Question Help w/ Unusual Recurring Frontal Sinus Squeeze (Only Happens After Ascending, and Then Re-Descending)

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Messages
2
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Location
North America
# of dives
25 - 49
To start off: I have an appointment booked with a DAN recommended ENT next month. However, I'm perplexed by what I'm experiencing, and trying to see if anyone else has encountered something similar and what may have helped them.

I'm having some interesting issues with a Frontal Sinus squeeze (Sinus just underneath eyebrow), but only on a second descent. I am able to make my initial descent with no issues to any depth. However, if I ascend, and then attempt to re-descend, I have horrible pain in my frontal sinus and I am unable to re-descend.

This will happen at any depth for example:
-going over a wreck from 60 ft -> 50 ft I am no longer able to descend back down to 60
-going from 9 ft ->0 I can't even descend back down by a single foot

I'm regularly equalizing, and even try to pre-equalize with no luck. If anything equalizing seems to make it worse. I'm also equalizing my mask throughout the descent.

This issue does not appear between dives. If I'm on the boat between dive spots, I can start my second dive with no issues.

I used to Scuba and Free-dive on vacation. I would spend hours in the water, no issues. (Last vacation was 2019). I recently moved to a scuba destination and have completed 40 dives in the last 8 months. The issue has been there for every dive. Whether it's dropping a foot or 2 during a safety stop, and going over an obstacle, I can't go back down.

The only thing I can think of is:
-Potential allergies to my new environment, however I have no congestion (at least nasal)
-A polyp causing issues (I am unaware of any polyps atm...)

What confuses me is that I would expect either of these to cause issues on my initial descent, or potentially cause issues on ascent with a reverse block, but I've never encountered any issues with my initial descents or with reverse blocks.

Any ideas as to causes or solutions?

As always, I default to the medical professional that does a full exam, and history. But given the weird circumstances I'm encountering these squeezes, I thought I'd see what people have seen to help potentially give context to the issue.

EDIT:
Attached example of a dive
 

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To start off: I have an appointment booked with a DAN recommended ENT next month. However, I'm perplexed by what I'm experiencing, and trying to see if anyone else has encountered something similar and what may have helped them.

I'm having some interesting issues with a Frontal Sinus squeeze (Sinus just underneath eyebrow), but only on a second descent. I am able to make my initial descent with no issues to any depth. However, if I ascend, and then attempt to re-descend, I have horrible pain in my frontal sinus and I am unable to re-descend.

This will happen at any depth for example:
-going over a wreck from 60 ft -> 50 ft I am no longer able to descend back down to 60
-going from 9 ft ->0 I can't even descend back down by a single foot

I'm regularly equalizing, and even try to pre-equalize with no luck. If anything equalizing seems to make it worse. I'm also equalizing my mask throughout the descent.

This issue does not appear between dives. If I'm on the boat between dive spots, I can start my second dive with no issues.

I used to Scuba and Free-dive on vacation. I would spend hours in the water, no issues. (Last vacation was 2019). I recently moved to a scuba destination and have completed 40 dives in the last 8 months. The issue has been there for every dive. Whether it's dropping a foot or 2 during a safety stop, and going over an obstacle, I can't go back down.

The only thing I can think of is:
-Potential allergies to my new environment, however I have no congestion (at least nasal)
-A polyp causing issues (I am unaware of any polyps atm...)

What confuses me is that I would expect either of these to cause issues on my initial descent, or potentially cause issues on ascent with a reverse block, but I've never encountered any issues with my initial descents or with reverse blocks.

Any ideas as to causes or solutions?

As always, I default to the medical professional that does a full exam, and history. But given the weird circumstances I'm encountering these squeezes, I thought I'd see what people have seen to help potentially give context to the issue.
It sounds like the area might be suffering some trauma on the initial descent, which could prevent the sinus from equalizing on subsequent descents. The ENT visit will likely tell you more.

Also: @doctormike

Best regards,
DDM
 
As someone that has "suffered" for years with sinus issues, sounds like you may also have an undiagnosed sinus infection in that area that needs treatment.

I had one for 5 years under my right eye.
 
Agree with DDM.
I have and dealt with chronic sinus problems my entire diving career. Your body can, and will, change over time.
2 things I do to help.
1. Descend.....slowly.....really, really slowly. You can't equalize sinuses. They are kind of like a balloon with a small opening. The smaller the opening, the slower air will travel through it. Push too fast, you traumatize the area, it swells up > squeeze problems.
By slowly, I mean go no deeper than 10-15', and do that slowly. I try to dive from shore, submerge in chest deep water, and the process starts immediately. Use a line if you have to, or get exceedingly good at free descents. Pay attention to the pressure, close attention. Any pressure at all, stop.
If the initial 10-15' goes OK > STOP! Stay there for a couple minutes. Let those sinuses equalize. If you are a photographer, set up your rig, or just poke around.
Only then can you can continue the slow descent. Any pressure....stop, and wait until it goes completely away.
2. You can wait until you see the ENT, but I'm pretty sure you'll end up on nasal steroids. They are OTC now so You can pick one up, follow directions, and see if it helps. I've been using them for > 25 years now.
You could have allergies. The steroids are still useful, but there may be more targeted treatments.

I've had sinus reverse block. No fun to be hanging at 30-50' watching your air go down and feeling like your head is going to implode. Hurts.

I have to explain this carefully to new buddies. Never had anyone balk or complain. To the contrary, more than a few commented how other buddies forced their descent too fast. They appreciate the slower descent pace. It also helps start the dive more relaxed.
 
Hard to say, but if the frontonasal ducts (draining the sinuses) are in any way compromised, a bit of barotrauma may tip them over into non-functionality, causing more pain on the second descent. Bottom line is that - unlike ear barotrauma - you can investigate the problem pretty easily with a CT scan, and then you will have a better idea of what to do.

My son gave up diving for exactly this reason - he has some polypoid swelling of the lining of his frontal sinuses, and he gets pain with diving.
 
Thanks for the replies. I'm definitely looking forward to meeting with the ENT.

I'm somewhat medically knowledgable, (my degree is in health science, and am a certified EMT), but this throws me for a loop. I'm still puzzled as to why I don't experience any squeeze issues on the initial descents. I go relatively slow, and always follow the down line, and experience no pressure or pain in the frontal sinus during the initial descent. I only have squeeze pressure and pain on a second descent and only if I ascend a bit and try to go back down.

@doctormike did your son experience the sinus issues on initial descent, or was he able to successfully descend with no issues like me.

I've attached an example of what my dives look like (typically no deeper than 30 feet, however some dives are down to 60 feet.)
 

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Thanks for the replies. I'm definitely looking forward to meeting with the ENT.

I'm somewhat medically knowledgable, (my degree is in health science, and am a certified EMT), but this throws me for a loop. I'm still puzzled as to why I don't experience any squeeze issues on the initial descents. I go relatively slow, and always follow the down line, and experience no pressure or pain in the frontal sinus during the initial descent. I only have squeeze pressure and pain on a second descent and only if I ascend a bit and try to go back down.

@doctormike did your son experience the sinus issues on initial descent, or was he able to successfully descend with no issues like me.

I've attached an example of what my dives look like (typically no deeper than 30 feet, however some dives are down to 60 feet.)

Can't remember exactly, but I think that it was with the initial descent. But if you have a narrow passageway connecting the frontal sinus to the nasal airway, and you get some swelling of the lining of the pathway from the first dive, it's not hard to imagine the marginally functional ventilation of the space becoming worse with the second dive...

But a CT scan will be helpful!
 
Thanks for the replies. I'm definitely looking forward to meeting with the ENT.

I'm somewhat medically knowledgable, (my degree is in health science, and am a certified EMT), but this throws me for a loop. I'm still puzzled as to why I don't experience any squeeze issues on the initial descents. I go relatively slow, and always follow the down line, and experience no pressure or pain in the frontal sinus during the initial descent. I only have squeeze pressure and pain on a second descent and only if I ascend a bit and try to go back down.

@doctormike did your son experience the sinus issues on initial descent, or was he able to successfully descend with no issues like me.

I've attached an example of what my dives look like (typically no deeper than 30 feet, however some dives are down to 60 feet.)

1st off, that's a very detailed picture, lol.

2nd off, I get this. I have had 3 major sinus surgeries and while it's much better than ever it's still a pain in the ass. It's always the 2nd dive and sometimes I really have to work my nose back and forth to get it to equalize. Not the best, but that's what I've worked out.

My best advice if you dive again before you see the ent is use some sudafed and see if that helps.

I haven't missed a 2nd dive because if it, but I always have issues on dive 2. I move slow and work it out before descending any further so I don't force anything. Not ideal but it works.

Good luck!!
 

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