A reader of dekoblog.ch, being diagnosed with Menière’s Disease, raised the question, if he can still dive. With symptoms like vertigo, tinnitus, and hearing loss, the condition directly affects the balance and sensory awareness critical for safe diving. This article explores the nature of Menière’s Disease, its management and its implications for diver safety.
Overview
Menière’s Disease is a chronic disorder oft he inner ear involving recurring episodes of vertigo, which may be associated with vomiting, fluctuating hearing loss, ringing in the ears (tinnitus), and a sensation of increased pressure in the ear.
The exact cause of Menière’s Disease is unknown, but it is believed to result from abnormal fluid buildup in the inner ear (endolymphatic hydrops). Possible contributing factors include genetic predisposition, viral infections, autoimmune responses, allergies, or head trauma. This fluid imbalance disrupts the ear's ability to regulate balance and hearing, leading to the characteristic symptoms of the condition.
The disease’s hallmark symptoms include:
Episodic vertigo: Sudden and severe spinning sensations lasting from minutes to hours.
Tinnitus: Persistent or intermittent ringing in the ear.
Hearing Loss: Progressive, often fluctuating, loss of hearing, typically affecting one ear.
Aural Fullness: A sensation of pressure or fullness in the ear.
The unpredictable nature of these symptoms makes Menière's particularly concerning for activities requiring balance and coordination, such as scuba diving.
Management of Menière’s Disease
Treatment for Menière’s Disease focuses on symptom management. Key approaches include:
Lifestyle Adjustments: Avoidance of triggers such as stress, caffeine, nicotine and sodium may help reduce the frequency and severity of episodes.
Physiotherapy: Between episodes. Improves balance but does not reduce vertigo frequency. Not for acute vertigo episodes.
Medications: Anti-vertigo drugs are used to control vertigo, nausea, and vomiting during acute episodes.
Diuretics: Promote the production of urine by helping the kidneys remove excess salt (sodium) and water from the body. These may help regulate the excess volume of endolymph (the fluid contained in the inner ear) that contributes to symptoms.
Surgical Options: Consultation with an ENT physician is recommended. Surgical interventions may provide relief in severe cases.
Fitness to Dive
The variability of Menière’s Disease complicates assessments of fitness to dive. While the condition may spontaneously mitigate in some cases, it can also progress.
Divers with Ménière’s Disease face significant risks:
Disabling Symptoms Underwater: Vertigo, disorientation, nausea, or vomiting underwater can lead to panic, choking, or even drowning.
Pressure Regulation: Difficulty equalizing ear pressure during descent and ascent may trigger symptoms of Menières Disease
Mimicking Dive Injuries: Symptoms of Ménière’s Disease may be confused with dive-related injuries, such as inner-ear barotrauma or inner-ear decompression sickness, complicating diagnosis and treatment.
Balance Deficits: Impaired balance may hinder essential diving skills, such as maintaining orientation and buoyancy.
Diving Emergencies: An episode of acute vertigo could incapacitate a diver, making self-rescue or adherence to dive safety procedures impossible.
Permanent Hearing Loss: Exposure to underwater pressures may accelerate hearing degradation in individuals with Ménière’s Disease.
Recommendations for Divers with Menière’s Disease
Individuals with «active» Menières disease are at risk of experiencing disabling symptoms. Thus, Menières disease is an absolut contraindication to diving.
Individuals with Meniere's disease, who suffer attacks at short intervals, must not dive.
There is no cure for Menière's disease. Over time, some degree of permanent hearing loss is common. However, the worst symptoms of vertigo, nausea and vomiting often can be controlled.
Divers with very well controlled Menière’s Disease may be able to dive, but must prioritize safety. Considerations include:
Medical clearance: Obtain clearance from a dive medicine physician after consulting an ENT specialist.
Diving restrictions: Diving is absolutely forbidden during periods of active symptoms or if the condition is poorly controlled.
Buddy system: Inform dive buddies about the condition and ensure they are trained in emergency response.
Emergency preparedness: Be equipped to manage potential vertigo episodes, including practicing controlled ascent techniques.
Shallow dives: Minimize pressure changes by limiting dives to shallower depths.
Only dive under easy conditions: night dives, dives in poor visibility, dives in overhead situations (wreck, cave) etc. are strictly prohibited
Ongoing monitoring: Regular medical evaluations are essential to assess the condition's progression and its impact on diving ability.
The medical board of the EDTC (European Diving Technology Committee) classifies Menières Disease as an absolute contraindication to diving (but admits that this recommendation is based on expert opinion and not on study data).
Conclusion
Menière’s Disease poses a significant risk for divers, above all the risk of disorientation and panic leading to barotrauma, decompression sickness and drowning. While treatment can alleviate symptoms, the unpredictable nature of the disease requires great caution and, in many cases, refraining from diving. Divers with Menière’s Disease should seek expert medical guidance, adhere to strict safety protocols, and may only dive if the disease is very well controlled, i.e. if episodes occur at long intervals and symptoms are mild.
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