Sinus problem or reverse block?

[kdsmithjr]

Not sure if this is the right forum. I have about 180 dives and an advanced card, so I'm not tenderfoot green, but I aint got no barnacles either. Here is the history....and then the question:

About 15 dives ago i noticed that when i surfaced I had a spliting headache....almost blinding. I looked around to see if there were any visual problems (i'm 61 and i have a recent history of mild high blood pressure). No visual issues but the pain was excrusiating. The location was right between my eyebrows and it was like a super "ice cream headache"....i know we've all had those. I got back on the boat and the pain didn't really subside a lot even after an hour and a half topside and a relaxing...except of the pain....lunch on a beach here in the Davao Gulf. I canned the second plan dive of the day. By the time i got back to the dive op in Davao City i was functional...only mild pain that mefanamic acid took care of.

I have a diving buddy who is a surgeon and i dive with a lot of very experienced DM's. they all thought that I might have had a reverse block, even though there was on indication of too rapid ascent on my dive com. Most thought this because symptoms appeared on the surface; there were no symptoms at depth; and there was mention that only being in the Philippines a year or so at the time that I might be developing allergies that cause sinus inflamation that is not serious enough to be noticible on dry land. I too their advice and next time i dove i took an antihistamine (non drowsy) and a nasal decongestant about an hour before the dive. No headache and the two dives with that "self treatment" went well. Over the next few weeks or so i took an antibiotic...in case there was bacterial sinus infection, the anti histamine and the nasal decongestant. And no problems during dives of about 50-75 ft OR on dives to slightly more than 100 ft. In all cases I watch my dive comp so no too rapid ascents occur. Occasionally i would hear a telltale "squirt" (indicating air movement) but deep inside my head between my eyebrows not behind my ears. I surmise that my sinuses were not bone dry and clear but they were healthy enough for air to equalize naturally.

The last few dives I've taken no medication and, about 75% of the time, there is no real problem. About 20% of the time there is mild (seeming) sinus pain....which resolves itself on the surface going from mildly painful to not a bother at all within minutes. My last medicine-less dive was a repeat of my first excruciaing experience and, this time, on the surface, there was a violent, involuntary evacuation of my sinus, thru my right nostil, what was almost so powerful that it could propel me thru the water (no really put the volume of air thru my nostril was enormous). After the involutary violent "blow" the pain went from intense to almost nothing. all in a matter of seconds.

Question: Am I suffering from a classic reverse block? I know i can probably get some relief by going back down but I'd like to know what else i can do....especially in terms of prevention.

Thanks in advance.

 

[PfcAJ]

Sounds like a reverse block to me.

When your sinus evacuated, was it a snot rocket or just air? If it was a Gemini-class snot rocket, I would take a guess that you won't have much in the way of future problems. Also, be careful taking medicine pre-dive. If it wears off during the dive, you're gunna have a bad time.

Take a few days off and let everthing heal up.

 

[SangP]

It does sound like a combination of both. A sinus inflammation that resulted in some blockage however, not enough to cause equalization issues during the dive.

However, the cold air, pressure etc etc could have added more gunk in the trunk.

I have sinus issues too so I try to avoid morning dives during which my sinus is at its worse.

 

[TMHeimer]

My layman's advice is simply too much sinus congestion. Allergies killed me until my mid 30s, then dissappeared almost totally. But the nasty cold I get maybe every 8 months means no diving for at least 1-2 weeks. Used to be longer. When I know the cold is coming on I take Neo Citran (powder dissolved in hot water--there is something similar in the States) and I THINK this prevents so much sinus build up. My guess is you will be OK.

 

[flots am]

I have a diving buddy who is a surgeon and i dive with a lot of very experienced DM's. they all thought that I might have had a reverse block, even though there was on indication of too rapid ascent on my dive com.

A reverse block does not require a "too rapid ascent". If the openings to your sinuses are really blocked, any ascent will be painful.

However like many medical problems, this can best be handled by seeing an actual doctor, in person.

After the involutary violent "blow" the pain went from intense to almost nothing. all in a matter of seconds.

I'd still see a doc. It may have cleared up, or you may now have a new hole in one or more sinus cavities that goes somewhere it shouldn't.

flots

 

[Colliam7]

About 15 dives ago i noticed that when i surfaced I had a spliting headache....almost blinding. . . . I have a diving buddy who is a surgeon and i dive with a lot of very experienced DM's. they all thought that I might have had a reverse block, even though there was on indication of too rapid ascent on my dive com. . . . I might be developing allergies that cause sinus inflamation that is not serious enough to be noticible on dry land. I too their advice and next time i dove i took an antihistamine (non drowsy) and a nasal decongestant about an hour before the dive. No headache and the two dives with that "self treatment" went well. . . . And no problems during dives of about 50-75 ft OR on dives to slightly more than 100 ft.

The last few dives I've taken no medication and, about 75% of the time, there is no real problem. About 20% of the time there is mild (seeming) sinus pain....which resolves itself on the surface going from mildly painful to not a bother at all within minutes. My last medicine-less dive was a repeat of my first excruciaing experience and, this time, on the surface, there was a violent, involuntary evacuation of my sinus, thru my right nostil, what was almost so powerful that it could propel me thru the water (no really put the volume of air thru my nostril was enormous). After the involutary violent "blow" the pain went from intense to almost nothing. all in a matter of seconds. . . . Am I suffering from a classic reverse block?

Diagnosis from afar is almost always fraught with danger - to the credibility of the person making the diagnosis, and to the health of the person being diagnosed from afar, and accepting advice.

In this case, with that caveat, I will join the chorus and make four observations:

1. I fully agree that a visit to a qualified (i.e. dive knowledgeable) ENT physician would be a very good idea. They can observe the condition of your sinus passages, assess the possibility of a) infection, b) sensitivity to allergens, or c) something else, and the probability that what you are experiencing is reverse block. And, they can recommend appropriate remedial measures.

2. Reverse block can appear relatively late in a diving career - mine started at about 400 dives - and does NOT require a (too) rapid ascent. You can ascend at a very slow rate and it can still develop.

3. While many cases of reverse block are manifested in ear pain on ascent, that does not have to be the case.

4. The empirical evidence, including the a) symptom presentation, and b) remission of symptoms when you take medication, suggest that reverse block is possible. But, the same pattern also suggests the possibility of a (hopefully) transient sinus problem - infectious / inflammatory / both. It may have already been resolved by the involuntary evacuation of your sinuses. But, I wouldn't bank on that, or on the previous benefits of medication.

Have it evaluated by a competent medical professional. As an aside, while I always agree that it is wise to understand the precautions appropriate when taking a decongestant while diving, doing so is also not contraindicated. Taking pseudoephedrine, for example, an hour before diving is unlikely to leave you in a situation where the medication 'wears off' during a dive.

However, don't just speculate or self-medicate, evaluate!

 

[o2dependant]

I doubt your going to get the best ENT doc in the Philipeans. Take a hit of hot Calamansi juice befor your dive. That seems to fix everything in the philipeans.
Sounds like your symptoms are getting better with time so Time is likely all you need

You look good for 61 BTW

 

[TSandM]

Given that diagnosis on the internet is not even a poor substitute for diagnosis in person, I agree that this sounds like a reverse block. All that requires is an obstruction to the expansion of air in the sinuses (or ear); any ascent at all can cause it. Slower ascents are less problematic, simply because the problem is often not a complete blockage, but a relative one, and if you give the gas enough TIME to escape, it can do so. But if there is complete obstruction, even the slowest ascent will cause symptoms.

I would agree that evaluation of your head by a good ENT doc would be in order. It is possible to develop problems (like, for example, polyps) that cause mechanical obstruction of the sinus ostia, and are amenable to correction. Even without polyps, it is sometimes possible to improve sinus drainage. In the alternative, you could continue with your medication regimen, but the downside of that is that whatever condition has caused this new issue may be progressive, and you may find that, either over time, or on a single, disastrous dive, the medication regimen is no longer working. In addition, at 61, there may be contraindications to decongestant medications. Consultation with a physician is always wise.

 

[sleepr]

I have started doing saline rinses twice a day and these have helped quite a bit with sinus issues. There is a thread on here somewhere.
http://www.scubaboard.com/forums/ba...everyday-feeling-good-anybody-else-doing.html

 

[al248005]

I do the saline rinses when my seasonal allergies start up in the mid April. It helps more than any allergy medicine I ever used. Not sure how much it would help though with congestion due to a cold.