- [Narrator] In a new series of videos,
DAN, the experts in diving medicine,
safety and scuba insurance,
talk about some of the diving incidents
they have come across over the years with the hopes,
future incidents can be avoided through education.
Let us know in the comments,
if you've been affected by today's topic,
or if you have any questions
so we can create video updates.
As always, don't forget to make your next dive
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if you enjoy the video.
Let's get into this week's topic.
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The diver was a 58 year old man
with approximately 150 lifetime dives.
He had hypothyroidism, which is a low thyroid hormone level,
for which he took levothyroxine daily.
He had no other medical problems
and reported being physically fit.
The diver and a companion were on vacation
in the Caribbean and planned to dive every day.
They had scheduled two morning
and two afternoon dives each day.
On their first dive the seas were calm
and current was minimal.
After a site orientation and dive briefing,
they descended to 20 meters for 35 minutes,
while breathing air.
The dive was mostly uneventful,
but the diver reported minor difficulty
equalizing his right ear.
He stated that it was not sufficient to cause discomfort
or make him abort the dive.
As he was removing his equipment, however,
he began to feel dizzy.
The dizziness soon became true vertigo,
a sensation of spinning and he vomited twice.
He also had difficulty standing.
The boat's crew placed the diver in the recovery position
and provided oxygen at as high a concentration as possible.
The oxygen did little to improve his symptoms.
Once all the divers were back on board
the vessel returned to the dock.
The crew contacted Emergency Medical Services, EMS,
while the boat was underway,
and the EMS crew met them at the dock.
On route to the hospital the diver realized
the vertigo was subsiding.
When they reached the hospital,
he was able to sit upright and the nausea had resolved.
The hospital staff worked efficiently
to evaluate this diver.
They performed an electrocardiogram or ECG,
and routine blood tests to determine
if there were any cardiovascular problems.
The doctor performed a neurological examination
and found the diver could walk normally without assistance.
He could easily walk heel-to-toe and maintain his balance.
His coordination, reflexes and motor function,
were all normal.
He displayed no short term memory problems.
His only complaint was muffled hearing in his right ear.
The doctor examined his ears.
The left ear appeared normal with no signs of Barotrauma.
The doctor could not evaluate the right ear
because of impacted cerumen or earwax,
blocking the ear canal.
After irrigating the wax from the canal,
the doctor was able to evaluate the diver's eardrum,
which displayed some minor redness.
Removal of the wax had relieved the diver's muffled hearing.
All test results were normal
and the diver was released back to the resort.
The doctor recommended that the diver not dive the next day
as a matter of prudence.
But said he could resume diving the following day,
provided he had no further problems.
It is impossible to state with absolute certainty,
what occurred with this diver.
From the available information,
we can reasonably speculate what may have happened.
The body naturally produces cerumen,
which is necessary for good ear health.
Some individuals, however, are much more prone than others
to accumulate too much cerumen.
This condition has little to do with hygiene
and is easy to manage.
It's also easy to not know that you have an excess
cerumen build up until it creates a problem.
The excess cerumen can act as a non-vented earplug.
As the water pressure increases during descent
an airspace may be between the cerumen plug and the eardrum.
The plug is forced inward towards the eardrum,
compressing the airspace.
This compression was likely the reason the diver
had some difficulty equalizing his right ear.
The compressed air did not allow the eardrum to move easily
when he was equalizing the middle ear space
on his right side.
The cerumen plug can be forced deeper
into the ear canal during descent.
During ascent, it will probably not return
to its original position,
even though the air that was compressed will expand
as the ambient pressure decreases.
This can cause a pressure difference between the two ears,
which can trigger alternobaric vertigo,
a spinning sensation caused by differential pressurization
of the ears.
The fact that this diver
did not have acute symptoms at first,
suggests that the expanding air had a passage
to escape through the cerumen.
When the diver's symptoms worsened abruptly,
that passage had likely become blocked.
And the expanding air then triggered alternobaric vertigo.
During the ride in the ambulance the diver experienced
reduced symptoms and he reported complete resolution
of his symptoms, besides muffled hearing,
when he arrived at the hospital.
The expanding air most likely found a passage
through the cerumen that allowed the pressure
on both ears to be equalized.
This scenario could happen to any diver.
Prevention is easy.
Consider irrigating your ear canals
prior to leaving on dive vacations.
Ear wax removal kits are available at local drugstores.
You can also use a simple bulb syringe
to flush the ear canals with warm, soapy water.
As with anything related to your physical health,
be sure to discuss this condition
with your healthcare provider.
The crew of this dive vessel did the right thing
in ensuring this diver got evaluated
by a medical professional.
If you have any symptoms or concerns after diving,
do not hesitate to contact the DAN Emergency Hotline.
If you like this video, don't forget to Subscribe
and hit that bell so you don't miss the next incident file.
Until next time, dive safely with DAN.
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