Cold and Airflow Sensitive Sinuses

[divinh]

This isn't strictly diving related, but it affects long surface swims...

I've developed a weird problem with only my left sinuses. Cold air and rapid airflow through my left nostril causes strong discomfort from mid-nasal down to the top of the left palate. The sensation is like breathing in cold, dry air directly through, without the air being moisturized and warmed by the nasal passages. And these nerves seem to be connected to my chest, as there's also the sensation of breathing in cold, dry air into my left lung/chest.

As with anything chest related, especially the left side, I was worried it might be also a heart problem. I went to my primary physician and she said my lungs and heart sound fine. As for the sinus problem, she thought it might be a development of asthma, but I don't feel difficulty in the process of breathing, but the dryness and temperature of the air. I was prescribed Albuterol in an inhaler, which I've yet to use, as I don't feel it's an asthma problem... though if someone who has asthma can relate to my symptoms, then I might give it a try. At the moment, I'd rather not use a medicine with its associated side-effects if it's not necessary. The other recommendation was to use Ocean Spray, a saline spray to moisturize the left nasal passage and this does relieve the discomfort for a bit.

So, how does this affect me? When I'm out in the cold, do a brisk walk or do any exertion that requires heavier than usual breathing through my nose, like long surface swims, I feel the discomfort. I can immediately stop moving or hold my breath and the sensation goes away within a few seconds. For example, if I'm walking fast, I can stop walking and within a few breaths, everything is good. For surface swims, I would need to stop swimming for a bit.

The discomfort isn't enough to completely stop me from doing activities, but it's enough to stop me momentarily, kind of like catching my breath, but more to slow my breathing so the sensation of breathing in cold, dry air goes away.

I've seen a head and throat specialist and my nasal passages look fine, moist as they should be, without any lesions or tumors. I was told it could be just an extra sensitivity that I've developed.

I can do a CT scan next, as the primary physician offered, but I'm unsure if that will provide any more data for analysis.

Anyone out there have similar symptoms? I've gone through my primary and a specialist so far. They're not recognizing anything. I'm hoping someone out there might have an idea.

Thanks!

 

[Duke Dive Medicine]

@doctormike is an ENT, I tagged him here. It sounds pretty benign but Mike is the expert.

Best regards,
DDM

 

[doctormike]

Yeah, hard to say much based on that. The evolutionary purpose of the nose is to warm, filter and humidify air that we breath. Asthma triggers are cold, dirty and dry air, so people with nasal congestion who mouth breathe often find their asthma symptoms to be worsened.

If you went to an ENT doc who looked in your nose with a telescope, that's good. If there is any sort of sinus problem present (suggested by your nasal symptoms), a CT would show that, and this might not be seen on endoscopy. Not sure what to make of the chest symptoms being one sided - that might warrant a consultation with a pulmonologist.

 

[divinh]

Yeah, hard to say much based on that. The evolutionary purpose of the nose is to warm, filter and humidify air that we breath. Asthma triggers are cold, dirty and dry air, so people with nasal congestion who mouth breathe often find their asthma symptoms to be worsened.

If you went to an ENT doc who looked in your nose with a telescope, that's good. If there is any sort of sinus problem present (suggested by your nasal symptoms), a CT would show that, and this might not be seen on endoscopy. Not sure what to make of the chest symptoms being one sided - that might warrant a consultation with a pulmonologist.

The weird thing for me is that there's less congestion on the left. If I were to get congestion, then the right would plug up and the left would still stay more open, less congested. This morning, when I woke up, I found the right side to have closed up more, while the left was open, even though there was some mucus. The left still produces mucus, but not enough to clog the left passages.

If it's cold and I mouth breathe, there's less airflow going through the left passages and it does relieve the discomfort. I'll pay more attention next time to this.

I have 30 days to opt-in for the CT scan. I have the time now to do it. Is it worth doing?

I'll ask about a pulmonologist. With medical issues, it's hard to know who to ask for.

Thank you!

 

[doctormike]

You might also have a deviated septum if one side is always more congested than the other, but if you saw an ENT doc, they would have picked that up, I think.

The CT scan would help look for chronic inflammation in the sinus, and obstruction of their outflow paths (as well some other anatomical variations and anomalies). I was thinking about your initial statement about the nasal discomfort.

 

[divinh]

You might also have a deviated septum if one side is always more congested than the other, but if you saw an ENT doc, they would have picked that up, I think.

The CT scan would help look for chronic inflammation in the sinus, and obstruction of their outflow paths (as well some other anatomical variations and anomalies). I was thinking about your initial statement about the nasal discomfort.

Is a deviated septum something that can develop later in life? The experience I'm having is that the right passages feel normal and the left passages feel overly open. What I said about the mucus was to say that the left passages can still produce mucus, but it's just not as much as on the right side.

I feel that I'm not having any obstruction or inflammation at all. The left feels more wide open, like I'm having the opposite problem.

If I breathe in through my mouth, the discomfort subsides.

If the airflow is incoming, there's discomfort. If the airflow is outgoing, there is relief, but this kind of makes sense since the air is warm.

 

[doctormike]

Is a deviated septum something that can develop later in life? The experience I'm having is that the right passages feel normal and the left passages feel overly open.

Hard to be specific about your particular symptom, but a deviated symptom does develop over time. Sometimes it's related to minor trauma, sometimes that's just the way the nasal cartilage grows. Usually, the symptom is better airflow on one side than the other. Of course, if you have already had an ENT exam, they would have noted any septal deviation, I suppose.

 

[divinh]

Hard to be specific about your particular symptom, but a deviated symptom does develop over time. Sometimes it's related to minor trauma, sometimes that's just the way the nasal cartilage grows. Usually, the symptom is better airflow on one side than the other. Of course, if you have already had an ENT exam, they would have noted any septal deviation, I suppose.

My primary looked at the report and said everything looks normal. I think the next step is to schedule the CT scan, if only to eliminate problems.

Thanks again!

 

[divinh]

CT scan came back normal, mostly "clear bilateral", except this one line:

NASAL CAVITY: Clear. Slight nasal septal spur/deviation to the right anteriorly, left posteriorly.

The symptoms still persist, but three days ago, I was up super late, then had to get up early, and only got three hours sleep. The left nasal passages almost felt normal, when doing things that would irritate it, being in cold air and walking fast. I've gotten more sleep in the last two days and the symptoms are still there, but not as bad. Just very odd and puzzling.

 

[doctormike]

Yeah, hard to say, but that scan doesn't sound like it is a very severe deviated septum. Almost no one has a completely straight septum.