Well Diving is Not Well for Hearing: Sudden Sensory Neural Hearing Loss-A Case Report

Introduction

Barotrauma was coined to describe the compression of gases at depth and its impact. Barotrauma may affect inner ear and middle ear. If the diver descends without properly equalizing the pressures within middle ear, both the surrounding pressure and inner ear pressures increase as depth increases. The inner ear pressure increases because it is fluid filled and ambient pressure is freely transmitted to and through the fluid. When the descending diver feels discomfort rather than rising to a comfortable depth the usual response is to attempt a forceful equalization with a valsalva maneuver. When the pressure in the middle-ear space is properly equalized, the risk of inner-ear barotrauma is extremely low. If the pressure in the middle ear is not equalized during descent, the water pressure on the eardrum transfers inward through the middle-ear ossicles to the oval window, and this causes the round window to bulge outward.

The pressure itself may damage sensitive inner-ear structures. If the pressure is excessive, either the oval window or, more commonly, the round window may tear, and the inner-ear fluid (perilymph) may leak into the middle ear (perilymph fistula). Pressure waves alone can cause damage to the inner ear without window rupture.

If the rupture occurs the loss of fluid from inner ear leads to damage of the hearing organ and sometimes of the balance organ. If the leak is not stopped, it results in permanent hearing loss. The divers also experience vertigo, tinnitus, nystagmus and aural fullness.

The aim of the present study was to examine a case of barotrauma following a dive in a well.

Case Presentation

A young adult male, 31years old came with a complaint of sudden hearing loss following a dive in the well on November 2019. The patient came for ENT and audiological evaluation 3 days following the incident. The major complaints were aural fullness, giddiness, ringing sensation and one episode of vomiting since past 3 days following a incident of diving. ENT evaluation revealed bilateral tympanic membrane intact. Audiological evaluation consisted of Pure Tone Audiometry, Emittance Evaluation, Oto-Acoustic Emissions, ABR and VEMP [1, 2, 3].

Discussion

Barotrauma usually causes damage to inner ear and middle ear and result in sudden sensory-neural hearing loss.

In the present study a 31 year old male who suffered sudden hearing loss and vestibular symptoms following a dive in well were analyzed.

After the client reported to hospital 3 days following the incident he was admitted in ENT ward, three courses of Intravenous injection and two courses of Intratympanic injections in both ears were given to the patient . Again a complete audiological evaluation was done to the patient. Following the course of treatment, there was improvement in his vestibular symptoms but there was no improvement in hearing.