.”

Also UM is internationally recognized for their work in the field and US News and World Report ranks them as the top ear clinic in the world.

Also, thank the Gods that I bought a DAN membership as a dive accident under my coverage is $500,000, which will cover any deductibles that I may incur. If you’re a diver and don’t have a membership get one now.

I’ll follow up on Monday.
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  #7  
Old 25 February 2018, 23:56
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That is great news! Keep us posted, wishing you luck.
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Old 26 February 2018, 21:50
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Agreed! Best wishes for a speedy recovery!
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  #9  
Old 26 February 2018, 22:06
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Follow up:

I saw Dr. Telischi after his fellow did the diagnostics and he initially concluded that it is probably a tear along the ligament between the stirrup and the Cochlea. This is probably a "broken seal" and is causing fluid to leak thus preventing the processing of sound waves to the nerves. He also said that I might have some nerve damage.

After his diagnosis, he recommended a CT Scan, which was done today, a follow up audio exam on Thursday and surgery on Friday to repair the leak using fat globules and a steroid injection to speed the healing process (I'm already on Prednisone). Based on his experience he believes that I will recover a great deal of my hearing through this procedure.

On a side note, if you're a medical professional (MD, RN, etc.), I think you would appreciate the University of Miami's Lennar Foundation Medical Center. It is less than a year old, integrates state-of-the-art technology and is patient-centric to a degree I've never seen. If you're looking to move to South Florida this could be an option and Coral Gables is one of the most pleasant cities in Florida (disclaimer, UM was my first school).

Finally, DAN rocks. I was able to process my membership as secondary insurance and they will pick up any co-pay, deductible or other fee. As I mentioned earlier, if you're a diver and you aren't a member sign up yesterday.
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Old 4 March 2018, 19:12
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Follow up:

I went in for surgery on Friday and here are the highlights:
  • Sedation was general, I was out for about an hour and it seemed like seconds.
  • The damage wasn't as severe as first thought by the ENT.
  • Dr. Telischi lifted the tympanic membrane, surveyed the damage and elected to seal the tear between the stapes and the oval window. The seal was made using fat globules as illustrated below; in addition, he injected a high dose of Prednisone into the vestibular nerve area to speed recovery of some damaged cells.

The really good news prior to the procedure is that I recovered approximately 60% of my hearing on the left side through the use of an oral Prednisone taper. I'm cautiously optimistic about recovering a good deal more. As far as diving goes, I'm grounded until cleared and that may take an extended period of time. Baby steps.
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File Type: jpg Procedure.jpg (44.0 KB, 142 views)
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  #11  
Old 5 March 2018, 00:01
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Baby steps are still forward progress. Thanks for keeping us updated. Here is to a speedy and complete recovery.
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Old 5 March 2018, 11:21
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Baby steps are still forward progress. Thanks for keeping us updated. Here is to a speedy and complete recovery.
Thanks, first-things-first, get cleared to resume a moderate PT regimen.
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Old 7 March 2018, 16:20
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I used to work for Duke hyperbarics, and we partnered with DAN (5 miles down the street). They'd send us (i.e., refer) patients all the time, most of whom were fairly benign. Our in-house dive medicine ENT guy is retired now, but his wait list could be 9 months long. Glad you got in so fast, and hope it works out for you.

Edited to add Telischi has a great rep.

Last edited by Devildoc; 7 March 2018 at 16:26.
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  #14  
Old 7 March 2018, 19:02
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Originally Posted by Devildoc View Post
I used to work for Duke hyperbarics, and we partnered with DAN (5 miles down the street). They'd send us (i.e., refer) patients all the time, most of whom were fairly benign. Our in-house dive medicine ENT guy is retired now, but his wait list could be 9 months long. Glad you got in so fast, and hope it works out for you.

Edited to add Telischi has a great rep.
Follow up hearing test is on Friday and I go back to Dr. T. the following week for his assessment. The surgery site is clean and aside from some low frequency tinnitus all seems good.
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Old 7 March 2018, 19:13
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Originally Posted by Justaclerk View Post
Follow up hearing test is on Friday and I go back to Dr. T. the following week for his assessment. The surgery site is clean and aside from some low frequency tinnitus all seems good.
Good news man.

I missed the earlier post about the surgery. That's pretty amazing. Thanks for the update.
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  #16  
Old 9 March 2018, 15:39
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Follow up. Improvement is steady. Here's the timeline from the initial hearing test to today's. Right end of the test is dog whistle range.
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File Type: jpg Hearing Tests (14 Day Observation).jpg (44.8 KB, 83 views)
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  #17  
Old 9 March 2018, 17:14
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Congrats, man. Glad you are on the mend. I burst my left ear drum, twice, diving; I can hear well enough but zip on the high-frequency stuff.
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Old 15 March 2018, 10:39
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Follow up.

Dr. T. examined me yesterday and removed the surgical packing from the middle ear and tympanic membrane. He ordered a hearing test and I scored an 88% on word recognition in my left ear (up from 68%). He then cleared me to run a Savage Race this weekend with the caveat of be safe.

Forward.
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  #19  
Old 15 March 2018, 10:46
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Good news, glad to hear.
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  #20  
Old 17 March 2018, 13:50
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Good news, glad to hear.
Ha! Good one. So am I. :-)
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