From the Guidelines
Vertigo after snorkeling is often caused by benign paroxysmal positional vertigo (BPPV), a condition where tiny crystals in the inner ear become dislodged and cause brief but intense episodes of vertigo 1.
Common Causes of Vertigo
- BPPV is the most common inner ear problem and cause of vertigo, characterized by sudden, short spells of vertigo triggered by certain head positions or movements 1.
- Other possible causes of vertigo after snorkeling include inner ear barotrauma or caloric stimulation, although these are less common 1.
Diagnosis and Treatment
- Diagnosis of BPPV typically involves a physical examination and a review of the patient's medical history, as well as tests such as the Dix-Hallpike test or supine roll test to confirm the diagnosis 1.
- Treatment for BPPV usually involves canalith repositioning procedures (CRPs), which are designed to relocate the dislodged crystals in the inner ear and relieve symptoms 1.
- In some cases, medication such as antihistamines or anticholinergics may be prescribed to help manage symptoms, although these are not always necessary 1.
Key Points to Consider
- Patients with vertigo after snorkeling should be advised to avoid diving or strenuous activities until symptoms resolve, and to seek medical attention if symptoms persist or worsen over time 1.
- A thorough medical history and physical examination are essential to rule out other possible causes of vertigo, such as Meniere's disease or vestibular migraine 1.
- Education and counseling are also important to help patients understand their condition and manage their symptoms effectively 1.
From the Research
Causes of Vertigo Following Snorkeling
- Vertigo following snorkeling can be caused by inner ear barotrauma (IEB), inner ear decompression sickness (IEDS), and alternobaric vertigo (AV) 2
- IEB results from inappropriate equalization of middle ear pressure and consequent inner ear injury produced by pressure changes within the middle ear 2
- IEDS is characterized by the formation of gas bubbles within the vessels of the inner ear during rapid ascent 2, 3
- AV typically develops while ascending or performing the Valsalva maneuver and can follow asymmetrical equalization of middle ear pressure transmitted via the oval and round window membranes 2
- Middle ear barotrauma due to dilatory Eustachian tube dysfunction (ETD) can also make divers prone to inner ear barotrauma and alternobaric vertigo 4
Risk Factors
- Poor subjective success in Valsalva and Toynbee manoeuvres are associated with an increased risk of middle ear barotrauma, which can lead to vertigo 5
- A persistent (patent) foramen ovale (PFO) can increase the risk of inner ear decompression sickness, which can cause vertigo 3
- Individual risk factors and predisposing pathological conditions, such as ETD, should be identified before diving to prevent acute events and preserve auditory and vestibular functions 2