Stint for blocked frontal sinus?

[bluebanded goby]

During my first year of scuba and free diving, I didn't have any significant problems with clearing, sinuses, etc. Then as of last December I started noticing a lot of problems with my left frontal sinus. During the period between then and now I've been freediving exclusively, on a total of three occasions. When I've tried to get deeper than about 5 fsw, I get a strong pain in my left eyebrow area. On one occasion I ended up with a fair amount of blood in my mask.

I tried descents in a swimming pool this week, and noticed a pain in the same area. I've come to the conclusion that I probably have what has turned into a chronic frontal sinus problem.

I'm going to book an appointment to see my family doc and most likely request a referral to ENT, but since my HMO often tries for doing the most with the least I wanted to throw out a question or two here first. It appears from a bit of searching on the web that in a case like mine an ENT doctor might typically do an examination of the sinus area with an endoscope. At least in some cases it seems as though a simple approach is to insert a stint (i.e. a little tube that will keep the sinus open).

Does this seem like a reasonable thing to ask about? Is this usually done as an outpatient visit? Are there any other treatments that I might ask about? This seems like a simple enough procedure that I'd be game to try it, although I'm gun shy on more extensive surgery unless it's really called for. I've been told that I quite quite a deviated septum, for example, but I'd prefer not to have surgery on it unless I really, really had to. Thanks in advance for any input on this.

 

[O-ring]

Not sure about the stint, but I have had sinus problems all my life. So far, I have had a septoplasty (to correct a deviated septum) and a somnoplasty (to reduce enlarged turbinates). I am going back again for another somnoplasty, as I have difficulty breathing through my nose at all unless I use over the counter nasal sprays (oxymetazoline hydrochloride based). I even carry a couple bottles of Afrin in my dive bag...

A lot of stuff is outpatient now, and I see my ENT a few times a year to try to get stuff corrected. I would go for the ENT and see what he/she can offer.

FWIW, before I started OW training I took my medical form to my ENT and had him look at it. He cleared me for diving even with my history of sinus problems and I have had no problems underwater so far.

FYI, you are right about the septoplasty...it is a PITA. You will spend a week or so with your entire face packed with gauze...the discomfort is pretty high, but worth it in my case as it improved my breathing dramatically.

 

[scubadoc]

Hello bbg:

Stents placed for obstruction of the nasofrontal duct are effective in close to 80% of surgeries (Vanderbilt report). This would depend to a certain degree on the pathology involved and the expertise of the surgeon.

Best advice here would be to see your ENT (if the HMO permits or not)- if you want to proceed with any kind of diving as a career or for fun.

See http://www.headandnecksurg.net/sinus_stents.htm
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10892692&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=11568548&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=11344065&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=11191431&dopt=Abstract

Good things!
scubadoc

 

[bluebanded goby]

Thanks for the input and links, Scubadoc.

Eighty percent aren't quite the odds I was hoping for (98 percent would have been better), but this provides some background for discussing it with the ENT doctor. I didn't previously realize that the stents aren't usually left in forever, so this is good to know.

 

[erwin.kodiat]

Dear all,
I got the same problem. Felt pain on my left eyebrow. I was thinking it's because of the pimple, but on the second time I found that it happened to my sinus. When I was having my DM course in the pool, I did free diving and later on I got sinus pain on my forehead (eyebrow). The second one happened last week, after 1 day of free diving, the day after I got the same pain on my left eyebrow. Both pain subside when I surfaced. However in the subsequent dive I did not get the same pain anymore.
Would it be something happen to my frontal sinus?
Thanks

 

[bluebanded goby]

Hi Erwin,

I'm not a doctor or medical person, but in my case when I got pain in the eyebrow area on descending it was identified as a blocked sinus. Sounds similar in your case.

Just a little update on my situation -- I scuba- and freedived for about a year from late 2000 to late 2001 with no problems. Then in December 2001 I suddenly got this sinus block. It prevented me from making freedives below about 6 fsw without a _lot_ of pain. This persisted on several freediving attempts through May 2002 (I wasn't trying to scuba dive during that time). The ear-nose-throat doctor said I have a deviated septum that she said was contributing to the problem of blocking my frontal sinus on one side, and recommended minor surgery to straighten it.

However, in May the problem mysteriously disappeared. I've been freediving pretty much weekly since then with no problems getting down to my usual depth range of 25-30 fsw. Actually, come to think of it, on one occasion I got a slight sinus pain after a morning of diving, but I eased off for the day and then had no trouble the following day.

If the problem comes back I suppose I could check out the septum surgery, but in the meantime if it ain't broke I'm not going to ask them to fix it.

If you keep having a problem, I'd suggest seeing a good ear-nose-throat doc. Besides surgery they may be able to prescribe medication that might help keep your sinuses clear.

One thing I learned from the experience is that, if I have eyebrow pain descending on freedives, it's _not_ wise for me to try to "push on through" it. I tried this once early on, and ended up with a lot of blood in my mask.

 

[The Iceni]

For all you budding DIY ENT surgeons thought I would let you have a look at just how big (and complex) the paranasal sinuses are.:mean:

The following link shows a schematic frontal section through a skull at about the plane in which the eyes sit. Thus the frontal sinuses are seen at the top above the eye sockets (which do not connect with the nose and do not have a mucosal lining), and with the maxillary sinuses each side immediately below the eyes with openings pointing upwards into the nasal cavity.

The nose itself is divided into two by the septum. The nasal passages look complex in the section but the lower left picture shows that this is because of the turbinates which protrude into the nasal cavity. These are used to moisten and warm the inspired air.

With a little bit of imagination you can see how a deviated septum, or a damaged turbinate, could block the opening into the frontal sinus sealing it off from ambient pressure. When this opening is blocked air cannot enter the affected sinus which remains at a lower than ambient pressure during further descent. The result is damage to the mucosal lining from the blood supplied to it, from the heart through the arterioles, the pressure of which is increased by the higher ambient pressure.

The result? The blood vessels rupture damaging the mucosal lining and they bleed into the sinus. On ascent some of this blood is forced out in to the nose by the relative increase in pressure but some must remain behind as debris, making equalisation even more unlikely on subsequent dives.

The moral?

Do not attempt further descents with a blocked sinus.:boom:

http://www.geocities.com/shouser144/anat.html

 

[Laurence Stein DDS]

Dear bluebanded goby,

I was just perusing the medical threads and I came to yours.

You make a comment which, as a health care provider always strikes a nerve and seems a bit oxymoronic. (Please understand, I am NOT berating you--your comment is so familiar that it has become a mantra for "everyman" in the same situation).

For patients who are members of HMO's, National Health Plans or any health care organization who's goal is to either limit access, maximize profit, or redistribute health care, I'm sure that is comes as no surprise that you're NOT going to get A-number 1 care through these systems. It may also not be the fault of the doctors either.

They will make you wait, sometimes for months for definative care, they often use a "gatekeeper" to limit referrals, they may limit the types of special procedures that can be done. The really amazing part is that EVERY MEMBER KNOWS THIS AND STILL THEY SAY "My insurance doesn't cover this." or "I have an HMO and have to wait for my doctor to refer me." What did you expect when you got this type of insurance? I realize you may not have had a choice but you had to know when you signed up what would happen.

Without getting emotional, Scubadoc basically said to go outside your present HMO and see the private ENT. Use your own money and get an answer you know is right and you are satisfied with. By playing the insurance's game, nothing gets done, you don't get better and you have nothing to show for the meager premium you are paying.

Don't use your insurance as an excuse for proper treatment. I will bet that you spent more for your scuba classes and equipment and vacations than you would have for a good consult with doctor who didn't have an agenda dictated by an insurance company.

Insurance is there as a supplement. It cannot be expected to supply any and all care. Do you want your care provided by the best doctor or the lowest bidder? If the lowest bidder is your choice, than don't complain about being part of an HMO.

I know I am sounding unsympathetic and elitist. This is not my intention. I am not picking on you for what YOU said. If I had a dime for every time I have heard a patient say that they can't do something because their insurance won't cover it, I wouldn't need the lottery. I just find it amazing that patients will put up with second rate care and then use it as an excuse to avoid proper care. Yet they often drive the cars they want and vacation where and when they want.

To ALL of you out there...if you have a medical problem and your health care provider can't or won't treat it properly, then follow up on it yourself. Find a private doctor. The suffering will stop faster and you will have the answer you need when you need it.

Laurence Stein DDS
:box:

 

[Grajan]

all the images I have seen (of my mess...) have been horisontal sections that are a little less easy to interpret.

One question though - You say that the eye socket is not connected to the nazal system but I thought there was a tear duct for drainage? The reason I ask is I am sure I get a displacement of fluid into my left eye socket if I sneeze or blow my nose too hard.

Is this my imagination? Or do I have a more serious problem?

I'm off to the diving ENT on Tuesday anyway but your advice is much valued.

Thanks

Graham.

 

[Laurence Stein DDS]

Grajan,

I believe Dr. Paul's comment was meant to mean that all the sinuses are interconnected and share a "common" mucous membrane.

The tear duct, or lacrimal duct empties into the nose rather than into the sinuses. While the interior of the nose--the septum and turbinate bones share a mucosal membrane with the sinus, the tear duct is not part of this "shared apparatus". It just dumps it's toxic waste here.

When your eyes water, they drain directly into the nose and will often cause your nose to run.

But, hey, Dr. Paul, help me out here.

Regards,

Larry Stein