Help with Sinus Problem

[love2mtb]

Ok, here's a problem that I've always had and I thought that it might help to post here and get more responses about it.

When I was around 11 years old, I got certified by my father, who is a Naui Instructor. I did very well on the check out dives and our family went to Roatan, Honduras for a diving vacation. On the second official dive of my life, I was about 20 feet down and felt the most horrible pain I've ever felt in my life, up in my sinus areas, forehead and nasal cavities. I had to do an emergency ascent with my father. The pain subsided after about a day, but immediately felt better when I wasn't under water. We tried again in Cozumel a year or so later, but on the first dive, about 5 feet under, same thing. I couldn't even go to the bottom of a pool without feeling it. I also had trouble with the same problem about two years ago on a plane ride from New York to Florida. They almost radioed in a paramedic, I was crying so hard on the plane. Since then, I haven't been able to dive with my extremely water-friendly family, and most of our diving vacations included me having to stay in the hotel. I'm 21 now.

I've always had sinus problems since I could remember. My mother has cats, and I'm allergic to them. I went to 8 or so specialists, ENT's etc, for this problem, and I've tried gads of medicines. But nothing seemed to work for the pressure under water, only for day to day easy breathing.

Then I moved away for college and the ENT suggested that as I grew older, the problem would dissipate. I've also moved away from the cats, which has seemed to help a lot. I'm getting ready to graduate and I want to try and scuba dive again. But I'm very afraid that the problem will happen again. I went to the ENT yesterday and he prescribed Nasonex to try out. I'm still apprehensive. The other alternative to meds is a surgery where he said they basically "microwave" your lower nasal-something, forgot the scientific name. Althought it's scary, surgery seems a little brighter for my future than having to pop drugs for the rest of my life in order to, maybe, get down with a tank again. I really miss it.

Any thoughts, or anyone have this happen to them, have any advice, etc? I'd really appreciate it. BTW, I've tried Afrin, that day in Cozumel, didn't work. But it does work on planes. Thanks for your help,


- Love2MTB

 

[laura storm]

Hi L2MTB
It sounds to me as though you could have a classic case of sinus congestion. If you are an allergy sufferer and are continually exposing yourself to the allergens that trigger a physiological response (in your case an increase in body histamine levels which leads to an inflammatory reaction within the sinuses), it is unlikely that dipping in and out of over the counter and prescribed remedies will actually sort out the problem - if it is as deep seated and as long in the running as you indicate. You need to consider adopting a long term strategy to improving the health of your sinuses. Diving should be possible once you have achieved this.
The medication you have currently been prescribed (Nasonex) is a steroid based drug used to treat the symptoms of rhinitis. What it won't do is sort out what is happening each time you continue to expose yourself to allergens. To resolve the problem long term you need to remove or reduce the cause.
Most rhinitis sufferers are allergic to more than one allergen. The most common being house dust mites, pollens, fungal spores and cat or animal hairs. What might be useful to begin with is to find out specifically what all your allergies are (your GP can refer you for testing). Once you know these you will be able to minimize your exposure to them, giving your sinuses a head start in the recovery process.
Nasonex is not a drug that in my opinion should be used long term. Most steroidal medication has side effects. These vary but can include thinning and weakening of the surrounding soft tissue and in the case of Nasonex, headaches and nose bleeds. It's fine to use short term and the fact that you have been given it to use implies your sinuses are badly inflammed and chronic in their condition.
It might be worth while discussing with your specialist the additional use of an oral anti-histamine (such as Loratadine) to be used in conjunction with Nasonex. This will help to reduce the swelling systemically, is non-drowsy and one reputedly safe for long term use.
Once your course of Nasonex is over, try using Salex (natural saline spray) to keep the condition of your sinuses healthy. Pre-empt any exposure to your allergens by taking something like Beconase about three days beforehand if possible - to give your sinuses some protection.
The headaches you mentioned could be caused by rupturing the mucosal membrane lining of your sinuses or a vacuum headache (or both). Each sinus connects to the nasal passage via a small duct. Both the sinus spaces and ducts need to be clear and free flowing. If air cannot exchange freely between the sinuses and nose then the body will attempt to absorb this air (defensive mechanism) and so a vacuum will form. Intense pain and a residual headache can be experienced, often continuing for a day or two. As well as this, if the sinuses membranes are damaged then scar tissue can develop creating a permanent weakness in the soft tissue.
Diet and hydration are particularly important. Reduce consumption of all dairy food for a good month before diving ( it is mucus forming), as are protein foods. Eat masses of fruit, veg, salads, and drink water. Loads of it. (I have a guide on hydration and diving on www.storm4divers.com if you're interested).
Before diving you should be able to close off either nostril and breathe freely, high up into your sinus spaces. If you can't then don't dive. Try a decongestant such as Sudafed and use it just once or twice the day before diving. This allows time for the sinuses to clear out the blockage. Don't overuse though as you can generate kick-back congestion and an increase in mucus formation.
Be patient. It can take a number of months to calm down angry sinuses. Work at it daily and you should get there.
Finally, when you do dive, equalize early and often and really slow your descents and ascents down. Take your time.
Hope this helps,
Laura

 

[love2mtb]

Wow, thank you so much for your help. You must be a doctor? I just have one more question that hopefully you could answer for me?

You said that when I go down the next time, to make sure that I can breathe freely from both nostrils while closing one off at a time. The last time that I dove, I had taken Sudafed and I could do that, but I still felt the pain. Any way to distinguish when it is safe to dive and when not?

Oh. and my ENT also said something about a surgery where they "microwave" your lower nasal something rather, I can't remember the name off the top of my head. Do you know what that is, or if any sort of surgery is warranted or safe?

Thanks so much again for your help. I'll keep you posted on the progress.

- Lauren

 

[laura storm]

Hi Lauren
I'm not a doctor at all....sports therapist and physiologist ( have studied though at a clinical level).
In reply to your last question, you have 4 pairs of sinuses. All are located next to or above the nose and all drain into the nasal cavity via their own tiny ducts. One of the pairs (the ethmoid sinus) is further divided into numerous smaller sinus cavities, between 7 and 15 on either side. Each of these drains independently into the nose via tiny ducts that are 1mm or 2mm in diameter. Every single cavity and duct needs to be clear of a blockage if air is to exchange freely and not cause discomfort.
In cases where a diver has rhinitis, unless you have undergone a sustained period of time without irritating the sinus linings, the chances are you could still have any number of the smaller, deeper ducts or spaces blocked.
It can take many months to clear the mucus from the cavities of the deeper sinuses. Even though you feel you can breathe free. it doesn't follow that they all will be. The only way of really knowing is to try and dive (taking it really easy as mentioned before) or if you have a sympathetic doc, you could have both an x-ray and an MRI scan of the area to check the condition and at the same time rule out any other potential abnormality.
But, assuming you follow a serious and prolonged sinus improving
programme, you should hopefully be able to overcome your problems.
In regard to surgery, if I ever have to advise a patient of mine, I always say it should absolutely be the last resort (unless it's quite obviously the only way forward). As far as your microwave question goes....I haven't a clue. That is way out of my field and I have never heard of it (laser yes but not microwaves). As an observation, if you say your lower nasal passages are clear or have been before, why have that area treated? It is the easiest part of your nasal and sinus region for you to self treat. Doesn't make sense to me.
Good luck.
Laura.

 

[love2mtb]

Thank you so much. Your help is so greatly appreciated. I'll keep you posted with the results some time from now. For now, I'm working on de-allergenizing my room and finding an ENT that scuba dives and will help me with an MRI and X Ray ...thanks again,

- Lauren

 

[cliffgollus]

You are not alone with this sinus congestion, squeeze, pain and even bloody mask problems. If you explore this forum you will find numerous references to problems and what folks have found to work.

It may help to try an expectorant (Robitussin is a common brand name, Guaifenesin is the active ingredient), which loosens mucous and helps it to drain. My doctor tells me there is no long term contrindication for using it on a regular basis (as compared to the steroids). Be aware that antihistamines do exactly the opposite, they will stop the running nose and watering eyes sometimes experienced with allergy problems but make it more difficult for sinus cavities to drain. I'm not sure of the exact mechanism of how decongestants (Sudafed) work, but have been told that Sudafed and Guaifenesin can be used together.

Good luck
Cliff G

 

[love2mtb]

Thanks so much Cliff. I'll skim the threads for more information, but you're suggestions were a lot of help. I'll try the Robitussin the next time I go down. Thanks!

- Lauren

 

[lionel]

Great thread. Thanks Laura for your detailed feedback.

I too suffer from time to time with those severe pangs of pain right between the eyebrows. Contact and/or Afrin usually do the trick for me. However, I am concerned about these drugs' effects on heart-rate and CO2/O2 physiology. This is because I am primarily a free diver. Does anyone have any information on this?

Thanks.

-- Lionel

 

[laura storm]

Lionel
The two medications that you mention you use both have potential side effects that are undesirable to freedivers and divers.
Firstly the Contact (contac 400). This is a two in one drug combining an antihistamine (chlorpheniramine) with a decongestant (phenylpropanolamine).
The decongestant used can have powerful side effects that mimic the actions of the sympathetic nervous system. These include palpitations, wakefulness, raised heart rate and in certain cases a severe elevation in blood pressure. This is the case with many decongestants. As freediving requires the opposite physiological state you can see that this drug won't be helping. Prolonged use or high doses can lead to anxiety. This is also one of the decongestants commonly found in cold & flu remedies.
The antihistamine used is one that can lead to drowsiness. To some extent the sedating action of the antihistamine will be offset be the stimulating action of the decongestant but all individuals respond in their own way to drug therapy and either one might prevail in its action.
The second drug you mention Afrin, I know as Afrazine (oxymetazoline). I assume it is the same drug. It is a topical decongestant. Once again the most important consideration is that long term use will lead to re-bound congestion. This happens when a decongestant is withdrawn suddenly or if a topical nasal decongesting spray has been overused. The blood vessels that line the nasal passages widen when they are no longer constricted by the action of the drug. The knock on effect is an increase in mucus production.
Even short term use, as with a cold, can extend the length of time it takes to clear the sinus spaces and nasal cavity of mucus.
Cliff mentioned the use of expectorants (Guaiphenesin). These are drugs that have a limited action and are normally prescribed to treat coughs. They belong to a group of drugs known as mucolytics whose action is to alter the consistancy of phlegm, loosening it and making it less viscous and sticky. Unusual for an expectorant to be prescribed for a sinus condition.
I strongly disagree with Cliff's comment about the use antihistamines making it hard for the sinus cavities to drain. It is the inflammation of the lining of the sinus cavities that causes the problem in the first instance. Antihistamines block the production of histamine and allow the irritation in the nasal passages and sinus cavities to dissipate. In time, if the allergic reponse is kept under control the sinuses will clear. This is done naturally by the action of cilia (fine microscopic hairs that sweep mucus along the sinus and respiratory tracts ).
To some extent it is all trial and error. Each individual will find something that works for them. The best approach however is one that will ultimately improve the health of your sinuses so that you don't need to take any medication at all.
Laura

 

[cdavis]

Hi love2mtb,

For getting rid of allergens, I found washing bedding religiously once a week, putting allergy cases on the pillows we sleep on and using hepa filters did wonders for my kids sinus problems. Cut my migraines down as well. You can get both from the National Allergy catalog. They should be on the internet.

Good luck

 

[sky_blue]

If the problem concerns sinus then biaxin should be used. Biaxin is a medicine which is used in case of sinus. I guess you have never heard about it even I was surprised when I saw this medicine but I must say that it provided great relief. Why don’t you try it? There is very useful information about this medicine on this page Buy BIAXIN (CLARITHROMYCIN) (KLACID) Online Now if you want more information about this medicine then I would advise you to read it.

 

[omega3]

Sorry I am in a bit of a rush and havn`t read the post fully but saw mention of surgery.... a few people I work with have had the surgery and are happy with the results. It was described to me as "boring out" the sinus and no mention of microwave but who knows with this lot and descriptions can sometimes be blunt .I will ask for full details if I work with these people again.