We have all experienced sometimes the feeling of dizziness, giddiness, unsteadiness, lightheadedness; we understand that all these symptoms mean some kind of body balance disturbance. The causes are diverse ranging from simple and well known causes, to most of us like low blood pressure, low blood glucose level, fever, sea sickness, electrolyte imbalance, gastro- intestinal problems, or (simply tired and did not sleep enough) to a diverse and serious number of central and peripheral nervous system illnesses.
So what is Vertigo?
Vertigo is simply hallucination of movement leading to the feeling that either the objects are moving in a certain direction around the patient (objective vertigo) or the patient himself (herself) is moving in a certain direction. It is always associated with Nystagmus (continuous involuntary oscillatory side to side movement of the patient's eye pupils). I think most of us have never experienced that feeling except sometimes if you visited your ENT (ear, nose and throat) specialist for an ear wash or unfortunate ear drum perforation due to inability to equalize the pressure on your ear drums whilst diving.
Disturbance in the vestibular pathway (semicircular canals in the inner ear and their connections to the brain) lead to this feeling.
Causes of Vertigo in diving
- Unequal stimulation of both inner ears (vestibular system)
a. This happens if the external ear canal is obstructed (partially or totally) by cerumen (wax), inflammation in the external ear canal (swimming pool fungal or bacterial infections) tight fitting hood, preventing the flow of water freely in both ears.
b. Tympanic membrane (ear drum) perforation, due to unequal pressure on both sides of the ear drums in case of
Middle ear barotraumas of descent.
Middle ear barotraumas of ascent.
External ear barotraumas.
Shock wave.
- Inner ear barotraumas
This happens as serious complication of middle ear barotraumas when the membranes separating middle and inner ear also rupture (round and oval windows) with damage and hemorrhage in the inner ear.
*** Serious inner ear barotraumas can happen by forceful Valsalva maneuver (pressure equalization on the ear drums during diving)
- Decompression Sickness
Inner ear decompression sickness explanations are diverse, but the definite outcome is pathology in the inner ear (hemorrhage, edema (tissue swelling and tissue fluid accumulation) caused by nitrogen or helium bubbles (in technical divers) formation in the inner ear space. This space is limited by the surrounding bones, so the manifestations of the pathology are rapid and dramatic.
Case Report
A 42 years experienced diver (Air) was on a vacation to the red sea , in the month of April , he had been diving for 3 days every day 2 dives, the depths ranging from 25 meters 12 meters, dive times were relatively long ( 60-70 minutes) due to his excellent air consumption, on the fourth day and about 10 minutes after his first dive (28 meters, 72 minutes), he experienced a sense of dizziness, he started vomiting, the best position for him was laying down, closing his eyes and with the slightest movement, he again started to feel dizzy and vomits.
This diver was very experienced, but he thought that he might have eaten something bad especially as he had some diarrhoea the day before.
His wife as a nurse was not convinced especially when the boat docked and her husband could not stand up or walk steadily, but still he insisted he was OK.
Any how, I saw this patient 4 hours later, when he started to think maybe there was something wrong and under pressure from his wife.
He was dizzy? He had vertigo. So a simple question? Do you feel the surrounding moving around with your eyes open or you are moving yourself around? If the answer is YES, give him oxygen and transfer him to the nearest recompression chamber.
So this was a case of straight forward Inner ear decompression sickness
During the chamber treatment and afterwards this diver kept repeating the same question? Why me? I did not make any thing wrong check my computer!
The answer is you are dehydrated by:
- You are coming from home (Europe) in April already dehydrated. How much do you drink (Water) at home in April?
- Repetitive long dives.
- Travelers' diarrhoea.
And also physiological variation as you are now 42 years old (of course he did not like this one).
This is a scenario that can happen to any of us especially on diving safaris.
To end the discussion about vertigo, there are other causes less important to divers,
But for us the expression dizzy, giddy, lightheaded, not feeling ok after any dive is not ok and should be well interpreted by the dive guide and not mislead by the experienced diver.
Dr. Hanaa Nessim
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