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Inner-ear decompression sickness: 'hubble-bubble' without brain trouble?

Lucio Tremolizzo1, Massimo Malpieri2, Carlo Ferrarese3

  • 1Deptartment of Neurology, San Gerardo Hospital and University of Milano-Bicocca, Italy,

Diving and Hyperbaric Medicine
|July 14, 2015
PubMed
Summary
This summary is machine-generated.

Inner-ear decompression sickness (DCS) may occur without brain involvement, even with a patent foramen ovale (PFO). This suggests the inner ear

Keywords:
Inner earcase reportsdecompression illnessletter (to the Editor)persistent foramen ovale

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Area of Science:

  • Diving Medicine
  • Physiology
  • Neurology

Background:

  • Inner-ear decompression sickness (DCS) is a recognized but poorly understood condition in divers.
  • A patent foramen ovale (PFO) is frequently associated with inner-ear DCS, suggesting arterial gas embolism (AGE) as a primary cause.
  • However, AGE does not always lead to inner-ear DCS, and other DCS mechanisms exist.

Observation:

  • A 44-year-old diver with a moderate-to-severe shunt (presumed PFO) experienced severe inner-ear DCS after a routine dive.
  • The diver presented with complete deafness and vertigo, but a brain MRI showed no signs of infarction.
  • This case suggests inner-ear DCS can occur with complete neurological sparing.

Findings:

  • The inner ear may have a unique vulnerability to AGE due to slower gas removal kinetics and the small labyrinthine artery.
  • Arterial bubbles may preferentially affect the inner ear, or direct bubble formation within the inner ear cannot be ruled out.
  • The association between PFO and inner-ear DCS might be circumstantial if direct bubble formation is the primary mechanism.

Implications:

  • Inner-ear DCS can manifest without clinical or radiological evidence of brain damage.
  • Further research is needed to determine the precise incidence of inner-ear involvement in divers with shunts.
  • This data is crucial for evaluating the risk-benefit ratio of PFO closure for preventing inner-ear DCS.