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Sinus Barotrauma

Discussion in 'Diving Medicine' started by takechair, Dec 7, 2011.

  1. takechair

    takechair Garibaldi

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    Hi everyone! I have this problem which happens in about a quarter of my dives. On descent I equalise my ears fine but I get this really bad pain behind my eyes which I think would be coming because my sinuses aren't equalising. So I read that a treatment for this is to use a nasal decongestant spray before diving. However I was looking at the sprays and they say not to use them for more than 3 days or some of them say 7 days. This is because you can get rebound congestion and so also dependency. But I was planning to go diving for a month or two. So I'm not sure what to do now. I wondered if anyone had any experience with this issue.


    Thanks alot!


    Dan
     
  2. DevonDiver

    DevonDiver N/A

    # of Dives: 5,000 - ∞
    Location: Subic Bay, Philippines
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  3. doctormike

    doctormike ScubaBoard Supporter Staff Member ScubaBoard Supporter

    # of Dives: 1,000 - 2,499
    Location: New York City
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    Hi, Dan...

    Barotrauma happens when there is an air filled space (such as in the sinuses) that is poorly ventilated, and in which the change of ambient pressure with descent can't be equalized. If you are having eye pain, this is potentially serious (some of the sinuses are right next to the eyes) and you should NOT push through this to dive. Nasal spray like afrin can sometimes help to ventilate the sinuses in cases where the blockage is partial, but if you have something like a cyst or polyp blocking the sinus outflow tract, it might not be enough.

    If you can see an ENT doctor, he or she might look in your nose, or recommend a CT scan to figure out what the anatomical problem is. Definitely do not use the spray decongestants for more than 3 days, you can get that rebound "addiction" to it, which will result in worsening obstruction as the spray wears off.

    Mike
     
  4. DocVikingo

    DocVikingo Senior Member

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    Hi takechair,

    Trying a saline spray (e.g., Ocean Premium, Ayr, Xlear, Simply Soothing Saline, Entsol) is an excellent place to start.

    If that doesn't prove fully effective, you may wish to experiment with a slightly more complicated nasal lavage.

    My Scuba Diving Magazine, Undercurrent Reviews Dive Resorts, Liveaboards, & Diving Gear sidebar on nasal irrigation in the May, '08 issue:


    “Shooting Saltwater Up Your Nose

    Is your nose stuffed up enough that diving isn’t appealing, or even to the point where congestion may dangerously interfere with equalization of the ears?

    It may sound a bit zany and gross, but the evidence, both published and anecdotal, largely supports the salubrious effects of saline irrigation on both nasal membrane drying and congestion (e.g., from long airplane flights, breathing hyper-dry scuba gasses and allergens). Such irrigation shrinks the mucus blanket and flushes out the excess, reducing nasal irritation and swelling.

    There are scores of salt-based OTC nasal washes on the market such as Sinucleanse, BreathEase and an array of NeilMed products. Many come with a soft syringe. Or you can purchase special tips that attach to oral hygiene devices (e.g., the WaterPik NA-2 Gentle Sinus Rinse).

    Many divers choose a simple home remedy that is cheaper and works just as well. Boil two cups of tap water for 10 minutes, stir in one teaspoon of salt (refined sea salt is recommended to avoid additives) and one-quarter teaspoon of baking soda (sodium bicarbonate). Adding more salt than recommended can do more harm than good, so don’t overdo it.

    After the brew has cooled to lukewarm, draw it into a clean nasal or ear syringe until full, then lean over the sink, squeeze gently and allow the solution to run through the nasal passages. Sniff it in, spit it out, then gently blow your nose. Repeat with the second nostril. Again, don’t overdo it - - one or two treatments a day should be sufficient.

    Now go make your next dive.

    - - Doc Vikingo"

    Regards,

    DocVikingo
     
  5. takechair

    takechair Garibaldi

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    Wow thanks so much everyone that's exactly what I wanted to know. I got my saline spray now so fingers crossed that will be enough!
     
  6. ScubaMarc

    ScubaMarc Manta Ray

    # of Dives: 200 - 499
    Location: Staten Island, NY
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    you can ask your doctor for corticosteroids like flonase. You can be on this stuff for months(Not advocating, but you can) with minimal issues. But you must start 2 weeks prior to when you really need it.

    Also for other sinus issues i have had, i had been on sudedfed for months. After 2/3 months there is a sense of nervousness i do get.
     
  7. takechair

    takechair Garibaldi

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    Ha yeah i think the over the counter form of Sudafed its one of the ingredients for methamphetamine. But which did you take for 2/3 months the tablets or the nasal spray?
     
  8. DocVikingo

    DocVikingo Senior Member

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    Hi ScubaMarc & takechair,

    Matters can get confused when only the word "Sudafed" is used in a post. This is because there about a dozen different Sudafed products (Sinus Pressure Pain and Cold Congestion Relief - SUDAFED®). Only a few of these contain pseudoephedrine, the methamphetamine-like chemical to which takechair is referring. And indeed it can cause "nervousness."

    For divers, one of the long-acting formulations with pseudoephedrine (a methamphetamine type chemical) (e.g., 24 hour (SUDAFED® 24 HOUR - SUDAFED®) or 12 hour (SUDAFED® 12 HOUR PRESSURE+PAIN - SUDAFED®) generally will provide good benefit and be unlikely to "wear off" during a dive. Unlike Sudafed products containing the often somewhat less effective phenylepherine, the purchaser will have to ask a pharmacist for the product and sometimes sign for it.

    However, the diver should not be deterred. This requirement was implemented as Sudafed products containing pseudoephedrine were being purchased in large quantities and used in the illegal production of methamphetamine. In some countries, such as Mexico, pseudoephedrine containing products can no longer be obtained even by prescription.

    Regards,

    DocVikingo

    This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.
     
  9. ScubaMarc

    ScubaMarc Manta Ray

    # of Dives: 200 - 499
    Location: Staten Island, NY
    620
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    Both Sudafed and Flonase, but Sudafed gave me the anxiety.
     
    Last edited: Dec 14, 2011
  10. DocVikingo

    DocVikingo Senior Member

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    Flonase (fluticasone nasal).

    Sudafed with pseudoephedrine commonly causes some degree of nervousness/anxiety.
    These are rarely reported with nasal steroid sprays such as Flonase.

    Regards,

    DocVikingo

    This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.
     

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