Frontal Sinus Equalization

[aquaticj10]

Hello,

I've asked previously a somewhat similar question, but does the valsalva manoeuvre equalize frontal sinus pressure, or is this done "automatically"? I have had previous troubles with this part of my sinus but managed to dive to 16M and 21M before without issue apart from some blood in my mask on ascent. I only equalize twice down to 6M on average and am wondering whether equalizing, quite literally, constantly on the descent to this depth would help my sinuses equalize.

Thanks!

 

[Wallowa]

I just had my right frontal sinus refuse to equalize....twice at 7ft ice pick stabbing pain....finally gave in and went to an ENT who cleared a cyst/polyp that was completely blocking the fundus/neck opening of that frontal sinus with a small wire and balloon that deflated the obstruction...just did first dive after procedure and sinuses and ears cleared/equalized easily with Valsalva pressure....critical that a reverse block does not occur or you are screwed trying to ascend, so if are having troubles going down; stop.....

Sinuses and eustachian tubes to middle ear are pressurized with Valsalva...common airway...I recommend a gentle Valsalva at surface and frequently in first 30ft, as that is where the pressure change is most abrupt....get deep and seldom need to push air in...

 

[Angelo Farina]

I instead do NOT recommend Valsalva at all, in general, and particularly for clearing a partially obstructed sinus. Valsalva can produce a very high pressure, which can effectively force open a blocked sinus.
But this required extra pressure can be very dangerous for the eardrums, which risk to be extroflected.
Another way of getting proper pressure without too much risk is using the Frenzel manouvre, which does not involve lungs in creating pressure.
A proper Frenzel requires no reg in mouth and lips closed, so, if the sinus is blocked, you have to suspend breathing briefly, perform the Frenzel, and then get the reg back in your mouth.
Not fast, not practical, but safer than a powerful Valsalva...
If the sinus blockage repeats, you need to see an ENT for opening it permanently.
A sinus which does not vent spontaneously can be the basis of other medical issues.

 

[Wallowa]

To be clear...my way of equalizing the ears and sinuses is my way....not saying it works for all nor is necessarily the best...but since I started using the Valsalva technique on dives in 1955 it has worked fine for me....few if any of my divers had sinuses or middle ears that equalized spontaneously...great if they do....big take away is not to continue a descent if you can't equalize or "force it", not so much the hazard on descent but if you trap air in any airway then ascent is dangerous and can be very injurious.. OK, remember to each their own but stay safe..

 

[Duke Dive Medicine]

Hello,

I've asked previously a somewhat similar question, but does the valsalva manoeuvre equalize frontal sinus pressure, or is this done "automatically"? I have had previous troubles with this part of my sinus but managed to dive to 16M and 21M before without issue apart from some blood in my mask on ascent. I only equalize twice down to 6M on average and am wondering whether equalizing, quite literally, constantly on the descent to this depth would help my sinuses equalize.

Thanks!

Blood in your mask indicates that you experienced sinus barotrauma. Sinuses should equalize themselves without any effort on your part. If you're consistently experiencing sinus barotrauma to the point of questioning whether you should be actively equalizing your sinuses, you are at risk for injury and need to be worked up by an ENT.

Best regards,
DDM

 

[Wallowa]

Blood in your mask indicates that you experienced sinus barotrauma. Sinuses should equalize themselves without any effort on your part. If you're having to actively equalize a sinus, you are at risk for injury and need to be worked up by an ENT.

Best regards,
DDM

Describe "without effort on your part"? Same for ears? Passive equalization? The diver does nothing to equalize sinuses/middle ear pressure? Hmmmmm...

 

[Duke Dive Medicine]

Describe "without effort on your part"? Same for ears? Passive equalization? The diver does nothing to equalize sinuses/middle ear pressure? Hmmmmm...

Yes, completely passive, without the diver doing anything.

Best regards,
DDM

 

[Wallowa]

Yes, completely passive, without the diver doing anything.

Best regards,
DDM

Really? Try that on a freedive.....see how that works for you. Explain the physics of passive equalizing of sinuses and ears on a freedive.

Honestly, there may be folks that never have to actively equalize their ears or sinuses on descent...I just have never met one....if someone not able to 'passively' let the pressure equalize and they believe that is the manner to descend, then they will suffer a barotrauma...not good.

 

[Duke Dive Medicine]

Really? Try that on a freedive.....see how that works for you. Explain the physics of passive equalizing of sinuses and ears on a freedive.

Sorry, I wasn't completely clear on my response to you. My reply to the OP was only referring to sinuses, and since you quoted it, that's what I thought you were referring to as well. The middle ears DO require active equalization. Healthy sinuses do not. The passages between the sinuses and the nasopharynx travel through bone and so are more stable than the Eustachian tubes, which go through bone only on the distal ends (the ends closest to the middle ears). There's no bone to support them in the pharynx, so the ends are often closed by default, which is why we have to actively equalize our middle ears.

Best regards,
DDM

 

[Wallowa]

Sorry, I wasn't completely clear on my response to you. My reply to the OP was only referring to sinuses, and since you quoted it, that's what I thought you were referring to as well. The middle ears DO require active equalization. Healthy sinuses do not. The passages between the sinuses and the nasopharynx travel through bone and so are more stable than the Eustachian tubes, which go through bone only on the distal ends (the ends closest to the middle ears). There's no bone to support them in the pharynx, so the ends are often closed by default, which is why we have to actively equalize our middle ears.

Best regards,
DDM

Good description. But again, it is not just the patency of the airways leading into and out of the sinuses and middle ear; bone vs soft tissue, that requires equalization....on descent all air spaces will be subject to squeeze unless air at the ambient hydrostatic pressure is introduced into them. On a freedive descent there isn't any passive increase of pressure inside the sinuses or middle ears, hence dive diver must actively increase that internal pressure to match the hydrostatic pressure increases.

The sinuses do not always have a patent air passage as is demonstrated when a sinus squeeze occurs or worst yet a reverse block on ascent. So if a diver is always blessed with open air passage to the middle ears and all sinuses then yes on compressed gas dives the inhaled gas could passively equalize the lungs, middle ears and sinuses if the descent and ascents are slow enough. That will not work on freedives as the diver must actively pressurize those air spaces.

No big contentious issues here, just my opinion that not all air spaces can be passively equalized with increasing hydrostatic pressure increases.