Distinguishing between inner ear decompression sickness and a perilymphatic fistula is difficult in cases of vertigo after diving. In case of inner ear decompression sickness, it is necessary to immediately perform recompression treatment; however, hyperbaric oxygen is a contraindication in cases of a perilymphatic fistula, in cases of which it is furthermore necessary to rapidly perform an exploratory tympanotomy. Therefore, the differential diagnosis between inner ear decompression sickness and perilymphatic fistula is important to distinguish in divers with vertigo. For accurate diagnosis, it is necessary to carefully obtain the history and check for barotrauma by otoscopy and for any pneumolabyrinth by computed tomography examination of the temporal bone. If a diagnosis cannot be determined, bilateral paracentesis should be performed before recompression treatment. Cochlin-tomoprotein is expected to be a marker for diagnosing a perilymphatic fistula and if rapid diagnosis of these can be achieved in the future, it will be useful for distinguishing between inner ear decompression sickness and perilymphatic fistula. We hope to establish normative guidelines for diagnosis and treatment of vertigo after diving.
