Always see a bit of blood in spit after dive over 6 metres

[d2001d2001]

hi folks,
I'm a newbie and I've done my first dive weekend where I did 4 dives. I did about 10 metres to 20 metres. But I noticed a ting of blood in my flem after every dive. my instructor told me its probably due to my sinus and it's nothing to worry about. is it ok to continue to dive after seeing a bit of red after each dive?

 

[Duke Dive Medicine]

hi folks,
I'm a newbie and I've done my first dive weekend where I did 4 dives. I did about 10 metres to 20 metres. But I noticed a ting of blood in my flem after every dive. my instructor told me its probably due to my sinus and it's nothing to worry about. is it ok to continue to dive after seeing a bit of red after each dive?

Agree that it's probably related to your sinuses, but I wouldn't brush it off. Sinuses typically equalize without difficulty or effort. If you're seeing blood, it means that one or more of them is not equalizing properly. It could be related to something transient like mucous membrane inflammation due to upper respiratory infection or it could be a chronic process or something related to your anatomy. Did you have any type of URI around the time of the dives? What about allergies?

Best regards,
DDM

 

[d2001d2001]

Agree that it's probably related to your sinuses, but I wouldn't brush it off. Sinuses typically equalize without difficulty or effort. If you're seeing blood, it means that one or more of them is not equalizing properly. It could be related to something transient like mucous membrane inflammation due to upper respiratory infection or it could be a chronic process or something related to your anatomy. Did you have any type of URI around the time of the dives? What about allergies?

Best regards,
DDM

Hi, thanks for replying. No URI, I felt fine but tired, which is normal. Shoukd I be worried or should I continue?

 

[Duke Dive Medicine]

Hi, thanks for replying. No URI, I felt fine but tired, which is normal. Shoukd I be worried or should I continue?

I would be hesitant to give you any kind of affirmation to dive not knowing what's going on with you. From a damage perspective, sinus barotrauma of descent (aka sinus squeeze) typically looks worse than it is, but the fact that you're getting sinus barotrauma in the first place means that there's something amiss there. Barotrauma itself irritates the mucous membranes and increases the likelihood of it happening again. What I'd be even more concerned about in your case would be sinus barotrauma of ascent (reverse sinus squeeze). That is painful and has the potential for causing serious harm. Not sure how quickly you can get in to see an ENT in the UK - understand the wait times can be long. Here's a link to the UKDMC diving medical referee page, you might consider contacting one in your area to see if you can get evaluated before your next set of dives.

Best regards,
DDM

 

[d2001d2001]

I would be hesitant to give you any kind of affirmation to dive not knowing what's going on with you. From a damage perspective, sinus barotrauma of descent (aka sinus squeeze) typically looks worse than it is, but the fact that you're getting sinus barotrauma in the first place means that there's something amiss there. Barotrauma itself irritates the mucous membranes and increases the likelihood of it happening again. What I'd be even more concerned about in your case would be sinus barotrauma of ascent (reverse sinus squeeze). That is painful and has the potential for causing serious harm. Not sure how quickly you can get in to see an ENT in the UK - understand the wait times can be long. Here's a link to the UKDMC diving medical referee page, you might consider contacting one in your area to see if you can get evaluated before your next set of dives.

Best regards,
DDM

Thanks DDM
I'm not sure if the blood in my flem is due to the ascent or descent because I check my flem after I blow my nose after I get out of the water. When descending it takes me a few minutes to pinch my nose and get down due to flight ear pain but I am improving my experience with that. There's no pain when I ascent, I just need to ascend slowly then I'm fine.

 

[rhwestfall]

When descending it takes me a few minutes to pinch my nose and get down due to flight ear pain but I am improving my experience with that.

I'm no doctor, so anything I say should not be taken as any professional advice...

Your quote seems to me to indicate that you may be waiting too long to begin to equalize, perhaps causing issues. You may also be equalizing harder to "catch up" than necessary and causing issues.

As @Duke Dive Medicine said, get checked out, but also consider your diving practices...

 

[Kendall Raine]

As previously mentioned seeing an ENT would be a good initial step to determine whether there is a structural sinus issue (polyps, deviated septum, other). If structural at least you know and can determine possible treatment options.

 

[Duke Dive Medicine]

Thanks DDM
I'm not sure if the blood in my flem is due to the ascent or descent because I check my flem after I blow my nose after I get out of the water. When descending it takes me a few minutes to pinch my nose and get down due to flight ear pain but I am improving my experience with that. There's no pain when I ascent, I just need to ascend slowly then I'm fine.

You're most welcome! The blood is very likely related to barotrauma of descent. When the sinus isn't equalized on descent, the increasing ambient pressure in the water causes the air trapped in the sinus to decrease in volume. Because the sinuses are rigid and resistant to volume change, blood gets pulled out of the small vessels that line the mucous membranes. On ascent, the air trapped in the sinus expands and forces the mucus and blood out of the sinus.

Given that you're experiencing sinus squeeze and are also having difficulty equalizing your ears, you should probably see an ENT before continuing to dive. And, when you return to diving, remember that if you're feeling pain in your middle ear, you've gone too far. You should be equalizing your ears before it feels like you have to.

Best regards,
DDM

 

[Leobendive]

After consulting an ENT as adviced in the other posts and knowing for sure that you are good to dive, I would recommend trying different equalization techniques. You can Google it or start reading here for example: 6 Methods to Equalize Your Ears

I guess you are currently using the valsalva maneuver. For me it never worked perfectly as I had to blow to hard. Most divers use "their own" technique which could also be a combination of the described methods. E.g. for me it works Best to pinch my nose, push my jaw forward and blow very very slightly. You can try the different methods at the surface first to find out what works Best for you. Then try it underwater and be prepared to adjust when necessary. E.g. I found out that pushing my jaw works great on the surface but I need to open the mouth a bit which makes the Regulator Fall out of my mouth underwater when pinching my nose while pushing my jaw I need very little movement and the reg stays in.

Also as already posted before you need to start equalizing early, right at the start of your descent. Also remember that the pressure changes Most on the first 10 meters (33ft). Between 0 and 10 meters you therefore need to equalize more often than between 10 and 20m etc.

 

[Reefy]

Not a doctor, so take my advice with that in mind, but I agree with others that you're likely experiencing barotrauma in your sinuses from waiting too long or not equalizing frequently enough on the descent. I like to tell students/clients that if you wait to equalize until the pressure starts to hurt, you've waited too long- it should be done as frequently as needed, especially in the top 10 meters where you have the greatest pressure change.

And I'd definitely recommend seeing an ENT specialist as well to be safe- if it is a true sinus issue, the last thing you want is to end up getting a reverse squeeze on a dive- it HURTS, and can lead to much more serious injuries!