Recreational scuba diving is an increasingly popular sport globally, with approximately 1.2 million divers worldwide. Originally, divers concentrated most of their dives in warmer coastal regions. However, expansions in the sport have extended recreational dive sites in other bodies of water, including temperate and even polar seas, lakes, quarries, and many others. This means that diving-related disorders can present to essentially any hospital, whether inland or coastal, and all emergency and urgent-care clinicians should be aware of signs and symptoms of decompression sickness, in addition to those working in and around formal decompression chambers.
The inner ear consists of the vestibulocochlear organ, which is involved in hearing and one's sense of position and balance. This organ is spiral-shaped and surrounded by a bony exterior and contains a fluid called endolymph, which is responsible for the conduction of sound and changes in position. The cochlea is the portion responsible for the conversion of mechanical sound waves into action potentials of the auditory nerve, while the vestibular component is comprised of the utricle, saccule, and the semicircular canals and modulates the sense of position and balance.
Inner ear decompression sickness (IEDCS) is an incompletely understood condition observed in compressed-gas divers, likely resulting from precipitation of gas bubbles in the endolymphatic and/or perilymphatic spaces during a quick ascent. Another suggested mechanism of IEDCS is that patients may also have a right-to-left shunt, suggesting arterial gas embolism (AGE) as a contributing factor if it enters the labyrinthine artery. The classic presenting symptom of inner ear DCS is a sudden onset of vertigo. However, tinnitus and acute sensorineural hearing loss may also be present alone or in any combination.
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