Inner ear decompression sickness in scuba divers: a review of 115 cases

Inner ear decompression sickness (IEDCS) in scuba divers is increasingly observed, but epidemiological data are limited to small case series and the pathogenesis remains elusive. We report our experience over a 13-year period. We also thought to demonstrate that the development of this injury is mainly attributed to a mechanism of vascular origin. Diving information, clinical data, presence of circulatory right-to-left shunt (RLS), and laboratory investigations of 115 recreational divers were retrospectively analyzed. A follow-up study at 3 months was possible with the last 50 consecutive cases. IEDCS (99 males, 44 ± 11 years) represented 24 % of all the patients treated. The median delay of onset of symptoms after surfacing was 20 min. Violation of decompression procedure was recorded in 3 % while repetitive dives were observed in 33 %. The median time to hyperbaric treatment was 180 min. Pure vestibular disorders were observed in 76.5 %, cochlear deficit in 6 % and combination of symptoms in 17.5 %. Additional skin and neurological disorders were reported in 15 % of cases. In 77 %, a large RLS was detected with a preponderant right-sided lateralization of IEDCS (80 %, P < 0.001). Incomplete recovery was found in 68 % of the followed patients. Time to recompression did not seem to influence the clinical outcome. IEDCS is a common presentation of decompression sickness following an uneventful scuba dive, but the therapeutic response remains poor. The high prevalence of RLS combined with a right-sided predominance of inner ear dysfunction suggests a preferential mechanism of paradoxical arterial gas emboli through a vascular anatomical selectivity.