Advanced Sinusitis Long Term Scuba Prognosis

[KevinNM]

So the CT and MR show bone windows to the brain and I just scheduled endoscopic surgery in a few months to try to get the stuff cleaned out of the sinuses. Until then I have various medications to take.

I'm not hoping on diving until surgery is done, but what is the typical future prognosis for resuming diving?

Thanks

 

[Moor3061]

I am not a Dr... As an adult I suffered from chronic sinusitis 6+ per year. Cat scan showed some major issues and blockage. I had a FESS To fix it. It was quite a long time ago, for 2 weeks I didn't go to work. but I think I may have dove after a few months and Dr clearance.

 

[Duke Dive Medicine]

Kevin, that's going to depend on where the bony dehiscences are and whether the openings of the sinuses remain patent and the sinuses can be easily ventilated with pressure changes. Many people have bony dehiscences in the sinuses and remain asymptomatic. It's easier for pathogenic organisms to reach the brain though soft tissue than it is through bone, and it also exposes that area of the brain to pressure differentials if the sinuses won't ventilate.

Best regards,
DDM

 

[doctormike]

Not sure what you mean by bone windows - there may be a miscommunication here!

Yes, it is possible to have areas of bony dehiscience in the cribiform plate (the roof of the nose) or in the sinuses, putting someone at risk for a leakage of cerebrospinal fluid (or worse) during surgery or with acute infections. Someone might use the term "bone windows" to describe that, but I have never heard the term used in that context. A much more common use of the term "bone windows" is the contrast setting on the CT scan that lets you look at bony detail.

If you want to post (or PM) me the scan report, I might be able to interpret it for you. I can't give you specific medical advice of course, but assuming that you get a good result and there is no unusual communication with the central nervous system, many people find diving and equalizing of the sinuses easier after this type of surgery once healing is complete.

I think that this is the sort of thing that DDM is referring to - this is extremely rare and not necessarily associated with chronic sinusitis. Teenagers who get brain infections from a frontal sinusitis often have no history of chronic sinus disease - the thinking is that the pathway through the bone - the valveless veins - actually get blocked off with chronic sinusitis.

 

[KevinNM]

Thanks, I'll have to get a copy of the images and reports. The doctor didn't use the word window, that was me.

What I saw as the ENT scrolled around with the CT was areas at the top of the right sinus where there didn't seem to be significant bone (no white line) between the sinus space and the brain. The Radiologist had put various symbols and lines drawing attention to this. The MR showed the dura in that area as different than next to the other sinus, but otherwise the brain wasn't exciting.

Pretty much all the sinuses on the side with issues were shown as completely full of stuff, with the ones on the other side having far less in them.

So yeah, not feeling really good about this. She has this long list of sinuses she wants to endoscopically clear in the OR.

 

[fmerkel]

Without seeing or knowing the specific details I can tell you that I have crummy sinuses that declared themselves on my first dive trip with reverse block and mildly bloody nose. Nasal steroids helped for years and then it got worse again with problems clearing the sinuses (not the ears). I did several years where I'd have a course of antibiotics+high dose oral prednisone until finally I lost my sense of smell and taste.....completely.
Got sinus surgery. Helped a LOT with diving, not at all with the sense of smell.
Had a lot of tests, tried a lot of things but nothing helped so I gave up on smelling and tasting for 7 years. Over that time I had to be very careful and easy with descents to not harm the sinuses. Even so, it got steadily worse.

Got a different ENT, did a lot of research and talking, and went for the 2nd sinus surgery. I actually had to talk him into it since he was open that he couldn't guarantee my sense of smell return. I knew that, but didn't have it anyway and no real hope of getting it back by doing nothing.

That surgery worked, diving/descent is easier, and I have about 50% sense of smell and taste back. I'm still on high doses of nasal steroids and regular sinus rinses, and some other more 'interesting' treatments but it's held out for a year.

So, I'd say barring specific problems or counterindications otherwise you have a good shot at improvement if you have a good surgical technician.

 

[doctormike]

Yeah, "sinusitis" is such a broad term that it's really hard for any general comments to be helpful - the devil is in the details.

Good luck!

M

 

[KevinNM]

So I went to see the nearest ENT in DAN's referral database, Dr. Taffet in Phoenix (a mere 400 miles away). He was not encouraging. Based on the data I'd given him (the CT, MRI and the ENT consult) he agreed that my sinuses were full of fungus and endoscopic surgery was the next step. He also said he wouldn't operate on me, he'd refer me to a specialist as I'd be too high risk for him due to the bone damage shown in the radiology studies, there was too much chance of blinding me or producing a CSF leak, it needed to be done by someone who does this sort of work routinely. He also said that until and unless I can get the damage to the left lamina papyracea, left orbital roof and the likely hole in my left anterior skull base repaired and verified as effective he said my diving should be suspended.

Anyhow, I got the PACS team to get me the version with the radiologist annotations, so here are the key images from the CT.

Key1

• KevinNM
• May 22, 2017

CT Key Image 1 of 2

Key2

• KevinNM
• May 22, 2017

Ct key image 2 of 2

 

[Kevrumbo]

(Wow. . .); compared to normal black clear bilateral sinus spaces and white boney borders:

Good Luck on your procedure -may you heal fast & well!

 

[RayfromTX]

I am not a dr and I'm not writing this related to diving or those pressures but I will share my experience.

I had sinus problems for years. 3 infections a year and the drs were recommending surgery. I put it off. I had allergy problems and a long list of other health problems. Several of the other issues went away when I went from 235 lbs to 175 lbs. I am 6'3 and ectomorphic. I'm 182 now 6 years later.

The second bit of magic happened when I got on a bicycle to improve my cardio. I ended up riding 8 or more hours a week. I blow my nose many times throughout the ride. (snot rockets they're called) More than anyone else I know. The long workouts thin the mucus and it gets flushed out naturally somehow. Again I'm not a dr so I'm describing this from my perception of what is happening.

I've never had the surgery. I haven't had a sinus infection or severe allergies for 6 years. Goodbye to allergy shots, zpacks flonase advair and the rest of it. During allergy season I can get by with sinus/nasal rinses when it gets bad and zyrtec once or twice a year.

I am not saying you don't need surgery. I'm telling you my experience. With or without it, if you aren't already doing a serious cardio workout, perhaps it could help. For me it made me 20 years younger and people noticed.