Frontal sinus pain after ascending

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Lopez116

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I'm hoping someone can point me in the right direction. I'm currently on a dive vacation in grand cayman and don't know what to do.

First dive of the trip was on the afternoon I landed (2 days ago). I kind of rushed to get a dive in because I was excited to dive. Dive went fine, no problems equalizing, etc. After being getting out of the water, felt a slight headache above my right eye (on the forehead). I took two Advil and it went away.

Next day I did 2 dives and after surfacing, same thing: pain to frontal sinus above right eye.

Yesterday I did 3 dives. After each, felt the same pain. The pain went away after dives 1 and 2, but I'm still feeling it mildly after dive 3 even though it's been about 12 hours of out of the water.

The dives were all pretty benign. Max depth of. 61' , average depth of about 38'.

I did not feel congested or sick in any way before the trip or the dives and do not have allergies. No blood tinged discharge of any kind after ascent either.

Is this sinus barotrauma? sinus infection even though I feel fine otherwise? Dehydration even though the pain is localized? Perhaps CO2 retention (I have been guilty of skip breathing before)?

I really don't want to stop diving but obviously don't want to hurt myself?

Any advice or input would be greatly appreciated.
 
Localized, one-sided pain that is reproducibly induced by ascent from depth has a pretty good chance of being sinus barotrauma (reverse block). No way of telling without a CT scan, to see if there is some sort of blockage of the right frontal sinus ventilation tract (for example, by a polyp). Have had this myself in the maxillary sinus. Can't really give a recommendation over the internet, but there is a theoretical risk of significant complications from frontal disease (specifically extension of infection into the area around the brain). Rare, and probably not much in the literature to "prove" that risk either way, but the most conservative recommendation would be to not dive until you get a scan of the area. The other things you mentioned are possibilities, but in the absence of any data, hard to be more specific than that.
 
From a lay perspective, many experienced divers would probably suggest that you take a decongestant, ensure that you are well hydrated, and that you avoid skip breathing. But as noted by doctormike, hard to know without further investigation.
 
Completely as a lay person, I ask whst kind of mouthpiece you have and how tightly you are biting down on it. Prrhaps you are having some referred pain from a tooth. Reverse block, I'm pretty sure you'd notice that on your ascent to the point thst if you can't clear it, you start to wonder if it wouldn't be better nust to stay down there so your head doesn't explode. :)
 
Now that I am thinking more clearly, I remember when we first arrived I was sort of rushing around and sweating a lot and a bit stressed. I felt the head pain and popped 2 Advil before I dived. It went away, but then a little after surfacing came back again. Then it's been pretty much around nonstop.

I've been trying to drink a lot of water, but I may still be dehydrated.

At the same time, the group I was leading was pretty inexperienced and relying on me for everything. I think I might have subconsciously skip breathing in an attempt to save air "just in case" the others ran into trouble. Those were all dives where I was working very hard "herding cats" underwater. Perhaps co2 retention was the culprit or a contributing factor along with dehydration.

This morning I woke up feeling better. One in our group is an ENT and gave me Dymista spray. I dove this morning and feel fine as of this moment (about 35 min post-dive).
 
Skip breathing implies CO2 buildup. A CO2 headache is typically more general and can't be localized to a specific area like "frontal sinus". From what you've posted I would agree with DoctorMike, who knows much more about the subject than I do anyway, that sinus barotrauma is the more likely culprit. If you keep experiencing it on ascent I would recommend that you refrain from diving until you're certain that it's not an anatomic blockage of some sort like DoctorMike mentioned. Sinus barotrauma on ascent can become very problematic and can cause unbearable pain if you try to push through it. I've seen divers get stuck at depth with reverse sinus block. Thankfully it was always in a chamber so there was no risk of gas supply exhaustion, but it still took some doing to get them back to the surface.

Best regards,
DDM
 
When I experienced similar it was given to be a reverse block. Slow your roll and ascend slower. Might help a bit

Sent from my GT-I9300 using Tapatalk
 
OP says it didn't bother him until after he'd surfaced and not during ascent. If it's reverse block why no significant pain during ascent?
 
OP says it didn't bother him until after he'd surfaced and not during ascent. If it's reverse block why no significant pain during ascent?

That's what's bugging me. I think of sinus barotrauma and I think (rightly or wrongly) that I would've felt some pain or a painful moment as I was ascending (sort of like when you force your ears too strongly). I also did not have any bloody discharge either, which I read is also a sign.

I made 3 dives today and was fine on all. I made a conscientious effort to breathe more fluidly and not pause. I've also been chugging lots of water all day today. Maybe it was jet lag, dehydration, stressful breathing, or a combination thereof. I really don't know.
 
OP says it didn't bother him until after he'd surfaced and not during ascent. If it's reverse block why no significant pain during ascent?

Hi Chilly,

It could be a mild barotrauma that caused some swelling after the dive, possibly complicated by sinusitis. He was able to localize the pain to his right frontal sinus and the pain set in after the dive, so that's first on the differential in my opinion but I've been wrong at least once before :wink:

Best regards,
DDM
 
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