Frontal Sinus Cysts

[Wallowa]

Had the old "ice pick" stab in the frontal sinus on descent at 7 FFW. Attempted two dives of different days 5 days apart with same "stop right there" pain. Ears no problem, nor any other sinuses. Ended up with a CT scan. Only 'compromised' sinus was the right frontal and that was described as having "multiple mucous retention cysts". Since I have had a prolonged discharge and congestion which often was yellow, I opted for and just stated a treatment of antibiotics, Augmentin.

Questions: Do cysts resolve themselves? How do cysts differ from polyps? Does infection generate cysts?

I know antibiotics are an arrow in your quiver not to be wasted. But surgery is a non-starter for me. I will also add irrigation to the mix in an attempt to again be able to equalize that frontal sinus.

Any shared insights and experiences will be appreciated.

DSO

 

[lexvil]

Had the old "ice pick" stab in the frontal sinus on descent at 7 FFW. Attempted two dives of different days 5 days apart with same "stop right there" pain. Ears no problem, nor any other sinuses. Ended up with a CT scan. Only 'compromised' sinus was the right frontal and that was described as having "multiple mucous retention cysts". Since I have had a prolonged discharge and congestion which often was yellow, I opted for and just stated a treatment of antibiotics, Augmentin.

Questions: Do cysts resolve themselves? How do cysts differ from polyps? Does infection generate cysts?

I know antibiotics are an arrow in your quiver not to be wasted. But surgery is a non-starter for me. I will also add irrigation to the mix in an attempt to again be able to equalize that frontal sinus.

Any shared insights and experiences will be appreciated.

DSO

Not a doctor nor have I played one on TV but my understanding of Cysts is that if not properly removed they have a high incidence of returning. And with that said and having heard from a few friend about sinus surgery, how bad and long does it hurt?

 

[Duke Dive Medicine]

@doctormike

 

[Wallowa]

@doctormike

I did not see any text? Did I miss it on my end?

 

[stretchthepenn]

I did not see any text? Did I miss it on my end?

No...the respondent is paging Dr. Mike.

 

[doctormike]

Hi!

Cysts and polyps may both be seen in the paranasal sinuses, and can both be associated with chronic inflammation. The difference is that cysts are actual sacs of fluid lined with cells secretes fluid. You can also have chronic inflammation of the mucosa which causes it to swell and enlarge. This can block the drainage and ventilation of the sinuses, and if that swelling gets large enough to form an actual mass, we call them "polyps".

The bottom line is that when diving, any air filled space (ear or sinuses) needs to be equalized to ambient pressure, othewise you get a pressure gradient that can lead to barotrauma (pain or actual damage to surrounding structures).

So while there are medical approaches to improving ventilation, like antibiotics, nasal irrigation, nebulizers (with steam, steroids or antibiotics), etc.. in some cases this isn't enough, especially in the case of cysts. If this is an actual cyst and not just polypoid mucosa, it may persist until you actually remove it surgically.

If it's blocking the sinus outflow tract, you may be able to eventually ventilate past it on descent if you try hard enough, but this is dangerous. If you ventilate a partially blocked sinus on the way down, but then that barotrauma makes the obstruction worse, you may end up with a reverse block (pain on ascent). And as the saying goes, descents are optional, ascents are mandatory.

If you have a reverse block in your ear, sooner or later you have to surface and you could cause an eardrum perforatiion, as the drum acts like a "burst disk" on a tank. That's a potential problem, but eardrums can heal or be repaired if you are lucky enough not to cause permanent damage. It can be much more dangerous in the sinuses.

Expanding gas in a closed space will decompress through the weakest portion of the wall. If there is a weakness of the back wall of the frontal sinus, and you get a reverse block, it's even possible for the sinus to decompress posteriorly. See the attached scans for examples of what can happen when air has to find its way out of the ethmoid (between the eyes) or frontal (forehead) sinuses...!

So the bottom line is that if you can't equalized your sinuses easily, you have to either not dive or somehow fix it. Sometimes - for this problem - that means surgery. Try the other things first, but then try ventilating in a pool before you book your next dive trip...

Feel free to DM me if you want to chat.

Mike

 

[Wallowa]

Hi!

Cysts and polyps may both be seen in the paranasal sinuses, and can both be associated with chronic inflammation. The difference is that cysts are actual sacs of fluid lined with cells secretes fluid. You can also have chronic inflammation of the mucosa which causes it to swell and enlarge. This can block the drainage and ventilation of the sinuses, and if that swelling gets large enough to form an actual mass, we call them "polyps".

The bottom line is that when diving, any air filled space (ear or sinuses) needs to be equalized to ambient pressure, othewise you get a pressure gradient that can lead to barotrauma (pain or actual damage to surrounding structures).

So while there are medical approaches to improving ventilation, like antibiotics, nasal irrigation, nebulizers (with steam, steroids or antibiotics), etc.. in some cases this isn't enough, especially in the case of cysts. If this is an actual cyst and not just polypoid mucosa, it may persist until you actually remove it surgically.

If it's blocking the sinus outflow tract, you may be able to eventually ventilate past it on descent if you try hard enough, but this is dangerous. If you ventilate a partially blocked sinus on the way down, but then that barotrauma makes the obstruction worse, you may end up with a reverse block (pain on ascent). And as the saying goes, descents are optional, ascents are mandatory.

If you have a reverse block in your ear, sooner or later you have to surface and you could cause an eardrum perforatiion, as the drum acts like a "burst disk" on a tank. That's a potential problem, but eardrums can heal or be repaired if you are lucky enough not to cause permanent damage. It can be much more dangerous in the sinuses.

Expanding gas in a closed space will decompress through the weakest portion of the wall. If there is a weakness of the back wall of the frontal sinus, and you get a reverse block, it's even possible for the sinus to decompress posteriorly. See the attached scans for examples of what can happen when air has to find its way out of the ethmoid (between the eyes) or frontal (forehead) sinuses...!

So the bottom line is that if you can't equalized your sinuses easily, you have to either not dive or somehow fix it. Sometimes - for this problem - that means surgery. Try the other things first, but then try ventilating in a pool before you book your next dive trip...

Feel free to DM me if you want to chat.

Mike

View attachment 841541View attachment 841542

DM sent and greatly appreciate your assistance.


DSO