Squeezed and reverse squeezed

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The Laconic

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I had my first actual diving-related injury yesterday, following my last dive of my trip to Grand Cayman. A sinus squeeze followed by a reverse sinus squeeze. I was just a little bit congested--I hadn't thought it was nearly bad enough to not dive. On the descent I felt some increasing discomfort and pressure on my sinus cavity, which went away. I didn't realize it until I surfaced, but I had blood in the bottom of my mask. It had happened the previous day, too, but it didn't hurt, and I knew it was something that could happen sometimes and wasn't too serious.

The worse part, though, was the ascent. (Which, for what it's worth, was nice and slow.) Because there was now air trapped in my sinuses that was expanding with nowhere to go, and as I got near the surface I thought "oh, this doesn't feel good at all". By the time I got back on the boat, I had a moderate sinus headache, and by the time I got back to the condo it was the worst sinus headache ever, mainly on one side. Painkillers did nothing (and my wife had the good stuff, ibuprofen + codeine). I rolled around miserable on the bed for about an hour, while my wife did research. It was getting bad enough that I contemplated calling DAN for advice, but I figured it would pass sometime. Following my wife's research, we drove to the store, got some Afrin and decongestants, and I took them as soon as I got in the car. When we got back to the hotel, I half-slept for about an hour, then I heard a weird squeaky pulsing sound, which I thought was coming from my phone. Then I realized it was the sound of air escaping from my sinuses, and I felt much better. It's still not quite back to normal; it doesn't hurt, but there's a vague discomfort.

I still haven't decided what the lesson is. I had only woken up with a bit of congestion on one side of my nose, which cleared right away, so I still don't think I was ignoring some big warning sign there. But on the other hand, I really should have expected a problem, since I'd had blood in my mask the previous day.

Next time in a similar circumstance, I think I'd use nasal spray just to be sure. If it were much worse, of course I wouldn't dive. And I'll have to move the line of what's "much worse" for me in a more conservative direction.
 
You were lucky. A bad reverse squeeze can blow the walls of the sinuses, and the top of the maxillary sinus blows right into the orbit.
 
My reverse block was so bad that I had to get back in the water and recompress everything. Took nearly 25 minutes coming up from 25 feet. And it still was not enough. This was under the supervision of an ER doc who happened to be at the site that day. He shot Afrin up my nose, advised the ibuprofen, and then we got back in the water. Doc Harry here on SB was my "attending" for that episode. I will be forever grateful for what he did for me that day.

It still took over three weeks for all the symptoms to disappear. Three days for the facial paralysis to resolve on the right side. A week for the numbness and tingling to go away. I just had a little sinus issues that morning. Took a 12 hour Sudafed that wore off in about 8 while I was under water DM'ing a class.

Now I won't get in the pool if I'm a little bit stuffy. Not worth it.
 
Psuedoephidrine. I couldn't dive without it.
 
I live in Oklahoma....insert joke here... But allergies are pretty much a fact of life, even for people that are not allergy prone. our instructor told us that a squirt of Afrin an hour before diving, even when not congested is a good idea, now I know why. During allergy season, the morning of a lake dive, we usually take an over the counter allergy pill as well. I stay away from Benadryl because it knocks me out, any of the over the counter wal mart sinus pills work. I've never had a sinus squeeze, but I damn sure don't want one. Generic Afrin is always in our gear bag and went to cozumel with us.

Good luck, safe travels.

jay
 
You are taking a serious risk by doing that. If it wears off during a dive and the congestion comes back the results could be very serious. Your instructor's advice could get you seriously injured. If he is not an MD it's highly irresponsible and unethical to give you such advice.
 
If congested I do not dive.

However, I often have a little bit of sinus drainage going on. I will not use anything that might wear off. If I have some drainage but no feeling of pressure or stuffiness I will sometimes take psuedophed 12 hour. Any diving will only be done if the P makes me feel totally clear, air flows freely, and diving is limited to hours 2 through 6 of the 12 hours. This practice is okayed by my ENT who is very familiar with diving and diving injuries and my personal medical history.
 
You are taking a serious risk by doing that. If it wears off during a dive and the congestion comes back the results could be very serious. Your instructor's advice could get you seriously injured. If he is not an MD it's highly irresponsible and unethical to give you such advice.

Had sinuses congestion medication wearing off during a dive, at around 40m, the effect of the medication ended and the result was a reverse sinus squeeze, the pressure was released through my nasolacrimal ducts after around 30 min into the surface interval, that was quite unpleasant.
 
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You are taking a serious risk by doing that. If it wears off during a dive and the congestion comes back the results could be very serious. Your instructor's advice could get you seriously injured. If he is not an MD it's highly irresponsible and unethical to give you such advice.

I agree with you post.

But if I can act as an apologist for the instructor - it's a case of "Do as I say - not as I do." As a recreational diver, the value of a dive should never justify the risk of injury. Diving with a cold / congestion carries some risk of injury / discomfort. But as diving professionals - our clients might not be happy to have their classes cancelled because we have the sniffles or a bit of an allergy. Hence I tell my OW students about the dangers of Sudafed or Afrin (and then secretly dose myself up while they aren't looking).

Thinking about it - I've gotten pretty good at blowing my nose under water - and keeping the airways clear... Not pretty - but my classes run as scheduled. :)
 
Psuedoephidrine. I couldn't dive without it.

Very important to know how you personally respond to any particular medication. I frequently take a prophylactic 12 hour psuedoephidrine dose, trusting it to work for about 4 hours or so. Fortunately for me diving seems to clear my sinuses - unless I experience squeeze (even very mild) which causes internal swelling.

OTOH I've taken generic claritin. That stuff solidifies any mucus in my sinuses - took it once and almost hurt myself on a dive. Made it to about ten feet and it took well over 10 minutes before I was able to surface. I usually just trust my computer to time my dives - but it considers me to have surfaced somewhere around 4-5 feet. Most of that dive took place within that depth, but with too much (reverse) squeeze to surface. Odd as it seems I'm grateful to have had both squeeze and reverse (simultaneously!) as I turned the dive before getting deeper and with plenty of air for the required 'deco' hang time.

Painful as our sinuses can get, it's more important to beware of chest congestion. Trapping air in a portion of the lungs can get fatal rather quickly. Not familiar enough with anatomy to compare nerve density, but suspect that we are more aware of sinus squeeze than we'd be with partial lung squeeze.
 
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