DrQ&A


Dr Ian Sibley-Calder has been a GP since 1988, is a medical referee for the UK Sports Diving Committee and is involved with hyperbaric medicine and commercial diving activities. He is a BSAC Advanced Diver and Club Instructor.
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Rapid expansion of gases and pressure changes can result in damage to the delicate tissues in the ear.
EAR PROBLEMS AFTER FAST ASCENT
I completed a 20m dive on which my buddy had a problem that resulted in us both shooting to the surface from 10m. Immediately after the dive I had no problems, but over the next 24 hours I experienced loss of hearing in one ear and loss of balance. I have attended an ENT department for seven weeks and the consultant has said that my hearing may not improve, though my balance should improve over time. At no time did I ever suffer pain. Could you advise me on my condition and whether I am fit to dive
Ken


Unfortunately there can be no doubt that you have suffered an inner ear barotrauma incident, which has resulted in damage not only to your hearing but also the balance apparatus in the ear. The rapid expansion of gases and pressure changes in the ear has damaged some of the delicate tissues and led to damage.
The hearing usually improves a little but the diver is often left with a sensorineural high tone loss of varying severity, and the balance should improve, particularly if balance exercises are practised.
Fitness to dive depends on the severity of the balance problems and any associated dizziness or risk of incapacity. Further episodes could increase the risk of damage further. There is no specific treatment.

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Diving with a pacemaker is possible so long as limitations are observed
Effects of an irregular heartbeat
In 1997 I was diagnosed with a heart condition, supraventricular tachycardia. My heart rate ranges from 130 to 146 constantly, rarely reverting to its proper rhythm. Luckily I have no other symptoms. It is believed this condition has been present since birth - it was diagnosed only during a routine knee operation. I have had three procedures using radiofrequency catheter ablation, all unsuccessful, but have had minimal improvement. The next step could be open heart surgery, a pacemaker or the same again. Can I dive, and do I need a special form or certificate to present to dive centres
Ben


Heart rhythm problems are potentially serious in diving, as they can lead to incapacity or even death under water. In general a diver should discuss the case with a cardiologist knowledgeable about diving. Your condition must not cause any loss of capability and there must be no other associated heart conditions, such as valve disorders or ischaemic heart disease.
Treatments such as pacemakers also need to be taken into account. Permission to dive will usually be accompanied by restrictions on depths and dive times to no-stop diving, so that the diver is always able to make a direct ascent to the surface without risk of being forced to make prolonged decompression stops while suffering the arhythmia.
Restriction to diving only with experienced companions will usually be a requirement.

Comeback from chest surgery
A year ago I suffered from an abdominal aortic aneurysm and underwent chest surgery to rectify it. When can I scuba dive again

I am afraid the question here is not when you can dive, but if you can dive again. This is an extremely big operation, with damage to all sorts of areas and potential damage to the lungs.
The other question that remains is why you had an aortic aneurysm, as it is often associated with arterial wall damage and in some cases congenital changes to the vessel walls. You may well be at increased risk of other vascular damage or heart attacks, which may make you unfit.
You will require careful evaluation by an experienced dive doctor - but you should not dive until then.

Back rash after first dive
I did my first dive in Aruba - not deep, only about 7m. A few days later I developed a hideous rash on my back (down both sides but not in the middle), consisting of red welts with pustules in the centre of each welt.
I saw a doctor on Aruba but he had no clue what it was. I then went to the dive shop, but obviously it wouldnt admit to anything. Now the pustules are gone, the welts are fading, and
I have no information on what it was. Can you help
Linda


You dont say whether you were wearing a suit or what type, or whether you had come across any wildlife such as fire coral. Diagnosing rashes without seeing them is extremely difficult but I can be sure that this was not related to decompression illness. The skin bend rash is nothing like the one you describe.
The most likely causes of this sort of rash are either allergic, infective or a reaction to some sort of toxin/poison from the wildlife.
I would not get too concerned unless this becomes a recurrent problem, in which case closer analysis is needed to determine cause.

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I have been reading up on all the info I can find about ear infections caused by diving and suggested solutions,
and found your advice in the December 2003 column on ear infections. You suggest using olive-oil drops in the ears before and after a dive. What does this actually do
Marcus


As with all skin, that of the canal going down to the eardrum can be susceptible to dryness and cracking. This is worse if someone has had frequent ear infections that reduce the wax production so essential for a healthy canal.
Olive oil works like hand cream or a moisturiser - it moistens the skin, improving its general condition and making it less likely to crack and allow an infection in. The water-dispersing features of the oil may also help reduce the amount of water remaining in the ear after a dive.

Stock letters to sign
My girlfriend and I are off to Australia for a year and have planned a stop-off in Tahiti. I have dived only twice before and she hasnt at all, but we were hoping to do our PADIs there, and also do plenty more diving over the year. It was suggested to me that some dive schools might request a letter proving medical fitness, especially in my girlfriends case, as she is mildly asthmatic. Is this the case, and if so, are there any standard letters available that our GPs could just sign

Firstly, there is no such thing as a mild asthmatic and diving. Any asthmatic potentially has the risk of pneumothorax (burst lung), CAGE, (cerebral arterial gas embolism) and death if the asthma is not well controlled, and if he or she is not assessed and advised by an experienced dive doctor.
The second issue is one of a doctor simply supplying a standard letter as a disclaimer. Any doctor not understanding the full ramifications of what he is signing should not be doing so, and having such a letter just to placate a diving school is irresponsible and, Im afraid, gives
no credence to the idea of personal responsibility.
There is no point in approaching a doctor to rubber-stamp an opinion that you have no intention of following, or avoiding one that you do not want to hear. Your girlfriend needs a proper medical.