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Duplessis C, Hoffer M. Tinnitus in an active duty navy diver: A review of inner ear barotrauma, tinnitus, and its treatment. Undersea Hyperb Med 2006; 33(4):223-230.This case elucidates subtle cues that must be appreciated by the examiner in diving related injuries, who may not have experience with barotrauma-mediated pathology. Inner-ear barotrauma (IEBT) does not mandate ostensible hearing loss or vertigo; tinnitus may be the sole manifestation. Symptoms may present hours or even days post-dive. A common misconception exists that there are no efficacious treatment options for IEBT short of surgery for an overt perilymphatic fistula (1). Treatment options are available including acute high dose steroid administration, as prescribed for acute noise-induced or idiopathic hearing loss, optimally administered within three weeks of the acute insult. Tinnitus does not necessarily constitute a chronic untreatable symptom, which the patient must learn "to live with" (6,7).
BACKGROUND
Tinnitus, derived from the Latin word tinnire ("to ring"), is defined by the unwanted auditory perception of internal origin (1,2). Tinnitus affects up to 30% of the adult population, with incapacitating symptoms reported in 6% of those afflicted, and significant depression experienced in 40% (2,3). Given similar psychoacoustic descriptions of tinnitus, individuals differ radically in the perceived intrusiveness of symptoms. A sobering statistic is that 94% of patients seeking medical care are not offered treatment for their affliction, exacerbating symptoms (3). Reassurance and hope are as appropriate and the cognitive appraisal of tinnitus is an integral component of the disease (4). There are efficacious treatments for tinnitus, with more novel treatments on the horizon. However, these are not effectively promulgated in the literature.
This case elucidates the subtle cues that must be appreciated by the examiner in diving related injuries, who may not have experience with barotrauma-mediated pathology. Inner-ear barotrauma (IEBT) does not mandate ostensible hearing loss or vertigo; tinnitus may be the sole manifestation. Symptoms may present hours or even days post-dive. A common misconception exists that there are no efficacious treatment options for IEBT short of surgery for an overt perilymphatic fistula. However, treatment options are available including acute high dose steroid administration, as prescribed for acute noise-induced or idiopathic hearing loss, optimally administered within three weeks of the acute insult (6,7).
CASE
A 20-year old white male,...