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Published on: May 19, 2018
Superior vestibular dysfunction in severe decompression sickness suggests an embolic mechanism
Luca Verrecchia1, Mikael Gennser, Arne Tribukait
1Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden. luca.verrecchia@karolinska.se
Aviation, Space, and Environmental Medicine
|November 20, 2012
Summary
Nitrogen bubble embolism is a key factor in inner ear damage from decompression illness. This case highlights selective injury to the superior vestibular division, impacting dive safety and understanding of vestibular disorders.
Area of Science:
- Neurology
- Otolaryngology
- Diving Medicine
Background:
- Decompression illness (DCI) can affect the inner ear.
- Previous theories suggest nitrogen bubble embolism or slow nitrogen washout cause selective inner ear vulnerability.
Observation:
- A dive master experienced DCI with residual vertigo.
- Neuro-otological evaluation revealed a selective lesion of the superior vestibular division of the left labyrinth.
- Vestibular testing showed absent caloric response and impaired head impulse tests in the affected ear, with divergent vestibular evoked myogenic potentials (VEMP) results.
Findings:
- The patient presented with a partial vestibular loss, specifically affecting the superior vestibular division.
- This selective lesion profile suggests a targeted impact on a specific inner ear sub-unit.
- Bubble microembolism, combined with the unique anatomy and slow nitrogen washout of this vestibular division, is the likely cause.
Implications:
- This case supports the critical role of nitrogen bubble embolism in inner ear lesions following decompression accidents.
- Understanding selective inner ear vulnerability is crucial for managing DCI in divers.
- Further research into the microvascular and anatomical factors of the inner ear in DCI is warranted.
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