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Sudden Deafness Experience: What Divers Need to Know.




1

Sudden hearing loss is a medical emergency.

You need to see a doctor immediately.


2

Be ready to get a second opinion.

Studies confirm the efficacy of a combination of

Corticosteroids and Hyperbaric Oxygen Therapy.


3

Sudden deafness is not just for divers.

Pass the word!



It was a pleasant surprise to reconnect with our friends Catherine and Bubba on Deep Blue's new dive boat last weekend. Both are avid underwater photographers. They were back in Aqaba after three months out and about, scouting some of the most spectacular diving spots in the world. When Bubba noticed that I was in no rush to put on my wet suit, he was quick to inquire:


Bubba: "You are not diving with us today, Dom?"


Me: "I wish I were! I am off diving for another four months. I suffered severe and sudden hearing loss in my left ear last November after a freediving course. I underwent intense treatment with a combination of steroids and Hyperbaric Oxygen Therapy. Now I need to give my ears a break and hope they'll keep healing naturally..."


Bubba: "I am so sorry, Dom. And how are you now?"


Me: "I am in high spirits. As for my ear, the glass is only half full. The hearing loss has gone from severe to moderate, so I consider myself lucky. I'll most likely need hearing aids, which is depressing for a musician like me. But now I am on a mission to share my experience with fellow divers because, sadly, I would have had greater chances of full recovery with better guidance from the onset. Maybe you would have ideas on how to go about this?"


Catherine: "I am so sorry, Dom. How about we write a blog post on Deep Blue's website? I have wanted to write about preventing diving-related ear injuries. I once had to take a few days off diving in the Philippines because of acute ear pain. What happened exactly?"


Me: "Oh, thanks, Catherine; I love the idea of a blog post! The first point to stress is urgency. My instructor was kind and reassuring when I got out of the water. He advised me to take it easy and suggested that my hearing would return to normal within a few days or weeks. The few online articles I read about barotrauma confirmed that healing could happen naturally, so I wasn't alarmed. I consulted an ENT doctor ten days after the incident. But what I know today is that I should have rushed to the emergency."


Catherine: "Yes, it would have been best to take corticosteroids immediately. I did that in the Philippines, and my earache when away after a few days. At least I got to enjoy some of the amazing dives!"


Me: "Well, not me, dear Catherine! I did not get a corticosteroid prescription right away; far from it! The first ENT doctor I consulted claimed that my only options were hearing aids or surgery. In his office, my stress level went up, not down! I quickly consulted a second ENT doctor, who immediately prescribed a high dose of corticosteroids. Later, a friend who had had a similar hearing loss experience nudged me to consider Hyperbaric Oxygen Therapy (HBOT). By the time I started the HBOT at the Prince Hashem bin Abdullah Military Hospital in Aqaba, four weeks had passed already. The best results are found when patients are treated in the first two weeks."


Bubba: "It sounds like this was a bit of a rough journey, Dom. What are your thoughts on prevention?"


Me: "We need to pass the word around. In scuba diving, we know about Hyperbaric Oxygen Therapy for decompression sickness. In freediving, we learn about sending a diver to the doctor after a blackout. But not many divers are aware that sudden deafness is a medical emergency, and not all doctors are knowledgeable about HBOT."


Catherine: "But what caused the hearing loss, Dominique? Could you have prevented the accident from happening in the first place?"


Me: "Ah, touché, Catherine. Well, I am at fault here. The textbooks are clear that we should never equalize forcefully and always before experiencing any pain. But I am a bit of a competitive hyper-achiever, and I pushed myself a little too much underwater. Performance should never trump safety..."


Catherine: "Ouch, you paid a high price for this lesson, Dom. How about getting started on that blog post? Would you come up with a draft, and we'll take it from there?"


Me: Sure thing! I'm on it. Enjoy your dive! See you in a bit!




What is sudden deafness (1):


  • Sudden sensorineural hearing loss is defined as a hearing loss of at least 30 decibels occurring over at least three consecutive frequencies and lasting at least 3 days.

  • Possible etiologies include vascular occlusion, viral infections, labyrinthine membrane breaks, autoimmune, trauma, toxins, cochlear membrane damage, demyelinating disease, stroke, and schwannoma.

  • The patient typically first notices symptoms upon awakening and describes an aural fullness/blockage. They may also experience tinnitus (usual), dizziness, or vertigo.

  • There are approximately 4000 new cases in the United States annually. The spontaneous recovery rate is difficult to determine since many patients do not seek medical care but it has been reported as low as 25% and as high as 65%.

  • Adult-onset hearing loss is the most common cause of disability globally and the third leading cause of years of productivity lost due to disability according to the World Health Organization (WHO). Hearing aids are recommended for moderate (41 decibels to 60 decibels) and severe (61 decibels and greater) hearing loss.


What are the treatments for sudden deafness (1):


  • More than 60 treatment protocols have been described for sudden sensorineural hearing loss, but the majority of these are not efficacious. The three most promising treatments include corticosteroids, vasodilators, and hyperbaric oxygen therapy. Of these, only hyperbaric oxygen has sufficient randomized controlled trials to have a positive meta-analysis Cochrane review.

  • The best results are found when patients are treated within 14 days of symptoms onset and with concomitant steroids (either systemically or intratympanic).

  • Steroids should be given at an initial dose of 1mg/kg/day and tapered over 2 to 3 weeks unless contraindicated.

  • Patients with moderate to severe hearing loss (more than 40 decibels) should be considered for hyperbaric oxygen therapy.

  • The American Academy of Otolaryngology recommends hyperbaric oxygen be considered as a treatment option for up to 3 months after symptom onset.

(1): Hyperbaric Treatment Of Sensorineural Hearing Loss; by Heather M. Murphy-Lavoie; Mesut Mutluoglu.

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