The Underwater “Spin Cycle” Known as Diver’s Vertigo

Years ago, at 60 feet off of Grand Cayman, my underwater world went spinning, turning in and out of focus, like how movies depict acid trips. I had no idea what was happening but knew that if I did anything other than stay still I’d be in trouble. I grabbed the edge of the wall, hung on and in a few seconds, the seascape stopped spinning. I’d just had a bout of vertigo, something I had never experienced on land but would experience twice again while diving.

Ian Sibley-Calder, M.D., the medical columnist for the British magazine DIVER, says it’s not an uncommon experience underwater. He recently wrote that “vertigo is the sensation of the room spinning around but what distinguishes the condition from dizziness is the sufferer can often tell you which way it is spinning. It is frequently associated with vomiting, often severe and prolonged, and incapacity due to the overwhelming sensations.”

A common origin of vertigo is problems in the inner ear. When we move, fine hairs lining canals in the inner ear are disturbed, allowing the brain to tell us our position. The inner ear also has two small windows covered in membranes. One transmits sound waves to the cochlea, while the other bulges slightly in response to sound waves.

Four conditions can cause imbalance between the two windows, and thus can cause vertigo:

Pressure. The most common cause of vertigo is when one ear clears but the other doesn’t. This leads to a pressure imbalance in the windows, sending confusing information to the brain. It often occurs on descent with ear-clearing problems but can also occur on ascent for the same reason. It usually clears quickly after the diver exits the water.

Round-window rupture. This serious vertigo is usually the result of excessive attempts to clear the ears, or severe barotrauma caused by failure to equalize pressure. The round window ruptures, leading to severe vertigo, vomiting, hearing loss and incapacity. This is an emergency, as permanent damage to hearing and balance can occur.

Temperature. If cold water gets into one ear canal but not the other, it can cause an imbalance between the ears. This vertigo type clears quickly once a diver is out of the water.

Decompression illness. You can get bubbles in the two windows or in the blood vessels around them. It should be treated as any other case of DCI, with immediate 100 percent oxygen and transport to a hyperbaric facility for recompression.

“Some issues in a diver’s medical history can make him more susceptible to vertigo,” says Ernest Campbell, M.D., the blogger for Scubadoc.com. They include chronic Eustachian tube dysfunction; a recent upper respiratory infection; previous barotraumas; nasal airway obstruction; and previous major sinus or ear surgery. Regardless of the vertigo type, says Campbell, a suffering diver should be taken out of the water as quickly as possible in a controlled fashion. Treatment is typically a suspension of diving and bed rest.

In each of my vertigo bouts, there was no way I knew up from down. It was as if I were staring into the window of a front-loading washing machine. I followed the rule everyone must follow to avoid panic: stop, relax, think. My decision was to wait, and the vertigo cleared in a few seconds. In one instance, it dissipated after I rose upward about six feet. In each case, I was buddy diving; no one noticed anything strange.

Keep in mind that with just about any incident underwater, if you don’t panic, you can think your way out and survive it.