| Alternobaric vertigo | |
|---|---|
| Specialty | Otorhinolaryngology, diving medicine  |
In aviation and underwater diving, alternobaric vertigo is dizziness resulting from unequal pressures being exerted between the ears due to one Eustachian tube being less patent than the other. [1] [2] [3]
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This might have occurred due to barotrauma of descent, and/or the effects of nasal decongestants. It is due to unequal increase in middle ear pressures on ascent, is usually mild, and most often cleared by further ascent. When the pressures in both ears reach ambient levels, the stimulus for the dizziness stops. [2] Although most often mild, the vertigo can persist until the diver reaches the surface continuing the unequal pressures, which can damage the inner ear or ear drum.
Alternobaric vertigo is most pronounced when the diver is in the vertical position; the spinning is towards the ear with the higher pressure and tends to develop when the pressures differ by 60 cm of water or more. [4] [5] Ear clearing may be a remedy. A similar vertigo can also occur as a result of unequal heating stimulation of one inner ear labyrinth over the other due to diving in a prone position in cold water - the undermost ear being stimulated.
In terms of diagnosis for alternobaric vertigo the medical history and physical examination, are important. Furthermore, Eustachian tube function testing is also performed [6]
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Decompression sickness is a medical condition caused by dissolved gases emerging from solution as bubbles inside the body tissues during decompression. DCS most commonly occurs during or soon after a decompression ascent from underwater diving, but can also result from other causes of depressurisation, such as emerging from a caisson, decompression from saturation, flying in an unpressurised aircraft at high altitude, and extravehicular activity from spacecraft. DCS and arterial gas embolism are collectively referred to as decompression illness.
Altitude diving is underwater diving using scuba or surface supplied diving equipment where the surface is 300 metres (980 ft) or more above sea level. Altitude is significant in diving because it affects the decompression requirement for a dive, so that the stop depths and decompression times used for dives at altitude are different from those used for the same dive profile at sea level. The U.S. Navy tables recommend that no alteration be made for dives at altitudes lower than 91 metres (299 ft) and for dives between 91 and 300 meters correction is required for dives deeper than 44 metres (144 ft) of sea water. Most recently manufactured decompression computers can automatically compensate for altitude.
The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air, as if blowing up a balloon. Variations of the maneuver can be used either in medical examination as a test of cardiac function and autonomic nervous control of the heart, or to clear the ears and sinuses when ambient pressure changes, as in scuba diving, hyperbaric oxygen therapy, or air travel.
Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with, the body and the surrounding gas or liquid. The initial damage is usually due to over-stretching the tissues in tension or shear, either directly by an expansion of the gas in the closed space or by pressure difference hydrostatically transmitted through the tissue. Tissue rupture may be complicated by the introduction of gas into the local tissue or circulation through the initial trauma site, which can cause blockage of circulation at distant sites or interfere with the normal function of an organ by its presence. The term is usually applied when the gas volume involved already exists prior to decompression. Barotrauma can occur during both compression and decompression events.
A diving mask is an item of diving equipment that allows underwater divers, including scuba divers, free-divers, and snorkelers, to see clearly underwater. Surface supplied divers usually use a full face mask or diving helmet, but in some systems the half mask may be used. When the human eye is in direct contact with water as opposed to air, its normal environment, light entering the eye is refracted by a different angle and the eye is unable to focus the light on the retina. By providing an air space in front of the eyes, the eye is able to focus nearly normally. The shape of the air space in the mask slightly affects the ability to focus. Corrective lenses can be fitted to the inside surface of the viewport or contact lenses may be worn inside the mask to allow normal vision for people with focusing defects.
In-water recompression (IWR) or underwater oxygen treatment is the emergency treatment of decompression sickness (DCS) by returning the diver underwater to help the gas bubbles in the tissues, which are causing the symptoms, to resolve. It is a procedure that exposes the diver to significant risk which should be compared with the risk associated with the available options and balanced against the probable benefits. Some authorities recommend that it is only to be used when the time to travel to the nearest recompression chamber is too long to save the victim's life; others take a more pragmatic approach and accept that in some circumstances IWR is the best available option. The risks may not be justified for case of mild symptoms likely to resolve spontaneously, or for cases where the diver is likely to be unsafe in the water, but in-water recompression may be justified in cases where severe outcomes are likely if not recompressed, if conducted by a competent and suitably equipped team.
In underwater diving activities such as saturation diving, technical diving and nitrox diving, the maximum operating depth (MOD) of a breathing gas is the depth below which the partial pressure of oxygen (pO2) of the gas mix exceeds an acceptable limit. This limit is based on risk of central nervous system oxygen toxicity, and is somewhat arbitrary, and varies depending on the diver training agency or Code of Practice, the level of underwater exertion expected and the planned duration of the dive, but is normally in the range of 1.2 to 1.6 bar.
High-pressure nervous syndrome is a neurological and physiological diving disorder which can result when a diver descends below about 500 feet (150 m) using a breathing gas containing helium. The effects experienced, and the severity of those effects, depend on the rate of descent, the depth and the percentage of helium.
Vertigo is a condition in which a person has the sensation that they are moving, or that objects around them are moving, when they are not. Often it feels like a spinning or swaying movement. It may be associated with nausea, vomiting, perspiration, or difficulties walking. It is typically worse when the head is moved. Vertigo is the most common type of dizziness.
Underwater demolition is the deliberate destruction or neutralization of man-made or natural underwater obstacles, both for military and civilian purposes.
Peter B. Bennett was the founder and a president and CEO of the Divers Alert Network (DAN), a non-profit organization devoted to assisting scuba divers in need. He was a professor of anesthesiology at Duke University Medical Center, and was the Senior Director of the Center for Hyperbaric Medicine and Environmental Physiology at Duke. Bennett is recognized as a leading authority on the effects of high pressure on human physiology.
Ear clearing, clearing the ears or equalization is any of various maneuvers to equalize the pressure in the middle ear with the outside pressure, by letting air enter along the Eustachian tubes, as this does not always happen automatically when the pressure in the middle ear is lower than the outside pressure. This need can arise in scuba diving, freediving/spearfishing, skydiving, fast descent in an aircraft, fast descent in a mine cage, and being put into pressure in a caisson or similar internally pressurised enclosure, or sometimes even simply travelling at fast speeds in an automobile.
A labyrinthine fistula is an abnormal opening in the inner ear. This can result in leakage of the perilymph into the middle ear. This includes specifically a perilymph fistula (PLF), an abnormal connection between the fluid of the inner ear and the air-filled middle ear. This is caused by a rupture of the round window or oval window ligaments separating the inner and middle ear.
Capt. Edward Deforest Thalmann, USN (ret.) was an American hyperbaric medicine specialist who was principally responsible for developing the current United States Navy dive tables for mixed-gas diving, which are based on his eponymous Thalmann Algorithm (VVAL18). At the time of his death, Thalmann was serving as assistant medical director of the Divers Alert Network (DAN) and an assistant clinical professor in anesthesiology at Duke University's Center for Hyperbaric Medicine and Environmental Physiology.
The Frenzel Maneuver is named after Hermann Frenzel. The maneuver was developed in 1938 and originally was taught to dive bomber pilots during World War II. The maneuver is used to equalize pressure in the middle ear. Today, the maneuver is also performed by scuba divers, free divers and by passengers on aircraft as they descend.
In physiology, isobaric counterdiffusion (ICD) is the diffusion of different gases into and out of tissues while under a constant ambient pressure, after a change of gas composition, and the physiological effects of this phenomenon. The term inert gas counterdiffusion is sometimes used as a synonym, but can also be applied to situations where the ambient pressure changes. It has relevance in mixed gas diving and anesthesiology.
Albert Alois Bühlmann was a Swiss physician who was principally responsible for a number of important contributions to decompression science at the Laboratory of Hyperbaric Physiology at the University Hospital in Zürich, Switzerland. His impact on diving ranged from complex commercial and military diving to the occasional recreational diver. He is held in high regard for his professional ethics and attention to his research subjects.
Inner ear decompression sickness, (IEDCS) or audiovestibular decompression sickness is a medical condition of the inner ear caused by the formation of gas bubbles in the tissues or blood vessels of the inner ear. Generally referred to as a form of decompression sickness, it can also occur at constant pressure due to inert gas counterdiffusion effects.
Middle ear barotrauma (MEBT), also known to underwater divers as ear squeeze and reverse ear squeeze, is an injury caused by a difference in pressure between the external ear canal and the middle ear. It is common in underwater divers and usually occurs when the diver does not equalise sufficiently during descent or, less commonly, on ascent. Failure to equalise may be due to inexperience or eustachian tube dysfunction, which can have many possible causes. Unequalised ambient pressure increase during descent causes a pressure imbalance between the middle ear air space and the external auditory canal over the eardrum, referred to by divers as ear squeeze, causing inward stretching, serous effusion and haemorrhage, and eventual rupture. During ascent internal over-pressure is normally passively released through the eustachian tube, but if this does not happen the volume expansion of middle ear gas will cause outward bulging, stretching and eventual rupture of the eardrum known to divers as reverse ear squeeze. This damage causes local pain and hearing loss. Tympanic rupture during a dive can allow water into the middle ear, which can cause severe vertigo from caloric stimulation. This may cause nausea and vomiting underwater, which has a high risk of aspiration of vomit or water, with possibly fatal consequences.
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