Thank you for sharing your concerns. Dizziness can be very distressing. I commend you for seeking help and taking steps to address it. Given that your symptoms began after swimming in April, several possibilities come to mind. These include but are not limited to: (1) Inner Ear Barotrauma: This can occur if pressure changes while swimming or diving affected your ear structures. (2) Inner Ear Irritation or Nerve Damage (Vestibular Nerve): Sometimes, inflammation or other factors can irritate the vestibular nerve, which helps control balance. (3) Mal de Débarquement Syndrome (MdDS): This rare condition involves a sensation of rocking or swaying, often triggered by motion exposure (e.g., being on a boat or swimming). Unlike vertigo, it feels like you're moving when you're not. (4) Chronic Pressure Disequilibrium: This could involve persistent middle or inner ear pressure issues affecting your balance. To better understand your symptoms, could you clarify what you mean by "dizzy"? For example: Is it a spinning sensation (vertigo)? Or do you feel unsteady, like you're losing balance (disequilibrium)? These two sensations have distinct causes, and your answer will help narrow down the possibilities. Given that your symptoms have persisted despite previous treatments, I strongly recommend seeing an ENT specialist with expertise in balance disorders. They can perform specialized tests to assess your inner ear and vestibular system thoroughly. If you could let me know your city of residence, I would be happy to suggest a specific specialist near you. Thanks again for watching our video and asking the questions. This is exactly why we release this material. We welcome your questions. Dr Frans Cronje

Thank you so much for sharing your experience and insights! You’ve highlighted a very important distinction between the risks associated with flying and diving after a spontaneous pneumothorax. You’re absolutely right-while the pressure changes during descent in an aircraft can actually help stabilize a pneumothorax, the pressure during ascent from a dive can dangerously expand trapped air, which could indeed be life-threatening. Your caution about diving is completely understandable, and it’s admirable that you’re thinking critically about your safety. Flying, especially with the option for emergency landings, does provide a level of security that diving doesn’t offer, given the complexities of underwater pressure changes. Your experience sheds valuable light on this, and it serves as an important reminder for others who might face similar concerns. Thank you again for sharing, and I wish you safe travels and continued good health! All the best Dr Frans Cronje

Thanks for your question. Vaping, particularly the inhalation of aerosolized e-liquids (commonly known as vape oils), has raised significant concerns regarding its impact on lung health. For scuba divers, maintaining optimal pulmonary function is critical, and vaping could pose additional risks due to its effects on the respiratory system. Here's a summary of the available evidence regarding vape smoking oils, residue, and its impact on the lungs, including short- and long-term risks for scuba divers: Short-term Risks: Airway Inflammation and Irritation: Vaping can cause immediate inflammation and irritation of the respiratory tract. The heating of e-liquids generates harmful chemicals like formaldehyde, acrolein, and volatile organic compounds, which can cause acute airway irritation. For scuba divers, this can lead to increased airway reactivity, a higher risk of coughing, bronchospasm, and potentially dangerous respiratory events while underwater. Bronchoconstriction: E-cigarette use has been linked to transient bronchoconstriction, which narrows the airways. Divers rely on unimpeded air passage, and bronchoconstriction could cause difficulty breathing under the increased pressure of diving, raising the risk of panic or hypoxia. Reduced Mucociliary Clearance: Vaping impairs the cilia's ability to clear mucus from the lungs, leading to mucus buildup. For divers, this could increase the risk of lung infections and blockages that could compromise air exchange, especially in deeper dives. Dehydration of the Airways: Vaping introduces aerosolized particles that can dry out the respiratory tract, further exacerbating irritation and inflammation. This can lead to a dry cough or throat discomfort during dives, reducing the diver’s overall comfort and performance. Long-term Risks: Chronic Obstructive Pulmonary Disease (COPD) and Lung Damage: Long-term exposure to vape residues can contribute to the development of chronic lung diseases such as COPD. Vaping oils often contain glycerin or propylene glycol, which may deposit residues in the lungs over time, contributing to scarring and impaired lung function. For divers, decreased lung function from COPD can limit gas exchange efficiency, increasing the risk of nitrogen retention and decompression sickness (DCS). Lipoid Pneumonia: Inhalation of oily substances from vape liquids can lead to lipoid pneumonia, where oil droplets accumulate in the lungs and trigger an inflammatory response. This condition reduces lung capacity, which is critical for divers who need optimal lung efficiency during dives. Decreased Diffusion Capacity: Long-term vaping may impair the lungs' ability to transfer oxygen into the bloodstream effectively. Divers with decreased diffusion capacity are at greater risk of hypoxia, especially during prolonged dives, or when diving at greater depths. Increased Risk of Lung Infections: Vaping weakens the immune response in the lungs, increasing susceptibility to infections such as bronchitis and pneumonia. In a scuba diving context, infections can increase the risk of barotrauma (injury due to pressure changes) and compromise lung function during a dive. Additional Considerations for Scuba Divers: Impaired Recovery from Respiratory Infections: Divers exposed to vape oils may take longer to recover from respiratory infections, which could delay their ability to safely return to diving. Increased Risk of Pulmonary Barotrauma: Compromised lung elasticity or airway obstruction from vaping-related damage could increase the risk of pulmonary barotrauma, a condition where the lungs over-expand during ascent, potentially causing lung rupture or gas embolism. Impact on Cardiopulmonary Fitness: Cardiopulmonary fitness is essential for divers. Vaping has been shown to affect vascular health, reducing exercise tolerance and overall lung capacity, which could limit a diver's endurance underwater. Conclusion: Vaping poses both short- and long-term risks to lung health, which are particularly concerning for scuba divers due to the increased pressure and oxygen demands of diving. Divers who vape may face an elevated risk of respiratory complications, including bronchospasm, decreased lung function, and increased susceptibility to lung infections. Over time, this can impair diving performance, increase the risk of decompression sickness, and result in long-term damage to the lungs. Scuba divers should avoid vaping to maintain optimal pulmonary health for diving activities. Thanks again for your question. I hope this helps. Kind regards, Dr Frans Cronje

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Thank you for this! First off, I want to congratulate you on making the life-changing decision to quit both smoking and vaping. It's clear that you've already experienced some remarkable benefits, especially when it comes to your diving. The difference in your air consumption is a strong testament to the positive impact of leaving these habits behind. While it's great that you've noticed improvements in your diving, I want to emphasize how much more you've gained by quitting. Beyond the well-known risks like lung cancer, smoking and vaping both contribute to more rapid aging of the lungs and significantly increase the risk of serious complications such as arterial gas embolism. In fact, smokers and vapers face a ninefold increase in this risk-a statistic that underscores just how crucial it is to keep your lungs as healthy as possible, especially for a diver like yourself. I admire your commitment to your health and your passion for diving. Now that you've experienced these benefits, I encourage you to continue steering clear of smoking and vaping. You've already done the hard work by quitting-don't let anything pull you back. Your body, your lungs, and your future dives will all thank you for it. Keep up the great work, and enjoy the many more dives that lie ahead with your improved air consumption! Dr Frans Cronje

Thank you Dr Cronje for your response.

Thank you for the great question. Flying in an aeroplane is a different issue from diving for several reasons. Firstly, an ascent to a cruising altitude (and a cabin pressure of 8000 ft) represents a drop of only 1/3 of an atmosphere - from 1 ATA to about 0.7 ATA. So, the pressure differentials are vastly smaller than when diving. Secondly, unlike diving, landing improves a pneumothorax as it represents compression; conversely, return to the surface is a decompression, which may convert a simple pneumothorax into a tension pneumothorax. For this reason, pilots and aircrews have more lenient medical standards on spontaneous pneumothoraces than divers do. Hope that answers your question. Thank you for that. Dr Frans Cronje

Thank you Dr Cronje for your response.

Great question! The current evidence on the effects of vaping on Eustachian tube function is limited, and most of the available research does not directly address this issue. However, there are some insights and indirect implications that can be drawn. Vaping, like smoking, involves inhaling substances that can irritate the respiratory tract, including the nasopharynx-the area connected to the Eustachian tubes. Inflammation or irritation in this region could potentially impact Eustachian tube function, as these tubes are responsible for equalizing pressure and draining fluid from the middle ear. Eustachian Tube Dysfunction (ETD) typically occurs due to inflammation, allergies, or infections that cause swelling at the opening of the Eustachian tube, leading to symptoms like ear pressure, pain, or hearing issues. While specific studies on vaping's impact on ETD are lacking, it is plausible that the irritation caused by vaping could contribute to or exacerbate these symptoms, similar to the effects seen with smoking. More research is needed to conclusively determine vaping's impact on Eustachian tube function, but current understanding suggests that anything causing inflammation or irritation in the upper respiratory tract could negatively affect the Eustachian tubes. So, is there specific research - no. Does it make sense to avoid vaping if you have equalising problems - yes. Hope that helps. Dr Frans Cronje

Thank you Dr Cronje for your response.

Thanks for the great question! Post-melanoma surgery, especially when it involves the lungs, raises concerns regarding SCUBA diving due to potential complications with air trapping, scarring, and lung tissue integrity. Here are the specifics you were asking about: 1. Scar Tissue and Off-Gassing: After surgery, scar tissue may develop in the lungs. This scar tissue can alter the normal elasticity and function of lung tissues. One concern is whether this scar tissue could affect the ability to off-gas nitrogen efficiently during ascent. If scar tissue impairs this process, it could potentially lead to an increased risk of decompression sickness. 2. Overpressurization Injury (Barotrauma): Another concern is the potential for barotrauma. Scar tissue from surgery can make parts of the lung less flexible and more prone to injury. If the lungs are not able to equalize pressure properly due to scarring, it could lead to tearing due to uneven expansion of the fibrous (scarred) vs. unscarred (elastic) parts of the lung, resulting in lung barotrauma which can lead to a pneumothorax or gas embolism. 3. Mechanical Integrity of Lung Tissue: The mechanical properties of lung tissue may be altered post-surgery. Scarred areas can be stiffer and less compliant, making them more susceptible to rupture under pressure changes. In conclusion: Both the ability to off-gas nitrogen and the potential for barotrauma are significant concerns for individuals with lung scarring post-melanoma surgery. It’s crucial for individuals with such medical histories to consult with a physician, preferably one who specializes in diving medicine, before engaging in SCUBA diving. They can provide personalized advice and may recommend further testing, such as lung function tests or imaging, to assess the risks. Kind regards, Dr Frans Cronje

⁠@@DrFJCronjethank you for your response. That helps. Two other questions, would the barotrauma occur potentially with normal inspiration and expiration or more so IF inadvertently holding one’s breath during an ascent which is always a no no. I was curious if the increased density of the gas and function at depth would be sufficient to precipitate such barotrauma. In short is barotrauma more a concern with descent or primarily ascent? Thank you so much for your response. For sure MD consultation is paramount. Last question, would use of a CCR rebreather mitigate to any extent barotrauma concerns? Cheers

Thank you Dr Cronje for your response.

@@DANSouthernAfrica Thanks for the added questions. In summary: Barotrauma and Breathing: Barotrauma can occur primarily during ascent, especially if a diver holds their breath. Normal inspiration and expiration while ascending or descending should not cause barotrauma as long as you are exhaling during ascent. In theory, air can be trapped locally in the lung (e.g., in a bleb) and cause a local over-expansion even while breathing normally. I am not aware of this actually being proven in any case. Obviously holding your breath is risky because the expanding gas can lead to lung overexpansion. Concerns with Descent vs. Ascent: Barotrauma is generally more of a concern during ascent. During descent, the pressure increases and can cause issues like squeeze, but rapid ascent and holding breath most often lead to barotrauma. Use of a CCR Rebreather: Using a Closed-Circuit Rebreather (CCR) can help mitigate barotrauma risks because it allows for more controlled breathing and less drastic pressure changes. However, proper training and knowledge are crucial for safe use.

Thank you for your question regarding the surgical considerations for the small bleb. While pleurodesis, which involves affixing the lung to the chest wall, significantly reduces the chances of developing a significant pneumothorax, it does not eliminate the risk associated with gas expansion in a bleb, particularly in the event of arterial embolism. Even with the positive history of a self-healed bleb and a clear lung scan, it's important to understand that any remaining bleb, especially if located lower in the lung, still poses a risk. During ascent, even a small pneumothorax can rapidly enlarge, potentially leading to serious complications. In summary, unless the bleb is situated in the very upper parts of the lung, there remains a considerable risk of embolism. Careful consideration of these factors is essential before proceeding with surgery. It may be beneficial to have further discussions with your healthcare team about the specific risks and benefits related to your individual situation. Dr Frans Cronje

Thanks for sharing!

Hi Ongo, Thank you for your stimulating question. Here is a summary of the latest information on mastoidectomy and SCUBA diving: The recommendations and guidelines emphasize careful evaluation and timing when it comes to scuba diving after undergoing a mastoidectomy due to the complexity of the surgery and the potential impacts on middle ear function. Healing Period and Medical Clearance: After a mastoidectomy, a minimum healing period of 8 to 12 weeks is generally required before considering a return to diving. This is to allow sufficient time for the surgical site to heal and for any inflammation or changes in ear anatomy to stabilize. Post-healing, an ENT specialist must evaluate the individual's ear to determine the eardrum's robustness and the ear structures' overall health. The ENT will also assess the patient's ability to equalize pressure effectively, which is crucial for safe diving​. Challenges and Considerations: The altered anatomy post-mastoidectomy can affect how well an individual can equalize ear pressure while diving. Eustachian tube dysfunction or incomplete eardrum healing can pose significant risks during dives. Even after the healing period, diving may still carry risks. Individuals might need to use specialized equipment, like a Pro-Ear mask or vented earplugs, to help manage water pressure and reduce the likelihood of water entering the ear canal​. Long-term Monitoring: Continuous follow-up with an ENT specialist is recommended to monitor any long-term changes or potential complications. The specialist can provide personalized advice based on the individual's healing progress and specific ear anatomy​. In summary, while it is possible to return to scuba diving after a mastoidectomy, it requires a significant healing period, a thorough evaluation by an ENT specialist, and potentially the use of specialized diving equipment to ensure safety. Depending on where you live, we may be able to assist you with an appropriate ENT for the evaluation. Kind regards, Dr Frans Cronje

Thank you Dr Cronje for your response.

@@DrFJCronje Yes, thank you, doctor, for such a detailed and helpful response. I didn't see this before. It is exactly the kind of information I was looking for and it brings a renewed optimism that I may be able to dive again.

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Dear Eric. Thank you so much for your kind and wise comments and for your encouragement. We value our fellow diving physician's input and thoughtful comments. Again, thank you so much. Kind regards, Frans

Thank you Dr Cronje for your response.

Thanks, will do!

Hi Gabi, thanks for engaging. You raise several valid points. A major element of this discussion revolves around the risk of seizures associated with bupropion and the risk of an instructor with bipolar disorder possibly putting his students at risk. First, a quick note on Bupropion: Bupropion has been linked to an increased risk of seizures (from 1/1000 on lower doses to 4/1000 on 450 mg). Certain people are more susceptible, such as those with a history of seizures, eating disorders, or those withdrawing from alcohol or sedatives. Numerous case reports and ongoing surveillance have documented seizures in patients taking bupropion, often associated with dose increases or existing risk factors. While the exact cause is unclear, it’s believed that bupropion's impact on brain chemicals may trigger seizures. Despite its benefits, it's important to be aware of this risk and use the medication cautiously. Given that seizures have a high risk of drowning underwater, this is not an insignificant risk. The additional confounding factor is being an instructor. In DAN Southern Africa, we consider Bupropion use a contra-indication to diving. It has also been ruled as unsuitable for Commercial Divers and Pilots. Thank you for your suggestions for mitigating the risk of using a divemaster. Kind regards, Frans

Thank you Dr Cronje for your response.

Hi Imam. Thank you for asking. If I understand your question correctly, my response would be that our lungs are compressible, and a dive cylinder is not. However, when we breathe compressed gas underwater, the gas pressure in our lungs must be at ambient pressure for us to breathe easily on demand. The gas in the cylinder is not compressed, but the amount of gas extracted from a dive cylinder would be greater the deeper we dive. I hope that addresses your question. I hope this translation in Bengali will be accurate - only you would know: হাই ইমাম। জিজ্ঞাসা করার জন্য ধন্যবাদ। যদি আমি আপনার প্রশ্নটি সঠিকভাবে বুঝে থাকি, তবে আমার উত্তর হবে যে আমাদের ফুসফুস সংকোচনযোগ্য এবং ডাইভ সিলিন্ডার তা নয়। তবে, যখন আমরা পানির নিচে সংকুচিত গ্যাস শ্বাস নিই, তখন আমাদের ফুসফুসে থাকা গ্যাসের চাপ আমাদের সহজে শ্বাস নিতে পারার জন্য পরিবেষ্টিত চাপের সাথে সামঞ্জস্যপূর্ণ হতে হবে। সিলিন্ডারের গ্যাস সংকুচিত নয়, কিন্তু আমরা যত গভীরে ডুব দেব, ডাইভ সিলিন্ডার থেকে তত বেশি গ্যাস বের করা হবে। আশা করি এটা আপনার প্রশ্নের উত্তর দেয়।.

Thank you Dr Cronje for your response.

Dear Darren, thank you for your comment. Indeed -- in addition to the risk of low blood glucose, scuba divers with diabetes should be concerned about secondary complications like heart disease, kidney disease, and neuropathy. Diabetic retinopathy is not worsened by the elevated pressures while diving, but visual acuity remains a safety concern. The pressure in the eye generally increases in proportion to other body fluids. However, if the face mask is not equalized, suction on the eye can cause issues like rupture of a weak cornea. Retinal detachment could be a concern, but other impacts on the retina are not considered significant. Thank you for your comments. Kind regards, Frans

Thank you Dr Cronje for your response.

Thank you for sharing.

Thanks for the great question: The evolving nature of CPR guidelines is primarily due to continuous research and advancements in medical science. The American Heart Association (AHA) and other global health organizations regularly review and update their guidelines based on the latest evidence and studies on cardiac arrest and resuscitation. Here are some reasons why CPR details have changed over the years: (1) Improved Understanding: Our knowledge of human physiology and the mechanics of cardiac arrest improves over time. New research can provide insights into more effective ways to perform CPR. (2) Technological Advances: Better monitoring and diagnostic tools help researchers understand the impact of different CPR techniques, leading to more refined and effective guidelines. (3) Statistical Data: Ongoing analysis of survival rates and outcomes from real-life CPR cases helps in identifying best practices and areas needing improvement. (4) Global Collaboration: Collaboration between various health organizations worldwide leads to a consensus on the most effective practices, which are then adopted and recommended universally. Regarding your observations about the DAN (Divers Alert Network) video and its lack of specific compression numbers, here are a few points: (1) General Principles Over Specifics: Some training materials focus on the general principles of CPR rather than specific numbers to emphasize the importance of high-quality, uninterrupted chest compressions over precise counting. (2) Context-Specific Guidance: CPR guidelines might differ slightly depending on the context, such as land-based emergencies versus water rescues. For instance, in water rescues, the priority is often to remove the person from the water safely before starting CPR, which might affect how and when compressions and breaths are given. (3) Current Guidelines: As of 2024, organizations like the AHA recommend 100-120 compressions per minute for adult CPR, with rescue breaths still considered important, especially for situations like drowning where the primary issue is often hypoxia (lack of oxygen). (4) DAN and Rescue Breaths: In water rescue scenarios, rescue breaths are crucial since drowning victims typically suffer from a lack of oxygen. DAN and other water rescue training emphasize the importance of providing rescue breaths as soon as it is safe and feasible to do so. This might involve giving breaths while still in the water if it can be done safely. Since you are about to take a CPR course provided by your workplace, you will likely receive the most current and context-specific guidance. It's a good opportunity to ask the instructors about any differences between land-based and water-rescue CPR techniques and how they align with the latest research and guidelines. Thank you again for some great questions!

Thank you Dr Cronje for your response.

Thank you for pointing out these crucial considerations, Kambiz. It's indeed vital to recognize that diving while experiencing uncontrolled manic or depressive states is highly unsafe, particularly during manic episodes, due to the potential for risky behaviors. Additionally, the effects of certain medications can increase the risk of drowning and make diving in hazardous conditions even more dangerous. Ensuring that any diver is both mentally stable and not adversely affected by medication is essential. I also agree that it would be highly exceptional for an Instructor to be approved to provide instruction with a confirmed diagnosis of Bipolar Disorder treated with medication -- for the safety of both the instructor and their students. Your insights highlight important safety protocols that must be adhered to in diving instruction. Thank you so much, Dr Frans Cronje

Thank you Kambiz. Yes, my personal advice would be conservative, as you suggested. If the individual is stabilized on medication with a better safety profile than bupropion, I will reconsider. This is the type of situation I would not make an individual decision on fitness. I would solicit the opinions of diving medical colleagues to have a consensus verdict. Thank you again.

Thank you Dr Cronje for your response.

Thank you for sharing your thoughtful perspective, Tanja. It's understandable to have concerns about the safety of both the instructor and the students in such situations. Your points about the importance of ensuring an instructor is not prone to risky or reckless behavior during a period of instability are well-taken. Educating potential students about the instructor's condition is a considerate approach, allowing them to make informed decisions. Additionally, respecting the personal autonomy of the instructor to dive, as long as it doesn't endanger others, is a balanced view. Whether it is possible to allow Instructors to dive with any potentially unstable mental health problem poses various challenges, including liability for the dive operator or resort. It's clear that your reflections come from a place of care and a desire to prioritize safety, which is essential in this context. Please read my response to Kambiz's comment below for additional information. Kind regards, Dr Frans Cronje

Hi Tanja, I like your succinct summary. A good track record of medication stability and safety, disclosure of the condition, and avoiding endangering others would be three important governing principles. The challenge would be the practical implementation. Thank you for your valuable perspectives!

Thank you Dr Cronje for your response.

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Interesting question. Inner Ear Barotrauma almost never occurs without concurrent straining maneuvers to equalize (i.e., forced prolonged Valsava maneuvers). Even elevator descents from the tallest skyscrapers in the world are unlikely to require such strainful efforts. One scenario in which inner ear barotrauma may occur is if there is a sudden rise in intracranial pressure after there has been a mild prior episode of inner ear barotrauma. For instance: We had this happen to a fireman. He had struggled to equalize the ear during a dive, and the next day, after carrying and nearly tripping with a patient on a stretcher, he developed sudden vertigo and deafness. This delayed form of inner ear barotrauma is rare, but it can occur. I am not sure if I have addressed your answer satisfactorily, so please refine your question if you need more information. All the best, Dr Frans Cronje

​@DrFJCronje hello Dr Frans, 4 years ago I had bacterial sinusitis from an Oro-Antral fistula after tooth #2 was extracted. The infection spread to both ears (I lost 95 percent of my hearing in one ear for a few hours and then I had pain in both eats with popping and crackling). I got tinnitus from this and in a desperate attempt to resolve my tinnitus I did the Valsalva maneuver a few times. While doing the valsalva maneuver I would: pinch my nose and close my mouth and slow to moderately blow out my nose to open my eustachian tubes. I would hear one open then I would continue to to do the valsalva maneuver until I heard the 2nd ear pop... then I would keep blowing a little longer then I would hear a weird noise from either my tympanic membrane expanding like a sail on a sailboat, my ossicular chain moving or both. I have normal audiograms but I have permanent bilateral high pitched tinnitus and my voice permanently and subjectively sounds like a broken speaker. What kind of damage could I have done to my inner ear? I never had vertigo. I eventually saw a few Nuerotologists to rule out Lateral/horizontal Semicircular Canal Dehiscence Syndrome (at John's Hopkins here in the states). Again , could I have caused permanent damage from doing the valsalva when I never ruptured my Tympanic membrane or my round or oval windows? I was 43 when this happened. Perfect hearing before the infection. My voice subjectively has sounded distorted eversince all those events occured 4 years ago. My voice sounds 85 percent normal with intermittent cacophony that shadows my voice and that occasionally gives me the nails-on-a-chalkboard like sensation. My recorded voice sounds normal to me (my normal recorded voice). My voice sounds the same to everyone but myself. I don't know if the damage in my maxillary sinus cavity could still be causing this OR if there is permanent damage to my inner ear? I have normal vemp tests, normal ABR, normal audiograms, normal CT scans and a normal MRI. I have been depressed and in severe distress over this everyday since this happened. What is your opinion what happened? Thanks

@@baseballlive77 Thank you for sharing your detailed history and experiences regarding your sinusitis and its aftermath. It’s understandable that this situation has caused you significant distress, and I appreciate the opportunity to address your concerns. From what you describe, it seems that you have undergone extensive evaluations, including audiograms, VEMP tests, ABR, CT scans, and an MRI, all of which returned normal results. This is reassuring in some respects, as it suggests that there may not be obvious structural damage to your inner ear or surrounding structures. However, the persistence of your tinnitus and the altered perception of your voice indicate that there may still be underlying issues to consider. The Valsalva maneuver, while often used to equalize pressure in the ears, can potentially lead to complications if performed improperly or excessively, especially in the context of existing ear conditions. While you did not rupture your tympanic membrane or windows, the repeated pressure changes could have impacted the delicate structures of the inner ear or exacerbated any existing conditions, such as Eustachian tube dysfunction. It’s also important to acknowledge that tinnitus can arise from various sources, including changes in auditory processing or issues within the auditory pathway that may not be easily detected on standard testing. Your description of your voice sounding distorted to yourself, while recorded versions sound normal, suggests a potential auditory processing issue or even a somatosensory contribution to your perception. Given your situation, I recommend continuing to work closely with your healthcare team, particularly an ear, nose, and throat (ENT) specialist who can help explore both auditory and non-auditory factors contributing to your symptoms. Cognitive behavioral therapy, neurofeedback, tinnitus retraining therapy, or sound therapy may also offer relief for the distress caused by your tinnitus. It’s crucial to be gentle with yourself during this time, as the psychological impact of your ordeal and ongoing frustration is not trivial; rather, it can be profound. Seeking support from mental health professionals or support groups may also help you navigate the emotional aspects of your experience. In conclusion, while it’s difficult to ascertain the exact nature of any potential damage without more invasive tests, your proactive approach to your health is commendable. Continue advocating for yourself and seeking answers, and please don’t hesitate to reach out for additional support as needed. Wishing you strength and clarity on your journey toward understanding and healing. Best regards.Dr Frans Cronje