Warning about Nasal Rinses!! Learn from my mistake. [Archive] - ScubaBoard - Scuba Diving Forum - Diving Social Network

View Full Version : Warning about Nasal Rinses!! Learn from my mistake.


Sponsored Link
ScubaSarus
March 27th, 2009, 07:48 AM
We have had previous discussion about nasal rinses and I want to send a warning about them.

I just had sinus surgery that included removing lots of nasal polyps. It appears polyps can be caused by bad nasal irritation, allergies, etc. Prior to my polyps developing, I was doing a fairly harsh nasal rinse that included 1% of 3% peroxide per instructions found on the web. What a mistake. The rinse was way too harsh and caused swollen turbinates also. I just want to warn people not to use peroxide in sinus rinses nor make the rinse too harsh. Just use 1/8 teaspoon of salt and baking soda (buffer) per cup of mild water. Peroxide is not to be used in the sinuses ever as its a strong oxidizer, irritant, and can possibly propagate cancerous cells.The nasal wash should never burn. Learn from my mistake.

We can't prove for sure peroxide was the cause but there is evidence suggesting it could have been the cause; and its better to be safe as no medical literature supports using peroxide in a nasal wash. I just want to error on the side of safety here. Could be I used too much H2O2 but still the ENT is against its use in nasal washes.

All in all here is what the ENT did:

Full hollowing out of the thin bones of the ethmoid sinuses.
Polyps removal.
Evacuation of the sphenoid sinuses.
Trimming of the swollen turbinates.
Removal of cyst in the maxillary sinus
Septoplasty.

Packing comes out hopefully today - ouch!!!!!!

Steve02
March 27th, 2009, 08:14 AM
Thanks for the heads up.

I think I may need to head in for sinus surgury here one of these days (get that dremal warmed up!) ;) What did you ENT say about any side-effects as they relate to diving? Is thinning the bone in the sinus area going to effect equalizing or any other aspect of diving?

SelkieDVM
March 27th, 2009, 08:29 AM
Thanks for this. Peroxide is irritating to mucosal tissues, and will delay healing if used extensively in wounds so this makes sense. I use only non-iodized salt. I learned through experimentation what amount to add, as I found it would burn if either too dilute or too concentrated. I haven't measured it though, it's just an almost level "scoop" about the size of an 1/8 teaspoon added to my neti pot. My guess would be that this works out to be something close to physiologic saline (0.9%), but I should try it sometime with some medical grade normal (physiologic) saline just for comparison.

ScubaSarus
March 27th, 2009, 08:44 AM
Steve I haven't told him about diving (I ll bring it up today) and feel Ill be fine in a month or 2. According to the owner of our local dive shop, its like day and night now for his clearing. No hurry to dive yet as its quite cold here in CT.

The ethmoid is a honey comb structure of paper thin bones between the eyes and just under the brain linning, and probably are not effected with pressure as is the outter cavity bone structure containing the ethmoid thin bones (although not confirmed). The honey comb structure if clogged like mine was, will prevent drainage and air passage.

The bones were not thinned but actually removed making what was a honeycomb structure a hollow cavity. The turbinates were thinned though.


Agreed Selkie it needs to be close to physiological 9% or maybe slightly hypertonic to bacterial cells to creanate them.

On a pain scale of 1-10. I say the pain three days post op is 2.

doctormike
March 27th, 2009, 10:48 AM
Good discussion - just wanted to clear up a couple of points...

1) I agree, peroxide should not be used as a nasal rinse. Not sure where that recommendation came from, but a saline solution is good. There are a number of ways of going about mixing up a saline solution, and in general the more concentrated preparations actually work better at decongesting the nose. On the other hand, some people need to start with a more dilute solution and work up to it.

I recommend the products of this company: NeilMed (http://www.neilmed.com/usa/index.php)

However, there are probably many other companies that make similar products. It is a bit more convenient to use the daily packages of salt to make up your rinse solution fresh, but you can save money by making it yourself from kosher salt (which is not treated with iodine or other additives), sterile water and baking soda.

2) In sinus surgery, the thin bony walls between the ethmoid air cells (the "honeycomb" between the eyes) are removed. In some cases, the wall between the ethmoid sinuses and the eye (the lamina paprycea, or "paper plate") is thinned or even opened - this would be an issue with equalization, so be sure not to dive until your ENT doctor has given you the OK... It would be possible to force air from the nose into the orbit (the space around the eye)...!

Opening up the pathway to the maxillary sinuses (the big ones in the cheek) and/or shrinking the turbinates shouldn't be much of a problem with diving - if anything, it should make a sinus squeeze less likely..

Best,

Mike

ScubaSarus
March 27th, 2009, 12:48 PM
Thanks Mike

Just got the packing removed and quite painless. Im glad you pointed that out. Its too early to ask too many questions as the doctor had an emergency procedure to do before removing my packaging (a young girl came in with fluid filled ears and in pain).

Ill see him again Friday and can I ask what should I ask him or should I show him your post. Now Im concerned as I never brought up the fact I was a diver and don't want to have to sell my gear and take up snorkling or bird watching. I know the gel packing seemed to come out of the corner of my eyes.

Take care and thanks

doctormike
March 27th, 2009, 01:14 PM
Thanks Mike

Just got the packing removed and quite painless. Im glad you pointed that out. Its too early to ask too many questions as the doctor had an emergency procedure to do before removing my packaging (a young girl came in with fluid filled ears and in pain).

Ill see him again Friday and can I ask what should I ask him or should I show him your post. Now Im concerned as I never brought up the fact I was a diver and don't want to have to sell my gear and take up snorkling or bird watching. I know the gel packing seemed to come out of the corner of my eyes.

Take care and thanks


Sure, no problem! I'm glad to hear that you are on the mend..!

I didn't mean to imply that you might have to give up diving just because you had sinus surgery, but every case is different and you should check with him before doing any forced equalization, just in case there was any issue related to your operation...

Feel free to keep us posted!

Mike

ScubaSarus
March 27th, 2009, 02:03 PM
Thanks Mike

Will do. Very important information you posted though and I appreciate that.

He is a good plastic surgeon and used the halo with 3D Imaging.

I'll ask him if the lamina paprycea was thinned or opened to a point it would be contradictory to diving in the future. I really needed to get the polyps out and wouldn't hold it against him if I lost too much wall thickness in the process.

ScubaSarus
March 28th, 2009, 09:00 AM
AJR -- Momeni et al. 189 (6): S35 Figure IG2 (http://www.ajronline.org/cgi/content-nw/full/189/6_Supplement/S35/FIG2)

Enclosed is a nice link to a high resolution image of what Dr Mike is talking about. Probably the clearest I can find. Click on the image for enlargement. Well understood with this image. Amazing that the Lamina Papyracea (LP) is also mentioned in dive physiology as barotraumas a lot of us would never know about.

The LP is a very fragile wall. I'm hoping it want compromised during surgery (pulling out the ethmoid bones (E)), wasn't damage or scarrred duing forced clearing (I've felt eye pressure before on forced clearing and now know what it may have been); but if so, that it has healed peoperly before a next dive. My brother had mucas come out of his eyes during a dive a long time ago and that may have been a compromise of his LP.

Thanks Mike as your comments have lead to a neat educational experience.

doctormike
March 28th, 2009, 07:00 PM
The LP is a very fragile wall. I'm hoping it want compromised during surgery (pulling out the ethmoid bones (E)), wasn't damage or scarrred duing forced clearing (I've felt eye pressure before on forced clearing and now know what it may have been); but if so, that it has healed peoperly before a next dive. My brother had mucas come out of his eyes during a dive a long time ago and that may have been a compromise of his LP.

Thanks Mike as your comments have lead to a neat educational experience.

VERY nice visual aid..! Glad to be of help...

In doing the ethmoidectomy operation, the main trick is to open up all of those little cells without injuring the LP or (more important) the roof of the ethmoid. If you inadvertently move across the LP, you can get some bleeding into the space around the eye, but it is rare to actually injure the muscles that control the eye, or even the eye itself.

On the other hand, by going through the roof of the ethmoid, there is a the risk of leakage of cerebrospinal fluid (the fluid around the brain). This is also a pretty unusual complication, and if it happens, it can be repaired. It is VERY rare for there to be a more serious complication related to this type of problem (such as meningitis or damage of the intracranial contents).

While it is true that a sinus surgeon has to work in a small space between the brain and the eye, it is actually a very common procedure, and anyone doing it should be extremely comfortable with the anatomy and the procedures. To make things even easier, some centers have a computerized navigation system that lets the surgeon track the position of the instruments against the CT scan in real time. However, no gadget is ever a substitute for training and experience (just like in SCUBA diving!).

Mike

ScubaSarus
March 31st, 2009, 07:41 AM
It appears they used the the InstaTrak Surgical Navigation System by GE. They actually had a true 3D model of my head on the screen a splitting image of me.

Another Caution about Nasal Rinses: If ones sinuses are not draining properly, one could end up with stagnant pools of the nasal wash in the sinus cavities thus adding to the infection. Nasal rinses may be OK if ones sinuses are normal and can benefit from a washing. But if the sinuses are not normal and are obstructed, that obstruction may need dealing with before going all out with nasal washes. A CT Scan can probably make that decision. We have to be careful assuming what works well with one person works well with everyone.

One theory on the cause of polyps: if your sinuses get inflammed the tissues of the sinuses become more porous or absorbent to fluids. If you run water through your sinuses while they are inflamed, the water can be absorbed into the linings. Once this water is absorbed, gravity may cause the water to pull down into the tissues forming water sacks or polyps.

A lot of us take our sinuses for granted and are not careful on protecting them from harmful elements. From now on, I may keep masks handy these days in case I perform a task that will cause elements to get in the sinuses. I used to be a metal tumbler as a kid and would have black sinuses at the end of the work day.

Going back to the LP. For 2 weeks I have been told not to blow my nose or sneeze through it. And this is to avoid back pressure into the ethmoid space that could rupture the LP and force air out through the orbits and eyes.

The packing came out easy Thursday and this Friday I get the septoplasty splints removed and more cleaning done.

Had a close call yesterday as a soft clot the size of my fist was passed. I called the doctor but he said unless there is constant bleeding, not to worry. I slept propped up last night to make sure that doesn't happen again and may attempt a hike today.

ScubaSarus
April 3rd, 2009, 09:29 AM
Finally got the splint removed and my first official cleaning. The ENT really probed my sinuses and it was somewhat painfull with lots of wierd sensations. (I;d hate to be captured by aliens). A lot of junk was removed. He said the sinuses looked real good and started me on nasl rinses now.

He did confirm you have to be carefull using sinus rinses on cloggged sinuses as you can get pools of stagnant water in your sinuses if they can not drain properly and also said you have more danger of ear damage also.

Talk to an ENT before doing sinus rinses is my suggestion. Don't assume a nasal wash is going to work because it worked for someone else. Taht someone is not you and there are so many factors and variables in play to determine the outcome of a nasal rinse.

I asked him about the LP and did the surgery compromise it to a point future diving would be dangerous. He was quite baffled that I even asked the question and doesn't feel anything was done to the LP to compromise it and feels I should not have serious sinus squeezes to begin with to make diving a concern.

He said the LP is a paper thin bone to begin with and one should never force a clearing that puts pressure on it.

I take this as a OK to dive once the sinus cavities have healed fully.

I can breath nicely now and the septum seems to have healed nicely.

Next visit in 2 weeks for a folow up. I'll keep you all posted.

Distraction
November 11th, 2009, 12:23 AM
Seriously, while home remedies can work, you can also mess yourself up big-time if you get it a little wrong. Hang out in an ER one night and see.

A GOOD neti pot solution (http://netipotsolution.net) should be the right temperature, the right salt level, and the right pH. Some people make them too salty (hypertonic) to dry out their nasal passages, and while it temporarily works, it can also irritate the lining and cause inflammation and mucus production. It's like folks that use Afrin too much, and get rebound.

If you're going to do the nasal lavage thing, don't use anything that doesn't match your body's chemistry.

Sponsored Link

Search Engine Friendly URLs by vBSEO 3.6.1