Inner Ear Decompression Sickness

Recreational scuba diving is becoming an increasingly popular sport globally, with approximately 1.2 million divers worldwide. Originally, divers concentrated most of their dives in warmer coastal regions. However, recently they have been extending their dives in other bodies of water, including local lakes, quarries, etc. This means that diving-related disorders can present to any hospital, whether inland or coastal and all clinicians should be aware of signs and symptoms of decompression sickness.[1] The inner ear consists of the vestibulocochlear organ, which is involved in hearing and one's sense of position and balance. This organ is surrounded by a bony exterior and contains a fluid called endolymph, which is responsible for the conduction of sound and changes in position. The cochlea is the portion responsible for the conversion of mechanical sound waves into action potentials in neurons, while the vestibular system modulates the sense of position and balance.[2] Inner ear decompression sickness (IEDCS) is an incompletely understood condition observed in compressed-gas divers likely resulting from precipitation of gas bubbles in the endolymphatic and perilymphatic spaces during a quick ascent. Another suggested mechanism of IEDCS is that patients may also have a right-to-left shunt, suggesting arterial gas embolism (AGE) as a contributing factor if it enters the labyrinthine artery.[2][3] The classic common presenting symptom of inner ear DCS is a sudden onset of vertigo. However, tinnitus and acute sensorineural hearing loss may also be present alone or in any combination.[2][3]
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