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Sinuses..

Thread Status: Hello , There was no answer in this thread for more than 60 days.
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OceanSwimmer

OceanSwimmer

Well-Known Member
Nov 3, 2002
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Sinuses...

Thanks, Guys :)
I'm in contact with a colleague who has recommended a site for me to check about the latest with diving / sinus health. I'll get back to you with that....(just back from a job fair)

Of course the DAN website has plenty to say, all good.

---Hey Sven, Anytime for a latte!

Perhaps we love the Ocean because the approach must be respectful, humble, and with complete integrity :)
....like anything else unpredictable (like surgery)....if you think you're in control, you're in over your head.

And Pekka, don't mean to scare you....but I'm glad you will get some medical attention for your sinuses.

Have a nice weekend-- Be well.
 
OceanSwimmer

OceanSwimmer

Well-Known Member
Nov 3, 2002
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A bit more info...

"Paranasal Sinus Barotrauma:

This most often involves the frontal or maxillary sinuses and the pressure differential usually causes the lining of the sinuses to become swollen and bleeding can ensue.

Paranasal sinuses:
Nosebleed is a common event with diving and can be caused by negative pressure within the mask or from pressure change after ascent. Dull aching is present and treatment is directed at the use of nasal decongestants and symptomatic pain relief. Antibiotics are also used to treat infection.


Pneumocephalus:
Goldmann reported a case of sinus barotrauma presenting as air in the subdural space. (JAMA. 255:3154-3156, 1986.) There is really no difference between the damage and pain with descent or ascent. It occurs in both flyers and divers and the pathophysiology is the same--the inability to equilibrate the air pressure as it changes, up and down.

All of this depends mainly on the function of the mucosa of the nose and sinuses. Some people secrete large quantities of mucus in response to allergy. Others have a definite correctible problem, such as nasal septal deviation, polyps or tumors, resulting in blockage of the ostia (openings) of the sinuses.

The frontal sinuses are the most frequently involved, probably because the nasofrontal duct is longer and more tortuous. The damage that is done by the pressure change leads to a series of changes within the sinuses consisting of air absorption, decreased pressure in the sinus; swelling, engorgement, inflammation and fluid collection in the sinus cavity. This decrease becomes greater with descent (as with flying) the changes become greater, more painful and often associated with bleeding into the sinus cavity. On ascent, there is one-way valve blockage of the ostia, resulting in more barotrauma. The next step after all this is usually infection, which increases the blockage by causing it's own swelling and purulent discharge.

Common causes of all this include, allergy; chronic irritation, such as smoking, diesel fumes, chemicals, prolonged use of nose drops or nasal sprays; mechanical blockage; vasomotor problems from chronic tension, stress or anxiety.

It should be obvious that what should be a very simple problem can be stubbornly difficult to diagnose and manage."

---From "ENT Problems in Scuba" Ernest S Campbell, MD, FACS




:hmm Plenty to consider, amigos y amigas! The incident of air in the subdural space has me shuddering. Not a pretty picture. :yack

Anyway, dive safe :cool:
 
icarus pacific

icarus pacific

Human-in-training
Nov 7, 2001
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Re: A bit more info...

Originally posted by OceanSwimmer
It should be obvious that what should be a very simple problem can be stubbornly difficult to diagnose and manage."


And if it's not obvious, gimme a call... :crutch


sven
 
Jon

Jon

Dairyland diver
Supporter
Apr 7, 2001
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FUNNY STORY

I just read you post Oceanswimmer and it reminded me of a funny, and little bit embarrasing, story.:eek:

Dr. Goldman, who wrote that article, is the Local diving Doc in this area who I got to meet a few years back for a diagnosis.:waterwork

It was about 12 or 13 years ago and I had just started teaching grade school in the inner city. I was also teaching diving on the weekends and in the summer. One Saturday I went out to do some deeper deco-dives with a friend and by that evening my head and neck had swollen up like a balloon.:( I called DAN and they had no answer for me except to take two asprin and call the chamber in the morning.:duh

The next morning I get up and my head and neck are swollen like a mellon!:waterwork

So, I go to the local chamber with my dive log and wait to talk to the doctor onduty- at this time Subcutaneous Emphysemea is the only thing that I can think of. I get seen by two or three different doctors who can't figure out what it is. Finally, they call Dr. Goldman in out of bed, it was Sunday morning and he wasn't on duty.

In the 30 minutes that it takes him to get there I have a bunch of other doctors try and take a guess at what is wrong with me.

He gets in , takes a look at me, checks out my deco profile, and diagnoses me with the MUMPS!:head I was the first adult in that hospital in over 5 years that had a case of them and they thought that one of my unvaccinated students might have passed them around ( 33 kids in a very small classroom with poor ventilation passes around all kinds of stuff) and I got them.:head

He then goes home and I get inspected by every resident in the place- I think I lost count after 20 doctors. Everyone wanted to take a look at the freak in the hyperbaric unit.

In the end I was off of school for a week and my cheeks have never fully retracted to their former size. THis helps to explain why I need a wide skirt on all of my face masks.

Anyway, Dr. Goldaman was a good guy who related many funny stories about other, more serious, diving accidents.

For sinuse problems I lay off the dairy product and sugar for a couple of days before diving and drink lots of water and orange juice the day of. I have also used a "neti pot" to flush my sinus cavity with salt water and clear it out.

Jon:eek:
 
OceanSwimmer

OceanSwimmer

Well-Known Member
Nov 3, 2002
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The Mumps!

Poor Jon!
Great story, though....and a wonderful illustration of the saying, 'Start with the simplest explanation.'
A good doctor and diagnostician will always do that.....
 
Frank O'Donnell

Frank O'Donnell

Apneic shutterbug
Apr 23, 2003
132
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Cracking out the heavy artillery

Just a follow-up on sinuses ... this week I took Kirk Krack's four-day Performance Freediving clinic. Although I've freedived off and on for the last year I've always stayed shallow, so I was on the lower end of the curve in terms of depth and static breath-hold ability.

Going into the clinic I'd been washing clean saltwater through my sinuses 2x/day for a couple of weeks, and then just before the clinic started taking papaya/pineapple enzyme pills (these are supposed to act as a gentle anti-inflammatory). Both traetments were suggested by an ear-nose-throat doctor who specializes in diving.

When we started our open ocean descents, I found that when I got down to around 40 feet my teeth started aching -- very familiar feeling of cranky maxillary sinuses. I slowed down and equalized carefully and found I could keep the twinges at bay for a while. Eventually, though, my teeth hurt more and I had to stop.

The next day I decided to pull out the weapon of mass decongestion -- Afrin spray. This can be nasty stuff as there can be a rebound effect which causes some people to get habituated to it, but I figured very sparing and occasional use was worth trying. So an hour before hitting the water I gave both nostrils a good dosing. Voila, no sinus problems at all, and got another 10 feet or so down. Eventually my right eustachian tube seized up, though. My ear was plugged up for several hours after getting out of the water, but eventually got back to normal.

Had a gas in the clinic, incidentally, and highly recommend it to anyone, even those of us on the less advanced end of the freediving spectrum.
 
OceanSwimmer

OceanSwimmer

Well-Known Member
Nov 3, 2002
482
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Sinuses...

--Interesting anecdote, Frank. Thank you for sharing the tip about saltwater rinse combined with the papaya/pineapple combo for the enzymatic/antiinflammatory effect.
Out of curiosity, did you continue the regimen of saltwater rinsing and the enzymes in addition to the Afrin, or was the nasal medication a substitute for them... did you apply both supportive measures after the clinic? If you did, for how long? You mention it was a 4 day event: did you start the Afrin on days 2 or 3? Those of us who aspire to multiple day challenges may benefit from your experience. :)
--Thanks!
 
Frank O'Donnell

Frank O'Donnell

Apneic shutterbug
Apr 23, 2003
132
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Treatment schedule

Ocean, lessee, here is what I did in my case:

-- The saltwater nasal washes is just a background thing I do at least once daily on an ongoing basis. Some people say, "Why wash your nose with saltwater if you're going to be in the ocean anyway?" I find that I get less infections and colds if I rinse it out particularly after having been in the water. Also after pool it's helpful to get rid of the chlorine.

-- A couple of days before the clinic, I started taking the papaya-ppineapple enzyme pills, called Clear-ease.

-- The first two days of the clinic I didn't add anything else. We were doing pool work with a max depth of 12 feet, and that's not enough to trigger my sinus problems.

-- Then the first day of ocean work (third day of the clinic) I took two additional meds: aspirin (as an anti-inflammatory) and a prescription antihistamine spray my ENT gave me called Astelin. My sinuses were reasonably well-behaved for a while, and when I started getting twinges I found I could ease them by slowing descents and equalizing more thoroughly. Eventually, though, I ended up getting a fair amount of tooth pain (via the maxillary sinuses).

-- So the next day (fourth and final day of the clinic) I took all of the above except that I substituted Afrin spray for the Astelin. This kept my sinuses wide-open and I improved my depth over the previous day. However, eventually a eustachian tube sealed up and I couldn't clear my right ear.

-- After the clinic I dropped back to daily saltwater nasal washes. I've also been taking some ibuprofen as an anti-inflammatory for a knee injury.

When you talk about multi-day events, if you mean serious competitions that include doping tests it would probably be a good idea to check Afrin out further ... not sure if it sets off the alarm bells.

The other thing about Afrin is that you're not supposed to use it for more than 3 days running. It can lead to nasty habituation. But my diving is usually just one-shot days so I figure that some very sparing use might be okay.
 
icarus pacific

icarus pacific

Human-in-training
Nov 7, 2001
2,880
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Hey Frank! Whilst I recover from my latest episode of "Let's see if this will fit back there so we can see what's going on..." nasal-Hell, where'd you get the enzymes from? Being a California kinda guy, I'm hoping I won't have to go to some chic LA boutique cum health food outlet on Hollyweird Blvd.

Muchos and nice stuff about the clinic.


sven
 
Frank O'Donnell

Frank O'Donnell

Apneic shutterbug
Apr 23, 2003
132
1
103
To answer Sven's question ... actually the ear-nose-throat doctor I saw was an interesting fellow named Dr. Murray Grossan based out of Cedars-Sinai in L.A. who was recommended by Divers Alert Network. In his examining room he had his scuba cert from 1971 on the wall.

Anyway, it turns out that he's written a book ("The Sinus Cure") and owns a company that markets the papaya-pineapple enzyme pills in addition to other stuff. The pills, called Clear-ease, are described here:

http://www.sinus-relief.com/clearease.html

I have to be honest and say that the effect is subtle enough that I'm not 100% sure if it's helping. As opposed to, say, Afrin, where the difference is dramatic. Some divers I know just like to pop an aspirin or Advil as an anti-inflammatory to do the same thing as the Clear-ease. I think it's one of those your-mileage-may-vary things where you just have to try a bunch of stuff to see what works for you.
 
OceanSwimmer

OceanSwimmer

Well-Known Member
Nov 3, 2002
482
69
118
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Sinuses...

--Thank you, Jon and Pez, for the info on the 'neti-pot'.

--And Thank you, Frank, for documenting your methods during the Kirk Krak event: this is of interest to everyone who wants to maintain healthy sinuses, as well as all who have had sinus problems after diving, flying, etc.

--In my case, a multi-day event means a clinic, (like KK) or a situation when I'd go somewhere to get in multiple days of leisure freediving for fun.....okay, for the high..... ;)

The website for Dr. Grossan's papaya and pineapple enzyme tabs also has a very-well referenced Bibiography. Of special note is the fact that papain and bromelain apparently have anti-arthritic properties, as well as properties that prevent thrombosis....as mentioned in several of the articles in the bibliography. (Deep Venous thrombosis is something all travelers should be beware).
Anyway, this is great news, thank you! :D
 
L

luisboschmiami

New Member
Aug 3, 2003
1
0
0
sinuses and redish-brown mucus

hi all, I have a strange thing happen to me after a few 15m dives...I get the urge to blow my nose whe I reach the surface and when I do so I have a strange redish-brown mucus come out...I think its probably old mucus deposited in my sinuses that makes its way out due to the change of pressures.

The first time it happened I freaked out, I actually felt something coming out of my nose and into my mask as I ascended, then it happened on a different day etc...it happens after a few dives and not every day.

I realized this now since I started taking freediving more seriously and have been improving etc...

Luis
 
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