Maxilary Sinus Barotrauma....

[drainaps]

Gentlemen good morning.

First time ever I have an issue. First dive of the trip (I had had a cold the previous week but had only very slight symptoms remaining) and sharp teeth pain @ 3m depth. I called the dive, tried again a second time the day after, same thing @ around 6-8 m. Coming out of the water there was some blood in my nasal secretions, and I've been out of the water for 3 full days now.

Blood in small amounts has continued to taint the nasal secretions until today. I've been (self medication but I guess I'm a responsible boy who reads web medicine sites carefully and there's no serious doctor down here anyway) on (1) topic oxymetazolyne twice a day, (2) amoxycilyn 500mg every 8 hours as a profilactic (I don't have any symptoms of an infection but I don't want to have one, I'll follow the full 7 days treatment as instructed by the pharmacist) and (3) a mucolitic/ paracetamol in capsules, suggested by the pharmacist. I can't remember the name and I'm not in my hotel room now.
I've also washed the affected nostril / sinus with saline solution regularly to keep it clear.

3 days after, I still feel some light pain in my upper teeth, plus some light blood in the nasal secretions. I've not had a hemorrhage per se during the whole process, just some on-off traces of blood in my mucus. Darker yesterday, less dark today.

Anything else I should consider doing before hitting the water again?

I'm aware internet medicine is not the wisest of things, but proper medical attention is far away from here and my condition is annoying but doesn't seem serious. Thanks a million for help.

Safe dives.

 

[rsingler]

Paging @doctormike

 

[doctormike]

Well, I can't really "clear" you to dive over the Internet, but it sounds like you are doing the right things.

Unlike with ear disease, topical decongestants like Afrin (oxymetazoline) work very well for acute sinusitis, you just shouldn't use them for more than three days (you can get addicted), and there is some rebound (you get more congested as they wear off). So if you are going to use them it should be just before the dive. Oral decongestants like Sudafed may also help, as long as you don't have any cardiac or other reason not to use them. I'm a big believer in the Neti Pot, as long as you use CLEAN WATER! And the antibiotics are probably a reasonable coverage if you really have sinus barotrauma. Unlike the ears, the sinuses are pretty contaminated, and if you get bleeding into them, you set yourself up for an infection.

Of course, just like with ear disease, the final "clearance" comes from your being able to equalize on descent, and it's best to try it in a pool first. Don't force it, go slow, ascend a bit if you are having trouble, and be ready to thumb the dive if you can't do it. Remember, you may be able to force your way through a tough descent, only to end up with a reverse squeeze on ascent. And to adopt a saying from aviation - descents are optional, ascents are mandatory...

If symptoms persist, you might want to see an ENT doc when you get a chance, and possibly get a CT scan to check for chronic sinusitis or other intransal abnormalities.

Good luck, and dive safe!

 

[fmerkel]

Descend really......really.....really slowly. Think of a sinus like a small balloon with a very tiny opening. You can't force it open (clear it), but you can traumatize the mucosa causing it to swell and shut the opening down. It can do that amazingly quickly.
Routinely I've had to do very slow descents for the last dozen years. I take several minutes to get to 12-15 feet generally following the shore slope if possible, stop, setup my camera, and proceed maybe 3-5 minutes later....slowly. Any pain or pressure and I stop until it goes away.

 

[doctormike]

The ears and the sinuses both are potentially poorly ventilated spaces, so they are both susceptible to barotrauma with diving. The difference is that sinus obstruction from chronic inflammation or anatomical variants are easily treated with an operation if medical management isn't enough. Patients whose primarily symptoms are upper tooth pain may have disease limited to the maxillary sinuses (the big ones beneath the eyes). Opening this drainage pathway is one of the safest, quickest and simplest of all sinus procedures.

On the other hand, while there is some early data about the efficacy of balloon dilation of the Eustachian tubes for problems equalizing the ears, this is nowhere nearly as straightforward surgically, has some unique potential risks, and is commonly considered "investigational" by many insurance companies, so it is rarely covered.

While I don't doubt that equalization is possible in divers with relatively poor sinus ventilation, I would be careful if the OPs symptoms are new. Sometimes a little bit of acute congestion is enough to cause a reverse block, even if slow descents have been successful in the past.

 

[drainaps]

Well, I can't really "clear" you to dive over the Internet, but it sounds like you are doing the right things.

Unlike with ear disease, topical decongestants like Afrin (oxymetazoline) work very well for acute sinusitis, you just shouldn't use them for more than three days (you can get addicted), and there is some rebound (you get more congested as they wear off). So if you are going to use them it should be just before the dive. Oral decongestants like Sudafed may also help, as long as you don't have any cardiac or other reason not to use them. I'm a big believer in the Neti Pot, as long as you use CLEAN WATER! And the antibiotics are probably a reasonable coverage if you really have sinus barotrauma. Unlike the ears, the sinuses are pretty contaminated, and if you get bleeding into them, you set yourself up for an infection.

Of course, just like with ear disease, the final "clearance" comes from your being able to equalize on descent, and it's best to try it in a pool first. Don't force it, go slow, ascend a bit if you are having trouble, and be ready to thumb the dive if you can't do it. Remember, you may be able to force your way through a tough descent, only to end up with a reverse squeeze on ascent. And to adopt a saying from aviation - descents are optional, ascents are mandatory...

If symptoms persist, you might want to see an ENT doc when you get a chance, and possibly get a CT scan to check for chronic sinusitis or other intransal abnormalities.

Good luck, and dive safe!

Thanks a trillion Dr Mike et al. Let's see how it goes tomorrow morning. Fingers crossed.

 

[drainaps]

So here's the wrap-up of my sinus incident and my takeaways, in case they can be helpful to someone in the future.

1) Even if the damage to your sinus is light, as was my case, the incident will keep you out of the water for 3-4 days and you'll have to be vigilant and really careful with your diving during the next couple of days or so. Don't ever think of sorting thing out overnight, you'll only make then worse. Slow is fast here.

2) Put yourself on (1) amoxycilyn 500mg for a full 7 days, one capsule every 8 hours. Do NOT take shortcuts and take all your 21 pills even if symptoms have receded. This will help sure you don't get an infection from all the blood pooled in your sinus.

3) You need to empty your sinus of secretions (mucus) and blood. This will not be a one shot thing, but have to keep cleaning and emptying over a few days.

In my case it was the right sinus inky so everything below applies only to your affected nostril. I guess it's unlikely that trouble strikes both sinuses at the same time.


In order to help your sinus empty and recover:

a) Take an oral mucolitic (capsules in my case) to help dissolve your secretions. Dissolved secretions will flow at the back of your throat, so if you start feeling a lot of mucus there, then you know you're doing the right thing. Can't remember the name of the mucolitic I took though.

b) Keep your sinus as little clogged as possible: wash at liberty, as many times a day as you want with a saline solution spray up your nose. Inhale strongly until you feel the saline in your throat, that means it's done the circuit. Saline is just the equivalent of (table) salt and distilled water, so you're safe to use as much as you need.

c) TWICE A DAY MAXIMUM, AND FOR A MAXIMUM OF 3 DAYS, use an oxymetazoline spray. Press twice on the plastic bottle while you inhale strongly. Do this after washing your nostril with saline, so that you make sure the medicine goes into your mucose, not your secretions.

d) The first and second says of diving after the incident, use A SINGLE sniff of oxymetazoline a few minutes before the first dive of the day, to make sure your sinus and ostia (the conduct connecting your sinus to your oral cavity) are clean and don't secrete mucus.Make sure you feel your nose /sinuses clean (inhale strongly and no obstructions felt when the air moves in your upper respiratory tract) before getting in the water, otherwise DON'T DIVE.

Overall, I saw a lot of blood being washed away with my secretions (mucus), and probably a little additional blood being produced during the first few dives after the incident. It's a real PIA incident and something I'd not like to be through again in the future.

The fois news is shat if you are patient, you'll get through it.

Before I finish, I have NO MEDICAL QUALIFICATIONS Whatsoever, but was thrown into sorting things out by myself because of no competent medical help available on site. Luckily there was a well stocked pharmacist close at hand.

 

[drainaps]

And WARMEST thanks to Dr Mike for backing me up (see message above) with my self-prescribed treatment. You're a true asset to this board and to the diving community.

Safe dives all.

 

[doctormike]

I remember my sinus barotrauma reverse squeeze. Diving with a cold (bad idea!), was able to equalize my sinuses on descent and felt fine at depth. On ascent, I realized that I had a reverse block. But descents are optional, ascents are mandatory. I couldn't clear and eventually had to surface with extremely high pressure in my maxillary sinuses. You can get a much bigger pressure gradient in the sinuses than in the ears, since if it gets to big in the ears the tympanic membrane is your burst disk and just blows out. While that's possible with sinuses (into the orbit or even the brain), it's less common.

So I'm sitting on the dive boat in agony, with these two pressurized maxillary sinus cavities, still wearing my mask. Suddenly, there was this explosion of blood and snot into my mask as the sinuses opened into my nasal airway. That relief was perhaps one of the most wonderful sensations that I have ever had!

 

[chillyinCanada]

I remember my sinus barotrauma reverse squeeze. Diving with a cold (bad idea!), was able to equalize my sinuses on descent and felt fine at depth. On ascent, I realized that I had a reverse block. But descents are optional, ascents are mandatory. I couldn't clear and eventually had to surface with extremely high pressure in my maxillary sinuses. You can get a much bigger pressure gradient in the sinuses than in the ears, since if it gets to big in the ears the tympanic membrane is your burst disk and just blows out. While that's possible with sinuses (into the orbit or even the brain), it's less common.

So I'm sitting on the dive boat in agony, with these two pressurized maxillary sinus cavities, still wearing my mask. Suddenly, there was this explosion of blood and snot into my mask as the sinuses opened into my nasal airway. That relief was perhaps one of the most wonderful sensations that I have ever had!

Oh gross
But good, I guess, lol