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OBJECTIVES/HYPOTHESIS Inner ear decompression illness is thought to be a rare phenomenon in recreational divers, isolated signs and symptoms of inner ear dysfunction usually being attributed to inner ear barotrauma.STUDY DESIGN We present 11 cases of inner ear dysfunction in nine divers with inner ear decompression illness.RESULTS All nine divers had significant right-to-left shunt as diagnosed by transcranimal Doppler sonography.CONCLUSIONS The authors thought that mechanism of causation in these cases may have been intravascular bubble emboli and that inner ear decompression illness may be more common among recreational divers than currently recognized. Failure to treat inner ear decompression illness with recompression therapy can result in permanent disability. Because the differential diagnosis between inner ear barotrauma and inner ear decompression illness can be impossible, the authors suggested that divers who present with inner ear symptoms following a dive should have recompression immediately after having undergone bilateral paracentesis. [ABSTRACT FROM AUTHOR]