54
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FALL 2011
RESEARCH, EDUCATION & MEDICINE
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I N C I D E N T I N S I G H T
T
he diver was a 36-year-old
female who had done four
dives in the two months since
her certification. She was
physically fit and in good general health
but reported having had intermittent
difficulty equalizing during her
certification dives.
THE DIVES
On a Saturday in June, the diver did a
series of three dives to a maximum depth
of 64 feet in a freshwater quarry. Her
bottom times were within her computer’s
no-decompression limits, and she had
a minimum surface interval time of an hour between each
dive. Her last dive of the day was to 45 feet for 45 minutes.
She reported trouble equalizing during her first descent and
increasing difficulty on subsequent descents. She did not
complain of pain or any other significant symptoms, but she
did report a feeling of “fullness” in her left ear. She didn’t
dive for the next two days, and the sensation of fullness
decreased but did not resolve completely.
After the two days the diver believed she would be able to
equalize effectively despite the fullness, and she decided to dive
again at the same location. Unfortunately, this time she found
equalization difficult and uncomfortable as she descended.
The discomfort persisted to her maximum depth of 55 feet.
She continued to dive for about 20 minutes, but when she
could no longer tolerate the discomfort she signaled her buddy,
and they initiated their ascent. At approximately 20 feet, the
discomfort had intensified to the point of pain. This distracting
pain, combined with the diver’s inexperience, caused her failure
to vent her BCD, and she made an uncontrolled ascent to the
surface, during which the pain increased dramatically.
She had not done a safety stop, so she and her buddy
attempted to descend to 15 feet to perform the missed stop.
As they descended she was unable to equalize, and she made a
forceful attempt at approximately 10 feet. She reported feeling
and hearing a “pop,” and the pain in her ears became very
sharp. The diver aborted the descent and managed to return
safely to the surface, but she required assistance getting back
to shore. Once ashore she was observed staggering and unable
to walk without aid. She also became very nauseated and
vomited several times. She found she could not tolerate lying
flat or any movement of her head, both of which provoked
nausea and vomiting. The diver’s buddy called emergency
medical services (EMS), which arrived soon afterward and
transported her to the local hospital.
THE DIAGNOSIS
Upon examining the diver, the doctor observed nystagmus
(rapid involuntary eye movements) in addition to the acute
nausea and vertigo she reported. Additionally, the diver
complained of diminished hearing and a continued sensation
of fullness in the left ear. Examination of the ears revealed
slight redness of the right tympanic membrane (ear drum)
with no other abnormalities. The left tympanic membrane,
however, was markedly red and bulging, and an accumulation
of fluid and blood was observed behind the membrane. These
signs indicated an injury to the middle ear, but the diver’s
symptoms indicated something more serious. The evaluating
physician contacted DAN
®
for consultation.
Go Easy on the Ears
A seemingly mild injury can lead to
serious symptoms.
B y M a r t y M
c
C a f f e r t y
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