Michael McFadyen's Scuba Diving - Dizzy Attack
In 1998 I am on a dive holiday. I have been diving eight days in a row and this is the 17th dive. Most dives have been deep, over 30 metres and some over 50 metres. On the eighth day, I do a dive to 55 metres. From here I gradually come up to 41 metres after 15 minutes and then to 25 metres after 22 minutes. This is where the bottom time ends. At this time my dive computer shows 18 minutes decompression, four minutes at six metres and 14 minutes at three metres. I arrive at the first stop a few minutes later and do the first stop in a couple of deeper steps. After 46 minutes my dive computer clears but I stay an extra 17 minutes at the three to four metre depth.
A little more about the dive. The water temperature is 26°C, I have a 3mm shorty wetsuit, it is a wreck where I have done close to 45 dives, I use 13.0 litres per minute of air (normal), I am carrying a video camera, I am not overly narked and I have a very easy dive. Nothing unusual happens on the dive.
After the dive, I return to the dive boat and get aboard. I do not do any heavy work. As my group is the first one back from the boat, I wait around for the others to return. When they do, I move to the roof of the boat to get out of their way. I still feel okay and about 10 to 15 minutes have passed from the end of the dive. After a few minutes up here, I start chatting to two blokes who I have spoken to over the past few days. At this time I notice that the hearing in my right ear is a bit down and I feel that I have water in my ear. I attempt to remove the water, first by tilting my head, then with my finger and finally with my handkerchief. Nothing works. We start off towards the resort where these blokes are staying.
After 10 minutes or so we are approaching the resort and they go down below to get their gear together. I lay down in the sun, attempting to get a bit of a tan. A few minutes later we arrive at the resort and a couple of my friends call out to me to look at the very attractive girl sunbaking on the beach. I sit up but am immediately dizzy. Thinking that it is the sun, heat and quickly sitting up, I lay back down again and after a while sit up slowly. The dizziness is still there, the worst I have ever experienced. Hell! What is this? The whole sky is moving up and down, back and forward. This is very bad.
I return to laying down for the short run back to our wharf. We arrive there five minutes later and I sit up very rockily. I have to get off this boat, I am getting sick. I jump ashore and lie down on my back and close my eyes. This is far better. I call out to one of the dive masters and tell him to tell the skipper that I am dizzy. They come over and I quickly tell them what has happened. They decide to take me back to their place to put me on oxygen. I cannot walk so a couple of my buddies and the divemasters assist me by almost carrying me to the truck. I cannot sit up so I lay down and close my eyes. Once again, I feel better.
A couple of minutes later I am carried half walking into the house and placed on a bed. I start breathing oxygen. I lie on my back, close my eyes and feel better. The owner of the dive operation turns up a few minutes later and he examines me. I am still dizzy and cannot even read the logo on his T-shirt. I have no pain, no tingles, no lack of movement and no headache. In fact, my only symptoms are dizziness and feeling sick when I sit up every now and then to drink some water.
This is like bad seasickness (I have only ever been seasick once) and I have to be quick to avoid chundering in a bucket they have placed next to me (trusting lot aren't they?).
Anyway, after an hour I was only a little better and I go off oxygen for a short period while some tests (from a PADI rescue slate I think) are carried out on me to determine if I have any cerebral impairment (some would say I have this all the time!). Well, I pass this with flying colours, with 100% success. Therefore we come to the conclusion that I am not bent and that it is probably an ear problem. This was further confirmed by the fact that I do not get worse despite being off oxygen. I am still dizzy, but nowhere as bad as earlier.
However, we decide that I should remain on oxygen for a longer period of time and after another hour and a half, I can walk unaided, although not very steadily. After all the water I have drunk I have to go to the toilet many times and each time I wobble less than the one before. About three hours after the dizziness started, I have been off oxygen for over 30 minutes with no deterioration and can now read a magazine while lying down. After another hour I can sit up and read and nearly all the dizziness has gone.
That night while showering, I notice a minute spot of blood in my right ear. I am not game to go the the local doctor, so I take some antibiotics and stop diving. When I get home I visit the doctor who indicates that I have fluid behind the eardrum (which if it was perforated, is now repaired). After a week, the fluid is still there. I still feel full in the ear, I am still a little dizzy, have ringing in my ear and am still a bit deaf.
I am given a double prescription of stronger antibiotics. About 18 days after the incident the fullness disappears, after 24 days my dizziness goes away and after 30 days my hearing returns to (almost) normal. However, the ringing still remains (as it does 18 years later in 2016).
On the 32nd day I go to an ear, nose and throat specialist who confirms what I had already decided has happened. This is that I have suffered an implosion (my term) of the round window. This is between the middle ear and the inner ear. I still do not know why it happened and the doctor says that he really had no idea. He suspects that it must have been a minute tear, hence the delay in the onset of the fullness and dizziness. It probably just happened for no apparent reason, although some other incident earlier may have had some impact (I had a motor cycle accident some three months earlier).
After some tests, he advises that my hearing is normal and that would indicate the round window was repairing itself. He sends me to have further tests which are not completed for some weeks. He indicates that it would be two to three months before I could dive again and he even added that if it was him, he would never dive again (typical non-diving doctor!).
On the 36th day I go and had an ENG (electronystagmography and calorics) test. This is a fancy name for a balance test. Basically you are put in a darkened chamber, laying on your back. Electrodes are attached to your face on the side of the head next to each eye and one above your nose. You then watch a light which moves from side to side. The electrode measures the movement of your eyes as you follow the light. Since the relationship of eye movement to balance is known, they can measure your balance response to the following. Cold water is placed in one ear and within a minute or two, you are dizzy. The light is turned off and you are asked to keep your eyes focused on the same location. The device measures your eye movement which, hopefully, is quite dramatic. Within two or three minutes, the water warms up to blood temperature and the vertigo subsides. The same is repeated on the other ear.
After these tests, I am informed that my balance is okay.
On the 46th day I have a CAT scan. This focusses on my ears and shows nothing unusual. This same day I return to the specialist. He informs me that my ear appears to have repaired itself (since my hearing and balance is normal). He also says that the ear would possibly be okay with no further problems. However, he again says that if it was him, he would never dive again. He said that I could risk permanent hearing loss (partial or full), a repeat of the dizziness (possibly forever) and ringing in the ears (well, I still have this anyway).
After considering everything, I decide that I will take the risk of partial or even full deafness in one ear rather than never dive again. Time will tell if my decision is right (and it has been so far).
I dive again on the 78th day. I must say that I was very apprehensive, more than I have been for any other dive. Before the dive, I take a Sudafed to ensure that my ears are totally clear (I felt okay but this was a precaution I originally intended keeping up but I soon stopped this). I descend very slowly and once at the bottom (on the top of the reef at 12 metres), I check myself out. Everything is okay and I am very relaxed.
I then travel to the edge of the reef and slowly drop to the sand at 18 metres. Again, no problems. During the dive I reach 22 metres and eventually end up back in 12 metres. As I consider that the ascent is probably where my problem occurred, I come up as slowly as possible to the five metre mark. Again, no problems. After the safety stop, I again ascend very slowly and get back on the boat.
As you can imagine, the next 30 to 45 minutes are fairly tense as I wait to see if I would suffer symptoms similar to my previous dive. Remember, I had not suffered any noticeable problem on that dive. Anyway, I did not have any problem after the dive and during the dive I use even less air than normal, probably because I was taking it very easy.
On the 83rd day I do another dive with similar results. As of 7 December 2016, I have now done almost 2,700 more dives, including hundreds over 40 metres and well over 500 over 30 metres. Apart from the ocassional slow clearing of my right ear, especially when descending after a slight ascent, I have not experienced any problems when diving (although I did get dizzy again one other time but I believe that was not related to this incident at all). I still have a slight ringing in my ear and have some deafness in that ear.
In the few days leading up to this incident I had a couple of dizzy spells when lugging gear back to the dive accommodation from the dive operator's truck. These lasted at the most, one or two seconds. I put these down to the heat of the day and picking up equipment after bending over. It is now probable that each of these was a tiny amount of fluid leaking through the round window.
Also, about four months before this happened to me, I was on a dive in country NSW with some friends when one of the divers had, what we thought, was a case of decompression sickness and who ended up being evacuated to Sydney by rescue helicopter. This person had, what I now realise were, similar symptoms to mine, although he was violently ill, probably because we were in a small boat in rough seas.
He did not come good when recompressed and took a long time to get over the dizziness (months). Some time later (over 18 months), he had another such incident. Since then he had an operation to mend his round window. See the page on this incident.
Deeper into Diving by John Lippmann
Diving and Subaquatic Medicine (3rd Edition) by Carl Edmonds, Christopher Lowry and John Pennefather